2015 ISAKOS Biennial Congress ePoster #1622
The Role of Meniscal Root Pathology and Anterior Intermeniscal Ligament in Meniscal Displacement During Axial Joint Loadings
Halil Atmaca, Assist. Prof., MD, Antalya TURKEY
Kemal Gökkus, MD, Antalya TURKEY
Levent Ugur, Lecturer, MsC, Amasya TURKEY
Ahmet Turan Aydin, Prof., MD, Ankara TURKEY
Akdeniz University, Antalya, TURKEY
FDA Status Not Applicable
Summary: Although the isolated injury of anterior intermeniscal ligament (AIML) has no negative effect on contact pressure and meniscal displacement, AIML is a beneficial structure for meniscal stabilization and stress distribution during axial loadings in case of related injuries especially anterior root pathologies.
Purpose:Degenerative changes of the knee joint and clinical follow-up after meniscal subluxation are well documented. Meniscal root pathologies were found to be related with meniscal subluxation in magnetic resonance imaging (MRI) studies. The anterior intermeniscal ligament (AIML), also known as the transverse geniculate ligament, or meniscomeniscal ligament is an anatomically distinct structure that connects the anterior aspect of the medial and lateral menisci. Although some previous studies reported that isolated AIML injury has no biomechanical effect on tibiofemoral contact mechanics in the event of intact menisci root attachments, we hypothesized that absence of the AIML may affect both axial loadings on tibia articular cartilage and the amount of meniscus displacement in cases associated with meniscal root pathologies.
In the current study three-dimensional (3D) finite element analysis (FEA) of human lower limb was used to investigate the role of AIML and meniscal root pathologies on meniscal subluxation and stress distribution pattern in the loadings of the tibia articular cartilage. Initially ten 3D models were created according to whether absence of root pathology in anterior and posterior attachments of medial and lateral menisci (MM and LM, respectively). Then AIML injuries were combined with all models. Thus, a total of twenty 3D were investigated. ANSYS® 15 was used to analyze the stress/load distribution, that is to say maximum equivalent stress (MES) (von Mises stress), on tibia cartilage. MES was expressed as Newton/mm2 = Megapascal (MPa). The amount of meniscus displacement was measured as millimeter (mm) on ‘X’ axis by using displacement tool in ANSYS®. The data were evaluated in two groups with respect to AIML injury.
According to current static and standing upright position human model, the MES on tibia cartilage was 1.38 MPa in the reference model. MES increased 48,9 % in totally injured model (anterior+ posterior attachments of both MM and LM combined with AIML rupture) while the displacements of MM and LM increased 57,8% and 118,4% respectively when compared with reference model. The means of the MES and displacements of MM and LM in the group of intact AIML increased 24,1%, 19%, 31,9%, respectively while they increased 35,2%, 22,1% and 42,4%, respectively in the AIML ruptured group. The increases of MES were superior in cases of posterior root pathologies than anterior while the amounts of displacements were greater in anterior root pathologies than posterior root. LM was found to be more sensitive to AIML injuries with respect to meniscal displacement.
This study showed that meniscal subluxation is strongly associated with meniscal root pathologies. Although the isolated injury of AIML has no negative effect on contact pressure and meniscal displacement, AIML is a beneficial structure for meniscal stabilization and stress distribution during axial loadings in case of related injuries especially anterior root pathologies.