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Research Papers

The Effect of Kinematic and Kinetic Changes on Meniscal Strains During Gait

[+] Author and Article Information
Nathan A. Netravali

Department of Mechanical Engineering, Stanford University, Durand Building 204, Stanford, CA 94305-4038nan4@stanford.edu

Seungbum Koo

School of Mechanical Engineering, Chung-Ang University, Seoul, 156-756 South Koreaskoo@cau.ac.kr

Nicholas J. Giori

Bone and Joint Center, Palo Alto VA, Palo Alto, CA 94304; Department of Orthopedic Surgery, Stanford University Medical Center, Stanford, CA 94305ngiori@stanford.edu

Thomas P. Andriacchi

Department of Mechanical Engineering, Stanford University, Stanford, CA 94305; Bone and Joint Center, Palo Alto VA, Palo Alto, CA 94304; Department of Orthopedic Surgery, Stanford University Medical Center, Stanford, CA 94305tandriac@stanford.edu

J Biomech Eng 133(1), 011006 (Dec 23, 2010) (6 pages) doi:10.1115/1.4003008 History: Received July 09, 2010; Revised October 20, 2010; Posted November 10, 2010; Published December 23, 2010; Online December 23, 2010

The menisci play an important role in load distribution, load bearing, joint stability, lubrication, and proprioception. Partial meniscectomy has been shown to result in changes in the kinematics and kinetics at the knee during gait that can lead to progressive meniscal degeneration. This study examined changes in the strains within the menisci associated with kinematic and kinetic changes during the gait cycle. The gait changes considered were a 5 deg shift toward external rotation of the tibia with respect to the femur and an increased medial-lateral load ratio representing an increased adduction moment. A finite element model of the knee was developed and tested using a cadaveric specimen. The cadaver was placed in positions representing heel-strike and midstance of the normal gait, and magnetic resonance images were taken. Comparisons of the model predictions to boundaries digitized from images acquired in the loaded states were within the errors produced by a 1 pixel shift of either meniscus. The finite element model predicted that an increased adduction moment caused increased strains of both the anterior and posterior horns of the medial meniscus. The lateral meniscus exhibited much lower strains and had minimal changes under the various loading conditions. The external tibial rotational change resulted in a 20% decrease in the strains in the posterior medial horn and increased strains in the anterior medial horn. The results of this study suggest that the shift toward external tibial rotation seen clinically after partial medial meniscectomy is not likely to cause subsequent degenerative medial meniscal damage, but the consequence of this kinematic shift on the pathogenesis of osteoarthritis following meniscectomy requires further consideration.

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Figures

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Figure 1

Loading device to fix the femur and to prescribe motion on the tibia

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Figure 2

Finite element representation of the knee joint

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Figure 3

Location of elements chosen to represent the anterior and posterior horns for analysis

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Figure 4

An overlay of the meniscal movement at midstance from the experiment (white) and predicted by the model (dark)

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Figure 5

Maximum principal (tensile) logarithmic strains in the medial and lateral menisci at midstance after the normal loading case

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Figure 6

Maximum principal (tensile) logarithmic strains in the medial posterior horn at midstance for normal loading, an external tibial rotational shift (rot), an applied adduction moment (add), and a combination of an adduction moment and external tibial rotational shift (rot+add)

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Figure 7

Mean tensile logarithmic strains for the anterior (ant) and posterior (post) horn regions and overall for the medial (med) and lateral (lat) menisci at midstance for the simulated conditions of normal loading, an external tibial rotational shift (rot), an applied adduction moment (add), and a combined rotational shift and adduction moment (rot+add)

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