Increased Posterior Tibial Slope Increases Force on the Posterior Medial Meniscus Root.

Background: Posterior medial meniscus root (PMMR) tears have been associated with increased posterior tibial slope, but this has not been fully evaluated biomechanically. In addition, the effects of knee flexion and rotation on the PMMR are not well understood biomechanically because of technological testing limitations. A novel multiaxial force sensor has made it possible to elucidate answers to these questions.
Purpose: (1) To determine if increased posterior tibial slope results in increased posterior shear force and compression on the PMMR, (2) to evaluate how knee flexion angle affects PMMR forces, and (3) to assess how internal and external rotation affects force at the PMMR.
Study Design: Controlled laboratory study.
Methods: Ten fresh-frozen cadaveric knees were tested in all combinations of 3 posterior tibial slopes and 4 flexion angles. A multiaxial force sensor was connected to the PMMR and installed below the posterior tibial plateau maintaining anatomic position. The specimen underwent a 500-N compression load followed by a 5-N·m internal torque and a 5-N·m external torque. The magnitude and direction of the forces acting on the PMMR were measured.
Results: Under joint compression, an increased tibial slope significantly reduced the tension on the PMMR between 5° and 10° (from 13.5 N to 6.4 N), after which it transitioned to a significant increase in PMMR compression, reaching 7.6 N at 15°. Under internal torque, increased tibial slope resulted in 4.7 N of posterior shear at 5° significantly changed to 2.0 N of anterior shear at 10° and then 8.2 N of anterior shear at 15°. Under external torque, increased tibial slope significantly decreased PMMR compression (5°: 8.9 N; 10°: 4.3 N; 15°: 1.1 N). Under joint compression, increased flexion angle significantly increased medial shear forces of the PMMR (0°, 3.8 N; 30°, 6.2 N; 60°, 7.3 N; 90°, 8.4 N). Under internal torque, 90° of flexion significantly increased PMMR tension from 2.3 N to 7.5 N. Under external torque, 30° of flexion significantly increased PMMR compression from 4.7 N to 12.2 N.
Conclusion: An increased posterior tibial slope affects compression and anterior shear forces at the PMMR. An increased flexion angle affects compression, tension, and medial shear forces at the PMMR.
Clinical Relevance: The increase in compression and posterior shear force when the knee is loaded in compression may place the PMMR under increased stress and risk potential failure after repair. This study provides clinicians with information to create safer protocols and improve repair techniques to minimize the forces experienced at the PMMR.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: H.M. has received support for education from Smith & Nephew. M.T.P. has received royalties and consultant payments from Arthrex, Slack, and Joint Restoration Foundation; honoraria from Arthrosurface and Flexion Therapeutics; consulting fees from Zimmer Biomet Holdings; and royalties from Anika Therapeutics. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.