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EFFECTS OF TOTAL MEDIAL AND LATERAL MENISECTOMIES ON THE KNEE JOINT BIOMECHANICS
DURING NORMAL GAIT - A VALIDATED 3D FINITE ELEMENT METHOD STUDY
1Duraisamy Shriram, 2Hamid Naghibi Beidokhti, 1*Karupppasamy Subburaj, 2Dennis Janssen and 2,3Nico Verdonschot
1Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore
2Radboud University Medical Center, Orthopaedic Research Lab, Nijmegen, The Netherlands
3Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands
*email: subburaj@sutd.edu.sg
INTRODUCTION
Meniscal tears are among the most common injuries of the
knee. It has been commonly agreed that the total
meniscectomy (medial or lateral) prompts dynamics of
articular cartilage wear after a few years. The biomechanical
factors behind this damage, including change in the global
biomechanics of the knee joint and increased articular
instability, result in progressive and degenerative cartilage
tissue damage. Previously, a few studies targeted the total
medial meniscectomy in a limited loading condition. A
comparative study on influence of total medial and lateral
meniscectomies on human knee joint biomechanical behavior
has not been reported yet. Thus the purpose of this study was
to assess biomechanical behavior of the knee joint with total
medial and lateral meniscectomies using a validated subject-
specific finite element (FE) model.
METHODS
A 3D subject-specific validated FE model of a human knee
joint (Fig. 1a) was developed based on cadaveric experiments.
Menisci and tibiofemoral ligaments were modeled as
circumferentially and longitudinally fibric hyperelastic
material [1], respectively; cartilages were modeled as
hyperelastic material, and bones were considered as rigid
bodies. Loading condition was applied based on an
experimental gait data [2]. The FE simulations were
performed for a complete gait cycle (both stance and swing
phase) with intact meniscus, total medial meniscectomy, and
total lateral meniscectomy knee joint models. The contact
pressures of tibial cartilage and knee joint kinematics
including anterior translation, varus rotation, and internal
rotation of tibia with respect to femur were determined and
compared as a function of gait.
RESULTS AND DISCUSSION
Figure 1(b-c) shows the peak contact pressures of medial and
lateral tibial plateau. Total medial meniscectomy and lateral
meniscectomy increased contact pressure in the tibial cartilage
by 65% at 54% of gait cycle and 52% at 46% of gait cycle,
respectively, both occurred during the loading response of the
stance phase. Compared with the intact knee model, an
increase in anterior translation (1.5 mm), varus rotation (5.2°),
and internal rotation (18.6°) of tibia were observed, in the
knee model with medial meniscectomy at 54% of gait cycle
(Fig. 1(d-f)). Similarly, increase in anterior translation (1.3
mm), varus rotation (1.3°), and internal rotation (3.5°) of tibia
were observed, in the knee model with lateral meniscectomy
at 46% of gait cycle. These results show that total
meniscectomies have undesirable impacts on the
biomechanics characteristics of the knee joint. Also the
regions of articular cartilage that were not loaded in the intact
joint are getting loaded after meniscectomy, due to altered
biomechanics, which would increase the risk of osteoarthritis.
Figure 1: (a) 3D subject-specific knee joint model, (b)-(c)
maximum values of contact pressures of medial and lateral
tibial plateau, and (d)-(f) tibial translation and rotations with
respect to femur for a complete gait cycle
CONCLUSIONS
We have studied the effect of total meniscectomy (medial and
lateral) joint kinematics and contact pressure in articular
cartilages of the knee joint, during normal walking activity,
using finite element method. This study demonstrates that FE
tool could also be used for predictive analysis of treatment
options for patients with meniscal injuries.
ACKNOWLEDGEMENTS
We acknowledge our funding sources, SUTD Start-up
research grant (SRG EPD 2015 093), and Health Tech
Innovation Grant (CGH-SUTD-2015-003). This study is also a
part of BioMechTools project (received funding from the
European Research Council under the European Union’s
Seventh Framework Program (FP/2007-2013) / ERC Grant
Agreement no. 323091).
REFERENCES
1. Naghibi Beidokhti H, et al., 22nd Congress of the
European Society of Biomechanics, 2016, France
2. Kim HJ, et al., J Orthop Res. 27(10):1326-31, 2009
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