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Dynamic biomechanical effects of medial meniscus tears on the knee joint: a finite element analysis

Journal of Orthopaedic Surgery and Research volume 20, Article number: 26 (2025) Cite this article

Abstract

Background

Meniscus tears can change the biomechanical environment of the knee joint and might accelerate the development of osteoarthritis. The aim of this study was to investigate the dynamic biomechanical effects of different medial meniscus tear positions and tear gaps on the knee during walking.

Methods

Seven finite element models of the knee joint were constructed, including the intact medial meniscus (IMM), radial stable tears in the anterior, middle, and posterior one-third regions of the medial meniscus (RSTA, RSTM, RSTP), and the corresponding unstable tears (RUTA, RUTM, RUTP). The seven models applied a 1000 N axial static load and a human walking load, as defined by the ISO14243-1 standard.

Results

Compared with the results under static loading, the axial load ratio of the medial and lateral compartments was redistributed (ranging from 0.7:1 to 2.9:1). The stress concentration was in the middle and posterior portions of the lateral compartment, not in the anterior and middle portions of the medial compartment under dynamic analysis. Compared with that of the IMM, the maximum von Mises stress on the medial meniscus increased by approximately 24.68–57.14% in the RUTA, RUTM, and RSTM models, with a greater difference observed in the hoop stress on both sides of the radial tear. The peak radial tear gap appeared at GC6 and GC44, and the tear gap remained at a high level from GC30-GC60.

Conclusions

Radial tears should be considered for repair, and reinforced sutures should be placed on the anterior or middle regions of the meniscus. Greater attention should be given to the dynamic biomechanical effects on the knee joint during preoperative diagnosis and postoperative rehabilitation.

Introduction

A meniscus tear is a common type of injury to the knee joint. The transmission of axial load on the meniscus mainly depends on the integrity of the tissue [1,2,3,4]. When the meniscus is completely torn, its ability to convert axial load into circumferential stress weakens, leading to joint pain, instability, and other problems; this may further induce or accelerate the occurrence of osteoarthritis [1, 5, 6].

With an in-depth understanding of meniscus function and the progression of osteoarthritis after meniscectomy, it has been found that meniscectomy can increase the mean and maximum contact pressures, and decrease the contact area of the knee joint [7, 8]. The preferred treatment method for radial meniscus tears is meniscal repair [9,10,11,12,13], which relies on the meniscus’s ability to heal, or conservative nonsurgical treatment approaches, rather than meniscectomy [14]. Nowadays, it has been found that in addition to local vascularity, biomechanics would play an important role in postoperative meniscus repair healing [9, 15, 16].

The finite element method can be used to obtain the details of the biomechanical changes in the knee joint. Static analysis suggests that the stress generated near the torn tissue may compress or pull apart the surface of the meniscus [17]. Different types of medial meniscus tears have adverse effects on the residual meniscus, whereas the impact on the lateral compartment is not significant [18]. However, applying an axial load under static analysis cannot simulate actual human motion, such as walking, nor reflect the dynamic changes in the biomechanical environment. More recently, researchers have focused on dynamic analysis, which is important for the subsequent treatment and repair of meniscus tears, as well as the prediction of cartilage degeneration [19,20,21,22]. A cadaveric experiment revealed that radial tears had adverse dynamic mechanical effects similar to those after meniscectomy [23]. Wang et al. applied a gait cycle load to a finite element model and reported that radial tears at different positions and gaps had little effect on the tibial cartilage [9]. However, Sukopp et al. reported an increase in the stress on the tibial cartilage [24]. Yang et al. found more load was transmitted to the tibial cartilage when tears occurred [25]. The dynamic biomechanical effects of medial meniscus tears on the knee joint are still unclear.

The purpose of this study was to: (1) assess the differences in biomechanical changes in knee joints under static loads (twice the body weight) and human walking loads and (2) investigate the effects of different medial meniscus tear gaps (stable or unstable) and tear positions (anterior, middle, and posterior) on the biomechanical environment of the knee joint. A hypothesis was proposed that, unlike static analysis, dynamic analysis would show an increase in stress on the meniscus and articular cartilage after a meniscus tear. Compared with intact meniscus tears, unstable tears have a greater adverse impact on the knee joint, with the tear gap varying more greatly during the gait cycle.

Materials and methods

This study was approved by the board of the research ethics committee of Peking University Third Hospital (IRB00006761-M2019299). The right knee joint of a healthy adult male (39 years old, 48.5 kg) was selected for magnetic resonance imaging (MRI) and used to reconstruct a finite element model. A total of 480 MR images of the knee joint were obtained from Peking University Third Hospital, and the layer thickness was 0.5 mm. The collected data were imported into Mimics20.0 software (Materialise, Leuven, Belgium) for three-dimensional reconstruction of the knee joint, including the femur, tibia, articular cartilage, meniscus, and ligaments (anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament).

The material properties, meshing, and boundary conditions of the knee joint were set in ABAQUS 2021 (SIMULIA, Rhode Island, USA) to establish a complete finite element model. The material parameters and mesh element types of the main parts of the knee joint are listed in Table 1. The bone [26, 27] and meniscus [25, 26] were set as isotropic linear elastic materials. The cartilage was set as a transversely isotropic material [28,29,30]. The main ligaments of the knee joint were set as hyperelastic isotropic materials via the neo-Hookean model, and the element type was T3D2. The material parameters of the ligaments were derived from experimental data [31] and are listed in Table 2. Each part of the model has been performed the mesh convergency.

Table 1 Material parameters and mesh types of the main parts of the knee joint
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Table 2 Material parameters of the main ligaments of the knee joint
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The boundary conditions were defined as follows: In static analysis, the tibia was fully fixed, and the axial and varus/valgus degrees of freedom of the femur were released. In dynamic analysis, the anterior/posterior movement and internal/external rotation degrees of freedom of the tibia were additionally released, as well as the flexion angle degrees of freedom of the femur [25]. The loading point of the knee joint was set at the centre of rotation of the femur, which was 5 mm offset inward from the midpoint of the farthest point of the condyles on both sides of the femur [18, 25, 32]. The contact between the cartilage, meniscus and bone was set as frictionless in the tangential direction and “hard” contact in the normal direction. The standard solver was used in static analysis to apply a downwards axial load of 1000 N [27], and the knee flexion angle was 0 rad; the explicit solver was used in dynamic analysis, referring to the ISO loading standards for artificial knee joints, to apply axial force, flexion angle, internal/external rotation, and anterior/posterior force to simulate horizontal walking. Currently, there is no unified standard for dynamic loading of natural knee joints, and different studies have used varying gait data collection methods. Therefore, many studies have used the ISO 14243-1 standard to simulate daily horizontal walking [23, 33, 34], and its use in this study was acceptable.

In ABAQUS, the intact meniscus was cut under the guidance of a professional orthopaedic doctor. The radial stable tears were 1/6 of the meniscus width, and the unstable tears were 1/2 of the meniscus width [17]. A total of 7 models were constructed (Fig. 1): the intact medial meniscus (IMM); radial stable tears in the anterior, middle, and posterior 1/3 regions of the medial meniscus (RSTA, RSTM, and RSTP); and radial unstable tears in the three regions (RUTA, RUTM, and RUTP). Since there was only one sample for each model, no statistical analysis was performed. The axial load, von Mises stress, contact pressure, hoop stress and tear gap among the models under static and dynamic analysis were collected and compared.

Fig. 1
figure 1

A Front view of the constructed knee joint. B Intact medial meniscus (IMM). C Radial tears of the medial meniscus including: stable radial tears in the anterior region (RSTA), in the middle region (RSTM), and in the posterior region (RSTP); unstable radial tears in the anterior region (RUTA), in the middle region (RUTM), and in the posterior region (RUTP)

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Results

Axial load

Under static analysis, the load ratios of the medial compartment (MC) and lateral compartment (LC) of the seven models were almost the same, approximately 2.1:1 (Fig. 2A). In the medial compartment, compared with the IMM, the axial load in the other models was transferred more to the medial meniscus (MM) (approximately 40 N) than to the medial tibial cartilage (MTC). Unlike the static analysis results, the axial load was redistributed under dynamic analysis, and there were differences among the 7 models at the same point of the gait cycle. The load ratio of the MC to LC was 0.7:1 in the IMM at 2% of the gait cycle (GC2) and 2.9:1 in the RSTA at GC22. In the RUTA, RSTA, and RUTM at GC30, the axial loads on the medial meniscus were transferred more to the lateral meniscus (LM) than to the IMM (Fig. 2B).

Fig. 2
figure 2

Axial load distribution of the knee joint. A Static analysis. B 30% of the gait cycle in the dynamic analysis (GC30). Abbreviations: MM: medial meniscus. LM: lateral meniscus. MFC: medial femoral cartilage. MTC: medial tibial cartilage. LFC: lateral femoral cartilage. LTC: lateral tibial cartilage. MC: medial compartment. LC: lateral compartment

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Von Mises stress

According to both the static and dynamic analyses, the maximum von Mises stress of the unstable tear models on the MM was greater than that of the stable tear models (Table 3). At GC30, compared with that in the IMM (7.7 MPa), the maximum von Mises stress on the MM in the RUTA was 12.1 MPa, an increase of 57.1%, whereas that in the RSTA was 8.2 MPa, an increase of only 6.5%. Unlike the static analysis results, where the tear had a small impact on the lateral tibial cartilage (LTC) (< 10%), dynamic analysis showed that the maximum von Mises stress on the tibial cartilage transferred more from the medial to the lateral than the IMM did. In the RUTP, the maximum von Mises stress on the MTC was 6.8 MPa, with a decrease of 53.4%, whereas on the LTC, it was 9.7 MPa, with an increase of 64.4% compared to the IMM.

Table 3 The maximum Von Mises stress and maximum contact pressure at each part of the knee joint during static state and GC30
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Under static analysis, the von Mises stress is mainly concentrated in the anterior and middle portions of the MM and the MTC (Fig. 3). Under dynamic analysis, at GC44 (the second peak axial load in ISO14243-1), more von Mises stress was distributed towards the middle and posterior portions of the LM, MTC, and LTC. The variation in the maximum von Mises stress for the radial tears in the anterior and middle regions of the MM differed from that in the IMM (Fig. 4). However, the variation trend of radial tears in the posterior region and all stable tears was almost consistent with that observed in the IMM.

Fig. 3
figure 3

The von Mises stress distribution on the meniscus and tibial cartilage of the knee joint under static state and GC44. A Intact medial meniscus (IMM) under static state; B Radial tears of the medial meniscus including: stable radial tears in the anterior region (RSTA), in the middle region (RSTM), and in the posterior region (RSTP); unstable radial tears in the anterior region (RUTA), in the middle region (RUTM), and in the posterior region (RUTP) under static state; C IMM under GC44; D RSTA, RSTM, RSTP, RUTA, RUTM and RUTP under GC44

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Fig. 4
figure 4

The variation trend of the maximum von Mises stress on the MM of each stable and unstable tears and intact meniscus during static state and the gait cycle. The trend of radial tears in A the anterior region, B the middle region, and C the posterior region, compared with IMM. The solid line represents the maximum von Mises stress under dynamic analysis, and the dotted line represents static analysis

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Contact pressure

There was little change in the maximum contact pressure in each part of the knee joint under static analysis (Table 3). Unlike the maximum von Mises stress, the maximum contact pressure of stable tears on the MM was greater than that of unstable tears. The maximum contact pressures in the RSTA (11.4 MPa) and RSTP (11.2 MPa) increased by 25.3% and 23.1%, respectively, compared with those in the IMM (9.1 MPa). Like the von Mises distribution, the contact pressure was mainly concentrated in the middle portion of the MTC and the LTC and gradually changed to the posterior and lateral portions during the gait cycle.

Hoop stress

The hoop stress at GC44 on the medial meniscus is shown in Fig. 5. The occurrence of radial tears blocked the transfer of the local hoop stress on the meniscus, with stress concentrated at the apex of the radial unstable tears. Notably, the hoop stress was concentrated at the root of the posterior 1/3 portion of the MM. Compared with the IMM, the location where radial tears in the posterior region occurred did not completely destroy the transmission of hoop stress here to a certain extent.

Fig. 5
figure 5

Tensor plots of maximum principal stress on medial meniscus (MM) at GC44. A the stress in the posterior region of intact meniscus (IMM), stable tears (RSTP), and unstable tears (RUTP); B the stress in the middle region of intact meniscus (IMM), stable tears (RSTM), and unstable tears (RUTM); and C the stress in the anterior region of intact meniscus (IMM), stable tears (RSTA), and unstable tears (RUTA). The arrow direction indicated the hoop stress direction. The blue color represented the tensile stress, and the red color represented the compressive stress

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Tear gap

The changes in the gap of meniscal tears under dynamic analysis were measured and compared with those under static analysis (Fig. 6). The tear gap of all the models peaked at GC6. Compared with the tear gap in the static analysis, only the gap of the radial tears in the anterior region were smaller, whereas those in the other models were larger. At GC44, the second peak appeared, and the gap of all the radial tears were larger. During GC30-GC60, the tear gap remained at a high level. Compared with static analysis, the tear gap of radial stable tears changed little during the gait cycle.

Fig. 6
figure 6

A The comparison of the tear gap of each model under static and dynamic analysis. The solid line represented dynamic analysis and the dotted line represented static analysis. B The measure method of tear gap in radial tears

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Discussion

The important finding of this study was that different meniscal tears had comparatively obvious differences in the mechanical effects on the knee joint during walking, which was different from the static load. The stress on the tibial cartilage increases, which may exacerbate the development of osteoarthritis. Compared with IMM, radial tears in the anterior region had the greatest adverse impact, whereas radial tears in the posterior region and stable tears did not significantly change the biomechanical environment of the knee joint. Considering the change in the radial meniscus tear gap during a gait cycle, radial tears should be considered for surgical treatment.

The present models were validated by comparing with the finite element and cadaveric experimental results of previous intact meniscus models, whether under static or dynamic analysis (Table 4). Moreover, in the study of Mononen et al., stress was distributed mainly in the middle of the tibial cartilage and the inner edge of the meniscus, and stress concentration also occurred at the apex of the tears [35]. Medial meniscus tears increase the load on the articular cartilage and redistribute stress within the knee joint [3, 36], which was also confirmed by the results of this study.

Table 4 Comparison of maximum contact pressure in the medial compartment of intact meniscus models between previous literature and the present study
Full size table

In the present study, under static analysis, the load ratios of MC and LC in all the models were almost the same, approximately 2.1:1, which is consistent with a previous study [2]. Under dynamic analysis, the loads in the MC and LC were redistributed. At GC30, the load ratio of MC and LC in RUTA was approximately 1.6:1, and that in RSTM was approximately 2.1:1. More axial load was transferred to the lateral compartment, indicating that the occurrence of unilateral meniscal tears may have adverse effects on the opposite compartment during horizontal walking. The stress distribution of the knee joint is mainly concentrated on the inner edge of the MM and the anterior and middle portions of the MTC under static analysis [18]. Under dynamic analysis, the stress concentration gradually changed towards the middle and posterior regions of the MM, LM, MTC, and LTC [5]. The von Mises stress on the MM was greater than that under static analysis because the axial load variation in the gait cycle was greater than the static load [35]. Wang et al. reported that radial tears of the MM had a smaller impact of stress on the tibial cartilage (< 9%) [9]. However, in this study, there was a difference in the maximum contact pressure on both sides of the tibial cartilage. At GC30, compared with the IMM, the maximum contact pressure on the MTC in the RSTA increased by 32.7%, and that on the LTC in the RSTM increased by 45.9%. Sukopp et al. also reported an increase in the stress on the tibial cartilage [24] and widening of the radial tear in the MM after inside-out repair under a cyclic axial load [37]. Reinforced suture repair for radial meniscus tears results in a lower rate of tissue failure or meniscus cut-out, which may be due to the spread of stress over a larger surface area [38]. This evidence suggests that reinforced sutures are needed for radial tear repairs to restore the function of the meniscus in load transmission in the knee joint.

Radial tears limit the ability of the meniscus to transmit hoop stress, leading to an increase in stress at the apex of the meniscus tear. The mechanical results of stable tears were not much different from those of the IMM, possibly because the RSTA, RSTM, and RSTP involve only areas without a blood supply and do not significantly damage the shape of the meniscus. In clinical practice, meniscus repair is generally not used for the RSTA, RSTM, or RSTP [2, 15, 16]. However, attention should be given to the possibility of stable tears developing into unstable tears, especially in the middle and posterior regions of the meniscus. Unstable tears severely damage the circumferential fibres of the meniscus. At GC30, compared with that at the IMM, the maximum von Mises stress on the MM of radial unstable tears in the anterior region increased by 57.1%, whereas that of stable tears increased by only 6.5%. Similar to the findings of Hirose et al., larger radial tears in the meniscus width had a greater influence on the load transmission function of the meniscus [39]; this may suggest that patients with unstable radial tears of the meniscus should be managed with expedited surgical intervention. The variation in the maximum von Mises stress in the RSTA and RSTM differed from that in the IMM, which may be due to the wider posterior body of the MM [1, 4], with a greater distribution of hoop stress in the root. Both sides of the tear surface in the RSTP and RUTP tended to be squeezed together by compression stress (Fig. 5), suggesting that tears in the posterior region may be more prone to healing [2, 12, 15, 16, 40].

Owing to the femur only being vertically pressed down on the meniscus under the static state, the tear gap was slightly wider compared with that of the original model. However, during the gait cycle, the radial tear gap fluctuated around that of the static state. At GC6, the maximal peak tear gap appeared in all the models. Only the gap of the radial tears in the anterior region were smaller, whereas those in the other models were larger; this may be related to the anterior/posterior force (AP) and the internal/external rotation (IE) applied during the gait cycle. At GC6, the negative peak value of the AP force occurred, and the femur rotated inwards and backwards. Owing to the limitations of the meniscus attachment ligaments and other ligaments, the medial and posterior portions tend to be opened. At GC44, the second peak tear gap appeared. Compared with those in the static analysis, all the radial tear gaps were larger; this was also the second negative peak value of the AP force, during which the femur rotated outwards and backwards, driving the anterior region of the MM forwards and causing the tear to open. In Sukopp’s study, the inside-out suture repair of radial tears still tended to gap under a cyclic axial load [37]. In the present study, during the period of GC30-GC60, the radial tear remained at a relatively high level for a long period of time, which may have had a long-term adverse effect on the development of the tear gap.

It has been reported that meniscectomy can effectively alleviate pain in patients in the short term; however, it may accelerate the progression to osteoarthritis [10, 25, 41, 42]. In this dynamic study, long-term radial unstable tears potentially interfered with the hoop stress, and stress concentration may further lead to the progression of the tear gap [9, 35]. More evidence has shown better meniscal healing and less MM extrusion progression following meniscal repair of stable tears [43]. Reinforced sutures should be employed in the anterior and middle regions of the radial tears to secure the repair [10,11,12, 37, 40].

This study had several limitations. First, this study used the knee joint of one subject in a standing position to establish the model, which introduced certain individual differences and did not account for changes in knee flexion and extension during construction of the model [44, 45]. However, there is little differences between the results of different models. Second, only the cruciate and collateral ligaments were modelled, so there may be some influence on the results of the simulation during dynamic analysis. Third, the meniscus was set as an isotropic material and the properties came from young samples. However, material properties of the meniscus were varied with age, so we need to consider material properties that are more appropriate for the meniscus and aligned with the age of our model [46]. Cartilage is a transversely isotropic material that has been used in many studies [28,29,30]. The next step would be to better observe the mechanical changes in cartilage via dynamic analysis of biphasic fibre-reinforced materials [47, 48]. Fourth, the ISO standard applied by dynamic analysis was based mainly on knee arthroplasty models, and there were some differences in the calculation of the real gait cycle and the complexity of the relative motion of the tibia and femur. In addition, the research results were analysed only from a simulation perspective, and a clinical study may be necessary to verify these results in the future.

Conclusion

Under dynamic analysis, the load ratio of the MC and the LC was redistributed, and the stress on the tibial cartilage increased. Stable tears, including those in the RSTA, RSTM, and RSTP, presented few biomechanical changes compared with those in the IMM. Unstable radial tears damage the circumferential fibres of the meniscus; therefore, repair should be considered. In addition, reinforced sutures are needed for repairs in the anterior and middle regions of the meniscus. Attention should be given to the long-term effects of horizontal walking during preoperative diagnosis and postoperative rehabilitation.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We thank Anqi Xue and Xiaoyu Zhu for their discussions and assistance regarding the results of this study.

Funding

This work was supported by the National Natural Science Foundation of China (11072021, 82072428), the National Key Research and Development Program (2016YFC1103202, 2019YFB1706900).

Author information

Authors and Affiliations

  1. Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China

    Zuming Mao, Qiang Yang & Feng Zhao

  2. Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China

    Xiangyu Meng & Dong Jiang

Authors
  1. Zuming Mao
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  2. Qiang Yang
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  3. Xiangyu Meng
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  4. Dong Jiang
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  5. Feng Zhao
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Contributions

ZM and FZ conceived and designed the study; ZM, QY, and DJ constructed models; ZM and QY performed the experiments; ZM and XM analyzed the data; ZM, QY and XM interpreted the results; ZM and QY plotted figures; ZM drafted the manuscript; ZM, QY, XM, DJ and FZ edited and revised the manuscript; All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding authors

Correspondence to Dong Jiang or Feng Zhao.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the board of the research ethics committee in Peking University Third Hospital (IRB00006761-M2019299). The volunteer involved in the study consent to participate in the study.

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All individual data consent to publish.

Competing interests

The authors declare no competing interests.

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Mao, Z., Yang, Q., Meng, X. et al. Dynamic biomechanical effects of medial meniscus tears on the knee joint: a finite element analysis. J Orthop Surg Res 20, 26 (2025). https://doi.org/10.1186/s13018-024-05401-8

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Keywords

Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X