Archives of Orthopaedic and Trauma Surgery (2018) 138:361–367
ARTHROSCOPY AND SPORTS MEDICINE
Medial meniscus grafting restores normal tibiofemoral contact
· Kirk Campbell
· Alaa Kalloub
· Eric J. Strauss
· Katrina Kuban
· David N. M. Caborn
Received: 1 May 2017 / Published online: 2 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Background Tissue excision in the setting of a meniscal tear has been shown to dramatically increase peak contact stresses
in the aﬀected tibiofemoral joint compartment, leading to the development of degenerative changes and osteoarthritis.
Purpose/hypothesis The current in vitro study utilized a porcine model to evaluate the eﬀectiveness of segmental medial
meniscal grafting following partial meniscectomy. The study hypothesis was that the procedure would normalize medial
tibofemoral joint compartment pressure magnitudes, areas, and locations relative to an intact meniscus.
Study design Controlled laboratory study.
Methods Using pressure ﬁlm, medial tibiofemoral joint compartment peak, and mean pressure magnitudes, peak pressure
location and peak pressure area were determined using 12 potted, fresh frozen, porcine knee specimens. Data were collected
at three diﬀerent knee ﬂexion angles (90°, 45°, and 0°) for three conditions: intact medial meniscus, following resection of
the central third of the medial meniscus, and following segmental medial meniscal grafting. For each condition, the potted
femur was positioned horizontally in a bench vise clamp, while a 20 pound (88.96 N) axial compression force was manu-
ally applied for a 60 s duration by the primary investigator through the base of the potted tibia using a digital force gauge.
Results Loss of the central 1/3 of the medial meniscus resulted in signiﬁcant increases in the mean and peak pressures of the
medial tibiofemoral joint compartment and decreased peak pressure area. Segmental meniscal grafting of the central third
defect closely recreated the contact pressures and loading areas of the native, intact medial meniscus.
Conclusion From a static, time zero biomechanical perspective, segmental medial meniscus grafting of a partially menis-
cectomized knee restored mean pressure, peak pressure, and mean peak contact pressure areas of the medial tibiofemoral
joint compartment back to levels observed in the intact medial meniscus at diﬀerent knee ﬂexion angles. In-vivo analysis
under dynamic conditions is necessary to verify the healing eﬃcacy and ability of the healed segmental medial meniscal
allograft to provide long-term knee joint homeostasis when confronted with dynamic shear, rotatory, and combined, higher
magnitude physiologic loading forces.
Keywords Meniscectomy · Meniscus allograft · Biomechanics
Weight-bearing load distribution by intact menisci is essen-
tial to normal knee kinematics and protection of tibiofemo-
ral joint articular cartilage [1–4]. Excision of tissue in the
setting of a meniscal tear has been shown to dramatically
increase peak articular cartilage contact stresses in the
aﬀected tibiofemoral joint compartment, leading to degen-
erative changes and osteoarthritis [5, 6]. Since the late 1940s
when Fairbank  described the radiographic changes that
developed following meniscus excision, numerous studies
have documented the poor clinical outcomes that occur sub-
sequent to meniscectomy [8, 9].
* John Nyland
Division of Sports Medicine, Department of Orthopaedic
Surgery, University of Louisville, Louisville, KY, USA
Athletic Training Program, Kosair Charities College
of Health and Natural Sciences, Spalding University, 901
South 4th Street, Louisville, KY 40203-2188, USA
New York University Hospital for Joint Diseases, New York,
Shea Orthopedic Group, KentuckyOne Health, 201 Abraham
Flexner Way, Louisville, KY, USA