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The Effect of Lower Limb Alignment on Tibiofemoral Joint Contact Biomechanics after Medial Meniscus Posterior Root
Alexander N Berk1, William M Cregar, Shangcheng Wang
1From the OrthoCarolina-Sports Medicine Center, Charlotte, NC (Berk, Cregar, Ifarraguerri, Piasecki, Fleischli, and Saltzman), the OrthoCarolina Research Institute, Charlotte, NC (Berk, Cregar, Ifarraguerri, Piasecki, Fleischli, and Saltzman), the Atrium Health-Musculoskeletal Institute, Charlotte, NC (Berk, Cregar, Wang, Habet, Ifarraguerri, Piasecki, Fleischli, and Saltzman), and the Columbia University Medical Center-Department of Orthopaedics, New York Presbyterian, New York, NY (Trofa).
Introduction:
The purpose of this study was to determine how variations in lower limb alignment affect tibiofemoral joint contact biomechanics in the setting of medial meniscus posterior root tear (MMPRT) and associated root repair.
Methods:
A finite-element model of an intact knee joint was developed. Limb alignments ranging from 4° valgus to 8° varus were simulated under a 1,000 N compression load applied to the femoral head. For the intact, MMPRT, and root repair conditions, the peak contact pressure (PCP), total contact area, mean and maximum local contact pressure (LCP) elevation, and total area of LCP elevation of the medial tibiofemoral compartment were quantified.
Results:
The PCP and total contact area of the medial compartment in the intact knee increased from 2.43 MPa and 361 mm 2 at 4° valgus to 9.09 MPa and 508 mm 2 at 8° of varus. Compared with the intact state, in the MMPRT condition, medial compartment PCP was greater and the total contact area smaller for all alignment conditions. Root repair roughly restored PCPs in the medial compartment; however, this ability was compromised in knees with increasing varus alignment. Specifically, elevations in PCP relative to the intact state increased with increasing varus, as did the total contact area with LCP elevation. After root repair, medial compartment PCP remained elevated above the intact state at all degrees tested, ranging from 0.05 MPa at 4° valgus to 0.27 MPa at 8° of varus, with overall PCP values increasing from 2.48 to 9.09 MPa. For varus alignment greater than 4°, root repair failed to reduce the total contact area with LCP elevation relative to the MMPRT state.
Discussion:
Greater PCPs and areas of LCP elevation in varus knees may reduce the clinical effectiveness of root repair in delaying or preventing the development of tibiofemoral osteoarthritis.
