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Review
. 2022 Oct;15(5):323-335.
doi: 10.1007/s12178-022-09768-1. Epub 2022 Aug 10.

Review of Meniscus Anatomy and Biomechanics

Enzo S Mameri  1   2   3 , Suhas P Dasari  1 , Luc M Fortier  1 , Fernando Gómez Verdejo  1 , Safa Gursoy  1 , Adam B Yanke  1 , Jorge Chahla  4
Affiliations
Review

Review of Meniscus Anatomy and Biomechanics

Enzo S Mameri et al. Curr Rev Musculoskelet Med. 2022 Oct.

Abstract

Purpose of review: Anatomic repair of meniscal pathology is critical for restoring native joint biomechanics and kinematics for patients who suffer from meniscal tears. The purpose of this review was to summarize the pertinent anatomy, biomechanics, and kinematics of the meniscus to guide surgeons during meniscal repair procedures.

Recent findings: Over the past decade, there has been a growing trend to save the meniscus whenever possible. The goal of repair should be to recreate native anatomy as close as possible to recapitulate normal mechanics. Studies describing the quantitative and qualitative relationship of the meniscus roots, ligaments, and attachments are key in guiding any meniscus repair. This review summarizes these relationships, with particular emphasis on meniscal roots and other key attachments to the meniscus. The composition, embryology, vascularization, biomechanics, in vivo kinetics, and in vivo kinematics of the meniscus are also discussed in this review. Meniscal tears can cause profound functional, biomechanical, and kinematic derangements within the knee joint leading to accelerated degeneration of the articular cartilage. A strong understanding of the quantitative and qualitative relationships of the meniscus and its attachments with key arthroscopic landmarks will allow a surgeon to anatomically repair meniscal pathology in order to restore native joint biomechanics.

Keywords: Anatomy; Knee; Meniscus.

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Conflict of interest statement

Dr. Jorge Chahla is a board member for AOSSM, Arthroscopy AANA, and ISAKOS and a paid consultant for Smith and Nephew, Arthrex, Conmed, and Ossur.

Dr. Adam Yanke is a paid consultant for Allosource, Conmed, JRF Ortho, and Olympus; an unpaid consultant for Smith and Nephew, Patient IQ, and Sparta Biomedical; and does research support for Arthrex, Organogenesis, and Vericel.

Figures

Fig. 1
Fig. 1
Medial and lateral meniscus zones and relevant anatomical relations. ACL, anterior cruciate ligament; PCL, posterior cruciate ligament
Fig. 2
Fig. 2
Cadaveric representation of intact medial meniscus posterior root (A) and root tear (B), with significant medial extrusion (black arrow) of the meniscus (gray triangle) in the root tear state
Fig. 3
Fig. 3
Anatomical relations of medial and lateral meniscal roots. MARA, medial anterior root attachment; LARA, lateral anterior root attachment; MPRA, medial posterior root attachment; LPRA, lateral posterior root attachment; MM, medial meniscus; LM, lateral meniscus; MTE, medial tibial eminence; LTE, lateral tibial eminence; ACL, anterior cruciate ligament; TT, tibial tuberosity
Fig. 4
Fig. 4
Cadaveric right knee specimen with a representation of a disrupted meniscotibial ligament at the posterior horn of the medial meniscus—or ramp lesion (A). Modified Guilquist arthroscopic view of a left knee ramp lesion (B), sutured with an all-inside all-suture technique via instrumentation through the posteromedial portal (C and D). MM, medial meniscus; MTL, meniscotibial ligament; MMPH, medial meniscus posterior horn; MFC, medial femoral condyle; PM, posteromedial
Fig. 5
Fig. 5
Superior view of microvascular anatomy of the menisci on India ink vascular injection. The peripheral 10 to 30% of the medial meniscus and the peripheral 10–25% of the lateral meniscus are perfused—with interrupted perfusion on the popliteal hiatus. Figure adapted from Evidence Based Management of Complex Knee Injuries [4]
See this image and copyright information in PMC

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