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Meniscal Function - Menisectomies and Degenerative Change

The medial and lateral meniscal cartilages are important for force distribution across the knee joint.  The anatomy of the menisci allows for the translation of vertical compressive forces into circumferential (hoop) stresses.  The menisci transmit between 50% and 70% of the load across the knee joint during weight-bearing (axial loading).  The menisci also increase joint congruity, stability and improve the nutrition and lubrication of the articular cartilage, thus helping to prevent or retard the development of osteoarthritis.

Although the etiology of degenerative change in the knee joint can be multifactorial, the importance of the menisci in preventing the evolution of arthritic change is well understood.  The removal of either meniscus may affect  the articular surface and eventually lead to destruction of the underlying subchondral bone.

The medical meniscus, secondary to the anatomy and biomechanics of the knee joint, is the one most frequently injured, and, thus, the one most surgically manipulated, leading to an increased incidence of medial over lateral compartment osteoarthritis in the knee joint.

Fairbanks was the first to relate meniscectomy to ensuing degenerative changes, with these clinical observations in the late 1940's being supported by extensive research since that time.  Clinical and animal studies have confirmed the increased potential for osteoarthritis after meniscectomy, with a near-certainty predictability of developing osteoarthritis over time following a total meniscectomy.

Orthopaedic management of meniscal tears has responded to this evidence by ensuring that every effort is made to maintain the integrity of the menisci, including repairing tears if possible, and completing a partial meniscectomy only if necessary.

References:

Fairbank, T. J.: Knee Changes after Meniscectomy ,  Journal of Bone and Joint Surgery, 30-B(4): pp. 664-670, 1948.

Clinical Orthopaedics 1987; 224: pp. 52-63.

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