The Meniscus-Deficient Knee: Biomechanics, Evaluation, and Treatment Options

Rao AJ, Erickson BJ, Cvetanovich GL, Yanke AB, Bach BR Jr, Cole BJ · Orthopaedic Journal of Sports Medicine

An injured meniscus distributes load and resists tibial translation less well, and partial or complete loss of it promotes early chondromalacia and osteoarthritis. The review reports contact stresses rising about 100% after medial meniscectomy and 200% to 350% after lateral meniscectomy, and describes a linear relationship between how much meniscus is removed and how far contact stress rises. Transplantation, high tibial osteotomy and distal femoral osteotomy all work by reducing load on the deficient compartment; reported complications include fracture, nonunion, patella baja, compartment syndrome, infection and deep vein thrombosis.

Population

Review of the biomechanics, evaluation and surgical management of the knee that has lost meniscal tissue

Intervention

Meniscal allograft transplantation, high tibial osteotomy and distal femoral osteotomy, alone or alongside ligament and chondral procedures

Limitations

A narrative review with no systematic search, so its biomechanical figures belong to the cadaver studies it cites rather than to itself, and its treatment recommendations are expert reading of a literature with no randomised comparisons in it. Several authors declare research support, consultancy, royalties and stock in orthopaedic device companies, including manufacturers of the implants discussed.