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Varus alignment aggravates tibiofemoral contact pressure rise after sequential medial meniscus resection

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Arthroscopic partial meniscectomy of medial meniscus tears and varus alignment are considered independent risk factors for increased medial compartment load, thus contributing to the development of medial osteoarthritis. The purpose of this biomechanical study was to investigate the effect of lower limb alignment on contact pressure and contact area in the knee joint following sequential medial meniscus resection. It was hypothesized that a meniscal resection of 50% would lead to a significant overload of the medial compartment in varus alignment.

Methods

Eight fresh-frozen human cadaveric knees were axially loaded with a 750 N compressive force in full extension with the mechanical axis rotated to intersect the tibia plateau at 30%, 40%, 50%, 60% and 70% of its width. Tibiofemoral mean contact pressure (MCP), peak contact pressure (PCP), and contact area (CA) of the medial and lateral compartment were measured separately using pressure-sensitive films (K-Scan 4000, Tekscan) in four different meniscal conditions, respectively, intact, 50% resection, 75% resection, and total meniscectomy.

Results

Medial MCP was significantly increased when comparing the intact meniscus to each meniscal resection in all tested alignments (p < 0.05). Following meniscal resection of 50%, MCP was significantly higher with greater varus alignment compared to valgus alignment (p < 0.05). Similarly, medial PCP was higher at varus alignment compared to valgus alignment (p < 0.05). Further resection to 75% and 100% of the meniscus resulted in a significantly higher medial PCP at 30% of tibia plateau width compared to all other alignments (p < 0.05). Medial CA of the intact meniscus decreased significantly after 50%, 75% and 100% meniscal resection in all alignments (p < 0.05). Lateral joint pressure was not significantly increased by greater valgus alignment.

Conclusion

Lower limb alignment and the extent of medial meniscal resection significantly affect tibiofemoral contact pressure. Combined varus alignment and medial meniscal resection increased MCP and PCP within the medial compartment, whereas valgus alignment prevented medial overload. As a clinical consequence, lower limb alignment should be considered in the treatment of patients undergoing arthroscopic partial meniscectomy with concomitant varus alignment. In patients presenting with ongoing medial joint tenderness and effusion, realignment osteotomy can be a surgical technique to unload the medial compartment.

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Funding

The Technical University of Munich did not receive funding for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Lukas Willinger, Daniel Berthold, Lukas N. Muench, Andrea Achtnich, Philipp Forkel & Andreas B. Imhoff

  2. Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Hospital Rechts der Isar, Munich, Germany

    Jan J. Lang, Rainer Burgkart & Constantin von Deimling

  3. Department of Trauma Surgery, Technical University of Munich, Hospital Rechts der Isar, Munich, Germany

    Jan J. Lang

  4. Chair of Non-destructive Testing, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany

    Jan J. Lang

  5. Chair of Applied Mechanics, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany

    Constantin von Deimling

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  1. Lukas Willinger
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Corresponding author

Correspondence to Lukas Willinger.

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Conflict of interest

ABI is a consultant of Arthrosurface and medi GmbH, and receives royalties from Arthrex Inc. and Arthrosurface. All other authors declare no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standard. An approval of the institutional ethic committee (Ethic committee, Faculty of Medicine, Technical University of Munich, Munich, Germany) was not applicable to this study.

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Willinger, L., Lang, J.J., Berthold, D. et al. Varus alignment aggravates tibiofemoral contact pressure rise after sequential medial meniscus resection. Knee Surg Sports Traumatol Arthrosc 28, 1055–1063 (2020). https://doi.org/10.1007/s00167-019-05654-5

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