Nonanatomic Placement of Posteromedial Meniscal Root Repairs: A Finite Element Study

Abstract Nonanatomic placement of posteromedial meniscal root repairs alters knee mechanics; however, little is known about how the position and magnitude of misplacement affect knee mechanics. Finite element knee models were developed to assess changes in cartilage and meniscus mechanics for anatomic and various nonanatomic repairs with respect to intact. In total, 25 different repair locations were assessed at loads of 500 N and 1000 N. The two-simple-suture method was represented within the models to simulate posteromedial meniscal root repairs. Anatomic repairs nearly restored total contact area; however, meniscal hoop stress decreased, meniscal extrusion increased, and cartilage–cartilage contact area increased. Repairs positioned further posterior altered knee mechanics the most and repairs positioned further anterior restored knee mechanics for posteromedial root repairs. Despite this, repair tension increased with further anterior placement. Anterior placement of repairs results in more restorative contact mechanics than posterior placement; however, anterior placement also increased the risk of suture cut-out or failure following repairs. Anatomic placement of repairs remains the best option because of the risks involved with anterior placement; however, suture methods need to be improved to better restore the strength of repairs to that of the native insertion. Proper placement of repairs is important to consider with meniscal root repairs because misplacement may negatively affect cartilage and meniscus mechanics in patients.