Objectives: There is no consensus on the limits of joint line obliquity (JLO) following high tibial osteotomy (HTO), beyond which double-level osteotomy may be indicated. JLO causes medial-lateral tibiofemoral subluxation that may be resisted by the menisci, but that role has never been studied. The objective was to measure meniscus posterior root tension, tibiofemoral medial-lateral subluxation and changes of peak articular pressure, and how they are affected by JLO. It was hypothesized that medial downslope would increase medial meniscus (MM) root tension, and vice-versa.

Material And Methods

Eight fresh-frozen knee specimens (based on power analysis) were mounted in a custom-built fixture in a compression loading machine with the native 4° medial downslope. A range of JLO from 12° medial (varus) to 16° lateral (valgus) downslope were created by tilting the load axis. Mediolateral subluxation was measured optically. Peak articular contact pressures were measured using Tekscan sensors inserted sub-meniscally. The posterior medial or lateral meniscus root was transected and repaired using suture tapes through a transosseous tunnel then attached to a tensiometer mounted at the tunnel entrance. The repair was tensed 30N with the knee preloaded 100N, then the tension with 2xBW was measured. This was repeated for both medial and lateral downslopes and both menisci, at both 0° and 20° flexion as in the stance phase of walking. Data were analyzed using Shapiro-Wilk tests, 2-way RM-ANOVA and RM-t post-tests.

Results

The walking load of 1.48±0.30kN caused mean meniscus posterior root tensions that were higher in 20° flexion than in full extension for both menisci: MM 83±15N and 64±9N (P<0.001) and lateral meniscus (LM) 75±16N and 63±13N respectively (P=0.006). Changing the JLO from 16° medial to 12° lateral downslope caused 5.4mm mean lateral femoral subluxation. With the medial femoral condyle resting more on the MM between 4° and 8° medial JLO the root tension increased significantly (66±14 to 78±14N, P=0.013) while the LM root tension reduced. Lateral downslope had less effect on lateral meniscus root tension: changing from 4° medial to 12° lateral downslope increased the root tension from 67±16N to 76±12N (P=0.005). Overall, JLO did not affect the MM tension greatly: at 20° flexion, it was in the range 80-90N at both 16° medial and 12° lateral. Conversely, while the lateral meniscus tension was also above 80N with 12° lateral JLO, it was below 60N with 12° medial downslope. There was no evidence to support the hypothesis that medial JLO would increase medial compartment peak articular pressure, while the lateral compartment saw reduced pressure with lateral JLO.

Conclusions

This is the first report of meniscus root repair tensions under physiological values of joint loading. These data can be used in future loading studies of root repairs. Variation of the JLO did not cause large tension or contact pressure effects on each meniscus in line with the subluxations observed, thus this work is clinically reassuring in that it does not support a limit on JLO less than 12° lateral following medial opening wedge HTO.

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The Static Allograft - Decreased Dynamic Meniscal Extrusion Alters Clinical Success 2 years after primary Medial or Lateral Meniscus Allograft Transplantation ePoster Presentation Valentin Hingsamer, CM, AUSTRIA Georg Brandl, MD, AUSTRIA Edin Muji, MD, AUSTRIA Thomas Hoffelner, MD, Prof, AUSTRIA Sebastian Rilk, MD, UNITED STATES
Ultrasonographic Findings Associated with Medial Meniscus Posterior Root Tear ePoster Presentation Manase Nishimura, MD, JAPAN Yasushi Takata, MD, PhD, JAPAN Yoshihiro Ishida, MD, JAPAN Naoki Takemoto, MD, JAPAN Kentaro Fujita, MD, JAPAN Takuya Sengoku, PT, PhD, JAPAN Yushin Mizuno, MSc, PT, JAPAN Junsuke Nakase, MD, PhD, JAPAN
Bucket Handle Meniscal Tear After ACL Reconstruction: Residual Knee Laxity Treated With Antwerp Monoloop Technique ePoster Presentation Alvaro Valenzuela, MD, CHILE Gonzalo Andres Marambio, MD, CHILE Eithan Goldbaum, MD, CHILE Pablo Armstrong, MD, CHILE José Manuel Irarrázaval Mainguyague, MBBS, CHILE Jose A. Hun, MD, CHILE Peter Verdonk, MD, PhD, BELGIUM
Repair Of Isolated Traumatic Lateral Meniscal Injury Yields Comparable Clinical Outcomes In Young And Middle-Aged Patients ePoster Presentation Kodai Hamaoka, MD, JAPAN Shinichiro Okimura, MD, PhD, JAPAN Kazushi Horita, MD, JAPAN Yasutoshi Ikeda, MD,PhD, JAPAN Yohei Okada, MD,PhD, JAPAN Tomoaki Kamiya, MD, JAPAN Atsushi Teramoto, MD, PhD, JAPAN
Detailed Anatomy of the Meniscotibial Ligament and Clock Face Position of Meniscal Attachments in the Tibia ePoster Presentation Keiichi Yoshida, MD, PhD, JAPAN Youngji Kim, MD, PhD, JAPAN Haruka Kaneko, JAPAN Yoshitomo Saita, MD, PhD, JAPAN Mitsuaki Kubota, MD, PhD, JAPAN Muneaki Ishijima, MD, PhD, JAPAN
Diagnosis Of Medial Meniscus Posterior Root Tear On Magnetic Resonance Imaging Using Deep Learning ePoster Presentation Yuta Nakanishi, MD, PhD, JAPAN Takehiko Matsushita, MD, PhD, JAPAN Atsuyuki Inui, MD, PhD, JAPAN Kyohei Nishida , MD, PhD, JAPAN Kanto Nagai, MD, PhD, JAPAN Yuichi Hoshino, MD, PhD, JAPAN Ryosuke Kuroda, MD, PhD, JAPAN
Ideal Remaining Meniscus Width and Risk Factors for Decrease of Meniscus Width after Reshaping Surgery in Pediatric Patients with Discoid Lateral Meniscus ePoster Presentation Kyeong Baek Kim, MD, KOREA, REPUBLIC OF Joon Ho Wang, MD, PhD, KOREA, REPUBLIC OF Seong Man Jeon, MD, KOREA, REPUBLIC OF

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Joint Line Obliquity Can Increase Meniscus Root Tension

Joint Line Obliquity Can Increase Meniscus Root Tension

Material And Methods

Results

Conclusions

Knee Meniscus ePosters

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Joint Line Obliquity Can Increase Meniscus Root Tension

Joint Line Obliquity Can Increase Meniscus Root Tension

Material And Methods

Results

Conclusions