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. 2019 Sep 5;14(1):300.
doi: 10.1186/s13018-019-1347-y.

Biomechanical influence of lateral meniscal allograft transplantation on knee joint mechanics during the gait cycle

Yong-Gon Koh  1 , Jin-Ah Lee  2 , Yong-Sang Kim  1 , Kyoung-Tak Kang  3
Affiliations

Biomechanical influence of lateral meniscal allograft transplantation on knee joint mechanics during the gait cycle

Yong-Gon Koh et al. J Orthop Surg Res. .

Abstract

Background: This study evaluated the influence of meniscal allograft transplantation (MAT) on knee joint mechanics during normal walking using finite element (FE) analysis and biomechanical data.

Methods: The study included 20 patients in a transpatellar group and 25 patients in a parapatellar group. Patients underwent magnetic resonance imaging (MRI) evaluation after lateral MAT as a baseline input for three-dimensional (3D) and FE analyses. Three different models were compared for lateral MAT: intact, transpatellar approach, and parapatellar approach. Analysis was performed using high kinematic displacement and rotation inputs based on the kinematics of natural knees. ISO standards were used for axial load and flexion. Maximum contact stress on the grafted menisci and maximum shear stress on the articular surface of the knee joint were evaluated with FE analysis.

Results: Relatively high maximum contact stresses and maximum shear stresses were predicted in the medial meniscus and cartilage of the knee joint during the loading response for all three knee joint models. Maximum contact stress and maximum shear stress in the meniscus and cartilage increased on the lateral side after lateral MAT, especially during the first 20% of the stance phase of the gait cycle. The transpatellar approach was most similar to the intact knee model in terms of contact stresses of the lateral grafted and medial meniscus, as well as maximum shear stresses during the gait cycle. In addition, the transpatellar model had lower maximum contact stress on the menisci than did the parapatellar model, and it also had lower maximum shear stress on the tibial cartilage.

Conclusions: Therefore, the transpatellar approach may reduce the overall risk of degenerative osteoarthritis (OA) after lateral MAT.

Keywords: Finite element analysis; Gait cycle; Meniscal allograft transplantation; Parapatellar; Transpatellar.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
Measurement of the meniscal extrusion. Three-dimensional reconstruction image showing how extrusion was measured. A, width of the extruded meniscus; B, width of the entire meniscus; A/B, relative percentage of extrusion
Fig. 2
Fig. 2
Parameters of the grafted meniscus. P1, plane of the bony bridge of meniscal allograft; P2, plane of the central line connecting each tibial attachment sites of the anterior and posterior cruciate ligaments. The obliquity of bony bridge and distance from the entry point of bony bridge to the center of the tibial plateau were determined by the angle and distance between P1 and P2
Fig. 3
Fig. 3
Methodology for the 3D modeling of the intact knee. a 3D bone reconstruction. b 3D soft tissue and ligament reconstruction. c 3D model modification
Fig. 4
Fig. 4
FE models used in analyses. a Intact model. b Transpatellar model. c Parapatellar model
Fig. 5
Fig. 5
FE model inputs as a function of the gait cycle. a Flexion angle. b Axial load. c Anterior-posterior displacement. d Internal-external rotation
Fig. 6
Fig. 6
Comparison of maximum contact stress and maximum shear stress in the three models
See this image and copyright information in PMC

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