Review Article

Finite element analysis of the knee joint: a computational tool to analyze the combined behavior after treatment of torn ligaments and menisci in the human knee joint

¹ Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke’s Hospital, 55236 Panorama-Thessaloniki, Greece
² Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France
³ Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
⁴ Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
⁵ Department of Trauma and Orthopaedics, Royal Free Hospital NHS Trust, W1W 5AQ London, UK
⁶ European University of Cyprus, 2404 Engomi, Nicosia, Cyprus
⁷ Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, 23100 Sparta, Greece
⁸ Laboratory for Strength of Materials and Structures, Department of Civil Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
⁹ Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
¹⁰ Department of Physical Education and Sports Sciences at Serres, Aristotle University of Thessaloniki, 62122 Serres, Greece

^* Corresponding author: vasiliadis.av@gmail.com

Received: 31 July 2024
Accepted: 15 September 2024

Abstract

Finite element analysis (FEA) is a fundamental tool that can be used in the orthopaedic world to simulate and analyze the behaviour of different surgical procedures. It is important to be aware that removing more than 20% of the meniscus could increase the shear stress in the cartilage and enlarge the risk of knee joint degeneration. In this fact, the maximal shear stress value in the medial cartilage increased up to 225% from 0.15 MPa to 0.5 MPa after medial meniscectomy. Also, meniscal root repair can improve meniscal biomechanics and potentially reduce the risk of osteoarthritis, even in cases of a loose repair. FEA has been used to better understand the biomechanical role of cruciate ligaments in the knee joint. ACLr with bone-patellar tendon-bone graft at 60 N of pretension and double-bundle PCLr were closer to that of a native knee in terms of biomechanics. The addition of a lateral extra-articular augmentation technique can reduce 50% of tibial translation and internal rotation, protecting the graft and minimizing the risk of re-rupture. Interestingly, anatomic and non-anatomic medial patellofemoral ligament reconstruction increased the pressure applied to the patellofemoral joint by increasing patellar contact pressure to 0.14 MPa at 30° of knee flexion using the semitendinosus as a graft. After all the advances in medical imaging technologies, future studies should take into consideration patient-specific data on both anatomy and mechanics, in order to better personalize the experimental model.