Meniscal Anatomy &

Biomechanics

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Introduction
• Originally considered as vestigial structures (Sutton – 1897)
• Semilunar fibrocartilaginous discs
• Primary function – load transmission
• Critical for knee biomechanics
• Removal is deleterious to the joint
• Pivotal in maintaining knee homeostasis, joint function, stability &
longevity (Fairbank - 1948, Roos et, al. - 1998)
• Alternative novel regenerative treatments are being attempted
Anatomy - Gross
• Crescentic fibrocartilages located in the medial/ lateral knee
compartments
• Enable effective articulation
• Triangular in cross section
• Cover one half to two thirds of tibial plateau
Anatomy - Gross
Anatomy – Medial meniscus
• Asymmetric C-shaped
• Wider posterior horn
• Periphery attached to joint capsule
& deep MCL
• AH attachment – Largest with
variable sites
• Majority attach anterior to ACL
• PH – directly anterior to PCL
Anatomy – Lateral meniscus

• Semicircular
• AH inserts adjacent to ACL
• PH attaches anterior to PCL and PH
of MM
• Two ligaments – Ligament of
Humphry & Ligament of Wrisburg
• Not continuously attached to joint
capsule
Biochemistry
• Wet weight
- Water 72%
- ECM 28%
• ECM
- Collagen 75%
- GAG 17%
- DNA 02%
- Adhesion Glycoproteins 01%
- Elastin 01%
Biochemistry
• Collagen
- Red - red Zone
Type I 80% of dry weight
Types II, III, IV, VI < 1%
- White - white zone
Type I 42% of dry weight
Type II 20%
Biochemistry
• ECM
- Proteoglycans are major component
- Chondroitin-6-sulphate – 60%
- Dermatan sulphate – 30%
- Chondritin-4-sulphate – 20%
- Enable meniscus to absorb water
- Regional variations +
- inner 2/3 contain more proteoglycans
Cells, Vessels & Nerves
• Cells
- Chondrocyte like, fibroblast like & intermediate cells
- Outer zone cells – behave & appear like fibroblasts
- Inner zone – chondrocyte like cells
• Blood supply
- Red-red zone is vascularized by branches of genicular Aa.
• Nerve supply
- peripheral zone and anterior & posterior horns – Innervated
- Inner core has no nerve fibres
Meniscal Biomechanics
• Complex functions are related to structure, composition &
morphology
• Functions
- Load transmission, shock absorption, stability, joint
lubrication & proprioception
- Also serves to -
contact stresses,
contact area
congruency
 Meniscal Biomechanics – Load transmission
• Viscoelastic properties
• Femur exerts vertical & horizontal
forces
• Tibia exerts vertical upwards force
• Above forces create forces acting
to extrude the menisci
• As menisci are strongly attached by
ant. & post. horns above axial
(compression) forces become hoop
stresses (tensile)
Meniscal Biomechanics – Load transmission
• Load transmission to menisci in extended knee – L 70%, M 50%
• In flexion ~ 90%
• Load is well distributed when meniscus is intact
• Removal results in increased contact pressure
• Lateral meniscectomy – 40 – 50% decreased contact area & 200 –
300% increased contact stresses
• Contribute to accelerated cartilage degeneration
Meniscal Biomechanics – shock absorption
• Shock absorption is 20% less in knees without menisci
• This function is associated with viscoelastic properties
Meniscal Biomechanics - stability
• Femoral & tibial articular surfaces are incongruent
• Shape of the meniscus compensates this
• Medial meniscus is firmly attached to the joint capsule
• Contributes to anterior stability of the knee
Meniscal Biomechanics – lubrication &
proprioception
• Menisci play a role in nutrition & lubrication
• Exact mechanism not known
• ? Compressed menisci release and circulate joint fluid

• Plays a proprioceptive role

• Presence of mechanoceptors in the anterior & posterior horns is
associated with feedback mechanism of the joint