Abstract
Pathophysiology of meniscus injuries comprises a combination of compressive, tensile, and shear forces. Besides the characteristics of the tissue itself, which comprises segmental and zonal variations, several other factors are enrolled in the etiology of meniscus tears. These include the external load/traumatic event in a given moment, the joint alignment, age, body mass index, or patient’s activity level. On the other hand, degenerative tears are usually multifactorial and not always easy to separate from the environment of a globally osteoarthritic joint. Herein, it is overviewed the most important features of anatomy, biology, and biomechanics contributing to the most frequent injury mechanisms for traumatic and degenerative meniscus tears for all ages.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abraham AC, Edwards CR, Odegard GM, Donahue TL (2011) Regional and fiber orientation dependent shear properties and anisotropy of bovine meniscus. J Mech Behav Biomed Mater 4(8):2024–2030. doi:10.1016/j.jmbbm.2011.06.022
Anderson AF (2003) Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg Am 85-A(7):1255–1263
Anderson AF, Irrgang JJ, Dunn W, Beaufils P, Cohen M, Cole BJ, Coolican M, Ferretti M, Glenn RE Jr, Johnson R, Neyret P, Ochi M, Panarella L, Siebold R, Spindler KP, Ait Si Selmi T, Verdonk P, Verdonk R, Yasuda K, Kowalchuk DA (2011) Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39(5):926–932. doi:10.1177/0363546511400533
Angel KR, Hall DJ (1989) The role of arthroscopy in children and adolescents. Arthroscopy J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 5(3):192–196
Baker BE, Peckham AC, Pupparo F, Sanborn JC (1985) Review of meniscal injury and associated sports. Am J Sports Med 13(1):1–4
Baker P, Coggon D, Reading I, Barrett D, McLaren M, Cooper C (2002) Sports injury, occupational physical activity, joint laxity, and meniscal damage. J Rheumatol 29(3):557–563
Baker P, Reading I, Cooper C, Coggon D (2003) Knee disorders in the general population and their relation to occupation. Occup Environ Med 60(10):794–797
Barrett GR, Field MH, Treacy SH, Ruff CG (1998) Clinical results of meniscus repair in patients 40 years and older. Arthroscopy J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 14(8):824–829
Beaufils P, Englund M, Järvinen TLN, Pereira H, Pujol N (2014) How to share guidelines in daily practice on meniscus repair, degenerate meniscal lesion, and meniscectomy. In: Zaffagnini S, Becker R, Kerkhoffs GMMJ, Espregueira-Mendes J, van Dijk CN (eds) ESSKA instructional course lecture book Amsterdam 2014. Springer, Berlin/Heidelberg, pp 97–112
Beaupre A, Choukroun R, Guidouin R, Garneau R, Gerardin H, Cardou A (1986) Knee menisci. Correlation between microstructure and biomechanics. Clin Orthop Relat Res (208):72–75
Bedi A, Kelly NH, Baad M, Fox AJ, Brophy RH, Warren RF, Maher SA (2010) Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg Am 92(6):1398–1408. doi:10.2106/JBJS.I.00539
Bendjaballah MZ, Shirazi-Adl A, Zukor DJ (1997) Finite element analysis of human knee joint in varus-valgus. Clin Biomech (Bristol, Avon) 12(3):139–148
Bernstein J (2010) In brief: meniscal tears. Clin Orthop Relat Res 468(4):1190–1192. doi:10.1007/s11999-010-1253-4
Bloome DM, Blevins FT, Paletta GA Jr, Newcomer JK, Cashmore B, Turker R (2000) Meniscal repair in very young children. Arthroscopy J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 16(5):545–549. doi:10.1053/jars.2000.7676
Bourne RB, Finlay JB, Papadopoulos P, Andreae P (1984) The effect of medial meniscectomy on strain distribution in the proximal part of the tibia. J Bone Joint Surg Am 66(9):1431–1437
Brian D, Mackenzie WG, Shim SS, Leung G (1985) The vascular and nerve supply of the human meniscus. Arthroscopy J Arthroscopic Relat Surg 1(1):58–62
Bullough PG, Munuera L, Murphy J, Weinstein AM (1970) The strength of the menisci of the knee as it relates to their fine structure. J Bone Joint Surg 52(3):564–567
Bursac P, Arnoczky S, York A (2009) Dynamic compressive behavior of human meniscus correlates with its extra-cellular matrix composition. Biorheology 46(3):227–237. doi:10.3233/BIR-2009-0537
Cengiz IF, Pereira H, Pego JM, Sousa N, Espregueira-Mendes J, Oliveira JM, Reis RL (2015) Segmental and regional quantification of 3D cellular density of human meniscus from osteoarthritic knee. J Tissue Eng Regen Med. doi:10.1002/term.2082, Epub ahed of print
Dacombe PJ (2013) Shelbourne’s update of the O’Donoghue knee triad in a 17-year-old male Rugby player. BMJ Case Rep. 2013. doi:10.1136/bcr.01.2012.5593
Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL (2012) Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 40(9):2128–2133. doi:10.1177/0363546512449994
Englund M, Felson DT, Guermazi A, Roemer FW, Wang K, Crema MD, Lynch JA, Sharma L, Segal NA, Lewis CE, Nevitt MC (2011) Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study. Ann Rheum Dis 70(10):1733–1739. doi:10.1136/ard.2011.150052
Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359(11):1108–1115. doi:10.1056/NEJMoa0800777
Englund M, Guermazi A, Roemer FW, Aliabadi P, Yang M, Lewis CE, Torner J, Nevitt MC, Sack B, Felson DT (2009) Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: the Multicenter Osteoarthritis Study. Arthritis Rheum 60(3):831–839. doi:10.1002/art.24383
Englund M, Guermazi A, Roemer FW, Yang M, Zhang Y, Nevitt MC, Lynch JA, Lewis CE, Torner J, Felson DT (2010) Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study. Ann Rheum Dis 69(10):1796–1802. doi:10.1136/ard.2009.121681
Englund M, Niu J, Guermazi A, Roemer FW, Hunter DJ, Lynch JA, Lewis CE, Torner J, Nevitt MC, Zhang YQ, Felson DT (2007) Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness. Arthritis Rheum 56(12):4048–4054. doi:10.1002/art.23071
Fayard JM, Pereira H, Servien E, Lustig S, Neyret P (2010) Meniscectomy global results-complications. The Meniscus, Springer-Verlag, Berlin Heidelberg. doi:10.1007/978-3-642-02450-4
Freutel M, Seitz AM, Galbusera F, Bornstedt A, Rasche V, Knothe Tate ML, Ignatius A, Durselen L (2014) Medial meniscal displacement and strain in three dimensions under compressive loads: MR assessment. J Magn Reson Imaging JMRI 40(5):1181–1188. doi:10.1002/jmri.24461
Friden T, Erlandsson T, Zatterstrom R, Lindstrand A, Moritz U (1995) Compression or distraction of the anterior cruciate injured knee. Variations in injury pattern in contact sports and downhill skiing. Knee Surg Sports Traumatol Arthrosc 3(3):144–147
Frizziero A, Ferrari R, Giannotti E, Ferroni C, Poli P, Masiero S (2012) The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures. Muscles Ligaments Tendons J 2(4):295–301
Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand 51(6):871–879
Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D (1999) Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoarthritis Cartilage 7(6):526–532
Garrett WE Jr, Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ, Harrast J, Derosa GP (2006) American board of orthopaedic surgery practice of the orthopaedic surgeon: part-II, certification examination case mix. J Bone Joint Surg Am 88(3):660–667. doi:10.2106/JBJS.E.01208
Guilak F, Butler DL, Goldstein SA, Baaijens FP (2014) Biomechanics and mechanobiology in functional tissue engineering. J Biomech 47(9):1933–1940. doi:10.1016/j.jbiomech.2014.04.019
Guo H, Maher SA, Spilker RL (2013) Biphasic finite element contact analysis of the knee joint using an augmented Lagrangian method. Med Eng Phys 35(9):1313–1320. doi:10.1016/j.medengphy.2013.02.003
Gupte CM, Bull AM, Thomas RD, Amis AA (2003) The meniscofemoral ligaments: secondary restraints to the posterior drawer. Analysis of anteroposterior and rotary laxity in the intact and posterior-cruciate-deficient knee. J Bone Joint Surg 85(5):765–773
Hunter DJ, Buck R, Vignon E, Eckstein F, Brandt K, Mazzuca SA, Wyman BT, Otterness I, Hellio Le Graverand MP (2009) Relation of regional articular cartilage morphometry and meniscal position by MRI to joint space width in knee radiographs. Osteoarthritis Cartilage 17(9):1170–1176. doi:10.1016/j.joca.2009.04.001
Hunter DJ, Zhang YQ, Niu JB, Tu X, Amin S, Clancy M, Guermazi A, Grigorian M, Gale D, Felson DT (2006) The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. Arthritis Rheum 54(3):795–801. doi:10.1002/art.21724
Hunter DJ, Zhang YQ, Tu X, Lavalley M, Niu JB, Amin S, Guermazi A, Genant H, Gale D, Felson DT (2006) Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis Rheum 54(8):2488–2495. doi:10.1002/art.22016
Jackson RW, Dandy DJ (1976) Arthroscopy of the knee. Grune Stratton, New York
Kawahara Y, Uetani M, Fuchi K, Eguchi H, Hayashi K (1999) MR assessment of movement and morphologic change in the menisci during knee flexion. Acta Radiol 40(6):610–614
Kenny C (1997) Radial displacement of the medial meniscus and Fairbank’s signs. Clin Orthop Relat Res 339:163–173
Killian ML, Lepinski NM, Haut RC, Haut Donahue TL (2010) Regional and zonal histo-morphological characteristics of the lapine menisci. Anat Rec (Hoboken) 293(12):1991–2000. doi:10.1002/ar.21296
Kim E, Kim YJ, Cha JG, Kim MY, Lee DH, Cho SG, Kim RS (2015) Kinematic change of the meniscus and the tibiofemoral joint space in asymptomatic volunteers using a wide bore 3T closed MRI system. Skeletal Radiol 44(10):1441–1451. doi:10.1007/s00256-015-2187-4
Kornaat PR, Bloem JL, Ceulemans RY, Riyazi N, Rosendaal FR, Nelissen RG, Carter WO, Hellio Le Graverand MP, Kloppenburg M (2006) Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology 239(3):811–817. doi:10.1148/radiol.2393050253
Kramer DE, Micheli LJ (2009) Meniscal tears and discoid meniscus in children: diagnosis and treatment. J Am Acad Orthop Surg 17(11):698–707
Lai JH, Levenston ME (2010) Meniscus and cartilage exhibit distinct intra-tissue strain distributions under unconfined compression. Osteoarthritis Cartilage 18(10):1291–1299, http://dx.doi.org/10.1016/j.joca.2010.05.020
Lee DH, Lee BS, Kim JM, et al. (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19:222–229.
Levy IM, Torzilli PA, Gould JD, Warren RF (1989) The effect of lateral meniscectomy on motion of the knee. J Bone Joint Surg Am 71(3):401–406
Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64(6):883–888
Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ (2010) Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther 40(6):A1–A35. doi:10.2519/jospt.2010.0304
Maffulli N, Chan KM, Bundoc RC, Cheng JC (1997) Knee arthroscopy in Chinese children and adolescents: an eight-year prospective study. Arthroscopy J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 13(1):18–23
Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13(3):184–188. doi:10.1016/j.knee.2006.01.005
Makris EA, Hadidi P, Athanasiou KA (2011) The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials 32(30):7411–7431. doi:10.1016/j.biomaterials.2011.06.037
Masouros SD, McDermott ID, Amis AA, Bull AM (2008) Biomechanics of the meniscus-meniscal ligament construct of the knee. Knee Surg Sports Traumatol Arthrosc 16(12):1121–1132. doi:10.1007/s00167-008-0616-9
Matsubara H, Okazaki K, Izawa T, Tashiro Y, Matsuda S, Nishimura T, Nakanishi Y, Kawamura H, Iwamoto Y (2012) New suture method for radial tears of the meniscus: biomechanical analysis of cross-suture and double horizontal suture techniques using cyclic load testing. Am J Sports Med 40(2):414–418. doi:10.1177/0363546511424395
McDermott ID, Masouros SD, Amis AA (2008) Biomechanics of the menisci of the knee. Curr Orthopaed 22:193–201
McDermott MJ, Bathgate B, Gillingham BL, Hennrikus WL (1998) Correlation of MRI and arthroscopic diagnosis of knee pathology in children and adolescents. J Pediatr Orthop 18(5):675–678
McDevitt CA, Webber RJ (1990) The ultrastructure and biochemistry of meniscal cartilage. Clin Orthop Relat Res 252:8–18
McNulty AL, Estes BT, Wilusz RE, Weinberg JB, Guilak F (2010) Dynamic loading enhances integrative meniscal repair in the presence of interleukin-1. Osteoarthritis Cartilage 18(6):830–838. doi:10.1016/j.joca.2010.02.009
McNulty AL, Guilak F (2015) Mechanobiology of the meniscus. J Biomech 48(8):1469–1478. doi:10.1016/j.jbiomech.2015.02.008
Meakin JR, Shrive NG, Frank CB, Hart DA (2003) Finite element analysis of the meniscus: the influence of geometry and material properties on its behaviour. Knee 10(1):33–41
Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 18(9):955–959
Mintzer CM, Richmond JC, Taylor J (1998) Meniscal repair in the young athlete. Am J Sports Med 26(5):630–633
Nishimuta JF, Levenston ME (2012) Response of cartilage and meniscus tissue explants to in vitro compressive overload. Osteoarthritis Cartilage 20(5):422–429. doi:10.1016/j.joca.2012.01.004
Noble J, Hamblen DL (1975) The pathology of the degenerate meniscus lesion. J Bone Joint Surg 57(2):180–186
Osawa A, Harner CD, Gharaibeh B, Matsumoto T, Mifune Y, Kopf S, Ingham SJ, Schreiber V, Usas A, Huard J (2013) The use of blood vessel-derived stem cells for meniscal regeneration and repair. Med Sci Sports Exerc 45(5):813–823. doi:10.1249/MSS.0b013e31827d1e06
Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V (2013) Meniscal root tears: from basic science to ultimate surgery. Br Med Bull 106:91–115. doi:10.1093/bmb/ldt002
Pellacci F, Zmerly H, Sacco G (1997) Anatomia patologica dei menischi. J Sports Traum Relat Res 19:2–5
Pereira H, Caridade SG, Frias AM, Silva-Correia J, Pereira DR, Cengiz IF, Mano JF, Oliveira JM, Espregueira-Mendes J, Reis RL (2014) Biomechanical and cellular segmental characterization of human meniscus: building the basis for Tissue Engineering therapies. Osteoarthritis Cartilage 22(9):1271–1281. doi:10.1016/j.joca.2014.07.001
Pereira H, Frias AM, Oliveira JM, Espregueira-Mendes J, Reis RL (2011) Tissue engineering and regenerative medicine strategies in meniscus lesions. Arthroscopy J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 27(12):1706–1719. doi:10.1016/j.arthro.2011.08.283
Pereira H, Silva-Correia J, Oliveira JM, Reis RL, Espregueira-Mendes J (2013) Future trends in the treatment of meniscus lesions: from repair to regeneration. In: Verdonk R, Espregueira-Mendes J, Monllau JC (eds) Meniscal transplantation. Springer, Heidelberg/New York/Dordrecht/London, pp 103–114
Pereira H, Silva-Correia J, Oliveira JM, Reis RL, Espregueira-Mendes J (2013) The meniscus: basic science. In: Verdonk R, Espregueira-Mendes J, Monllau JC (eds) Meniscal transplantation. Springer, Heidelberg/New York/Dordrecht/London, pp 7–14
Poulsen MR, Johnson DL (2011) Meniscal injuries in the young, athletically active patient. Phys Sportsmed 39(1):123–130. doi:10.3810/psm.2011.02.1870
Proffen BL, McElfresh M, Fleming BC, Murray MM (2012) A comparative anatomical study of the human knee and six animal species. Knee 19(4):493–499. doi:10.1016/j.knee.2011.07.005
Pujol N, Bohu Y, Boisrenoult P, Macdes A, Beaufils P (2013) Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients. Knee Surg Sports Traumatol Arthrosc 21(7):1530–1533. doi:10.1007/s00167-012-2099-y
Robert M, Gouault E, Moulies D, Alain JL (1986) Meniscal lesions in the child athlete. Acta Orthop Belg 52(1):72–80
Ruiz-Iban MA, Diaz-Heredia J, Elias-Martin E, Moros-Marco S, Cebreiro Martinez Del Val I (2012) Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. Am J Sports Med 40(10):2289–2295. doi:10.1177/0363546512457552
Rytter S, Jensen LK, Bonde JP, Jurik AG, Egund N (2009) Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers. The Journal of rheumatology 36:1512–1519
Ryzewicz M, Peterson B, Siparsky PN, Bartz RL (2007) The diagnosis of meniscus tears: the role of MRI and clinical examination. Clin Orthop Relat Res 455:123–133. doi:10.1097/BLO.0b013e31802fb9f3
Salata MJ, Gibbs AE, Sekiya JK (2010) A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med 38(9):1907–1916. doi:10.1177/0363546510370196
Sharma L, Eckstein F, Song J, Guermazi A, Prasad P, Kapoor D, Cahue S, Marshall M, Hudelmaier M, Dunlop D (2008) Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Arthritis Rheum 58(6):1716–1726. doi:10.1002/art.23462
Shelbourne KD, Nitz PA (1991) The O’Donoghue triad revisited. Combined knee injuries involving anterior cruciate and medial collateral ligament tears. Am J Sports Med 19(5):474–477
Smith CD, Masouros S, Hill AM, Wallace AL, Amis AA, Bull AMJ (2008) Mechanical testing of intra-articular tissues. Relating experiments to physiological function. Curr Orthopaed 22:341–348
Snoeker BA, Bakker EW, Kegel CA, Lucas C (2013) Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther 43(6):352–367. doi:10.2519/jospt.2013.4295
Spiro AS, Regier M, Novo de Oliveira A, Vettorazzi E, Hoffmann M, Petersen JP, Henes FO, Demuth T, Rueger JM, Lehmann W (2013) The degree of articular depression as a predictor of soft-tissue injuries in tibial plateau fracture. Knee Surg Sports Traumatol Arthrosc 21(3):564–570. doi:10.1007/s00167-012-2201-5
Sugita T, Kawamata T, Ohnuma M, Yoshizumi Y, Sato K (2001) Radial displacement of the medial meniscus in varus osteoarthritis of the knee. Clin Orthop Relat Res 387:171–177
Sweigart MA, Athanasiou KA (2001) Toward tissue engineering of the knee meniscus. Tissue Eng 7(2):111–129. doi:10.1089/107632701300062697
Takeda Y, Ikata T, Yoshida S, Takai H, Kashiwaguchi S (1998) MRI high-signal intensity in the menisci of asymptomatic children. J Bone Joint Surg 80(3):463–467
van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18(5):570–580. doi:10.1007/s00167-010-1064-x
Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WMW (1999) Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg B 81(1):37–41. doi:10.1302/0301-620X.81B1.8928
Verdonk PC, Forsyth RG, Wang J, Almqvist KF, Verdonk R, Veys EM, Verbruggen G (2005) Characterisation of human knee meniscus cell phenotype. Osteoarthritis Cartilage 13(7):548–560. doi:10.1016/j.joca.2005.01.010, S1063-4584(05)00050-6 [pii]
Verdonk R (2011) The meniscus: past, present and future. Knee Surg Sports Traumatol Arthrosc 19(2):145–146. doi:10.1007/s00167-010-1333-8
Walker PS, Hajek JV (1972) The load-bearing area in the knee joint. J Biomech 5(6):581–589
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 ESSKA
About this chapter
Cite this chapter
Pereira, H. et al. (2016). Physiopathology of the Meniscal Lesions. In: Hulet, C., Pereira, H., Peretti, G., Denti, M. (eds) Surgery of the Meniscus. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49188-1_5
Download citation
DOI: https://doi.org/10.1007/978-3-662-49188-1_5
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-49186-7
Online ISBN: 978-3-662-49188-1
eBook Packages: MedicineMedicine (R0)