The Morphological Anatomy of the Menisci of the Knee Joint in Human Fetuses

Abstract

Background: Development of the foetal period of the meniscus has been reported in different studies. Aims: Evaluation of lateral and medial meniscus development, typing and the relationship of the tibia during the foetal period. Study Design: Anatomical dissection. Methods: We evaluated 210 knee menisci obtained from 105 human foetuses ranging in age from 9 to 40 weeks’ gestation. Foetuses were divided into four groups, and the intra-articular structure was exposed. We subsequently acquired images (Samsung WB 100 26X Optical Zoom Wide, Beijing, China) of the intra-articular structures with the aid of a millimetric ruler. The images were digitized for morphometric analyses and analysed by using Netcad 5.1 Software (Ak Mühendislik, Ankara, Turkey). Results: The lateral and medial meniscal areas as well as the lateral and the medial articular surface areas of the tibia increased throughout gestation. We found that the medial articular surface areas were larger than the lateral articular surface areas, and the difference was statistically significant. The ratios of the mean lateral and medial meniscal areas to the lateral and medial articular surface areas, respectively, of the tibia decreased gradually from the first trimester to full term. The most common shape of the medial meniscus was crescentic (50%), and that of the lateral meniscus was C-shaped (61%). Conclusion: This study reveals the development of morphological changes and morphometric measurements of the menisci.

Keywords

• Foetus, meniscus, fetal development

References

1. 1. Amis A, Bull A, Gupte C M, Lee J. Pelvic girdle and lower limb; In: Standring S, editor. Gray’s Anatomy-The anatomical basis of clinical practice 40th ed. China: Churchill Livingstone, Elsevier; 2008:1393-411.
2. 2. Moore KL, Dalley AF. Clinically oriented anatomy. 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 1999:690-9.
3. 3. Murlimanju BV, Nair N, Pai MM, Krishnamurthy A, Chandra Philip X. Morphology of the medial meniscus of the knee in human fetuses. Rom J Morphol Embryo 2010;51:347-51.
4. 4. Fukazawa I, Hatta T, Uchio Y, Otani H. Development of the meniscus of the knee joint in human fetuses. Congenit Anom (Kyoto) 2009;49:27-32.
5. 5. Levy IM, Torzilli PA, Gould JD, Warren RF. The effect of lateral meniscus on motion of the knee. J Bone Joint Surg Am 1989;71:401-6.
6. 6. Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid and cysts. Orthop Clin North Am 2003;34:329-40.
7. 7. Kelly BT, Green DW. Discoid lateral mensicus in children. Curr Opin Pediatr 2002;4:54-61.
8. 8. Kale A, Kopuz C, Edizer M, Aydin ME, Demir M, İnce Y. Anatomic variations of the shape of the menisci: a neonatal cadaver study. Knee Surg Sports Traumatol Arthrosc 2006;14:975-81.

9. 9. Murlimanju BV, Nair N, Ray B, Pai MM, Amin S, Pai SR. Morphological variants of lateral meniscus of the knee: a cadaveric study in South Indian human fetuses. Anat Sci Int 2011;86:63-8.
10. 10. Clark CR, Ogden JA. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am 1983;65:538-47.
11. 11. Koyuncu E, Sulak O, Özgüner G, Cankara N, Albay S, Malas MA. The distal femur morphometry during the fetal period. S.D.Ü. Tıp Fak Derg 2011;18:48-53.
12. 12. Moore KL, Persaud TVN. The developing human, clinically oriented embryology. 7th ed. W.B. Saunders Company: Philadelphia; 1998:215- 7.
13. 13. Tena-Arregui J, Barrio-Asensio C, Viejo-Tirado F, Puerta-Fonollá J, Murillo-González J. Arthroscopic study of the knee joint in fetuses. Arthroscopy 2003;19:862-8.
14. 14. Andrish JT. Meniscal injuries in children and adolescents: diagnosis and management. J Am Acad Orthop Surg 1996;4:231-7.
15. 15. Bloecker K, Wirth W, Hudelmaier M, Burgkart R, Frobell R, Eckstein F. Morphometric differences between the medial and lateral meniscus in healthy men - a three-dimensional analysis using magnetic resonance imaging. Cells Tissues Organs 2012;195:353-64.
16. 16. Le Minor JM. Comparative morphology of the lateral meniscus of the knee in primates. J Anat 1990; 170:161-71.
17. 17. Smillie IS. The congenital discoid meniscus. J Bone Joint Surg 1948;30:671-82.
18. 18. Murlimanju BV, Nair N, Pai S, Pai M, Chethan P, Gupta C. Morphological study of the menisci of the knee joint in adult cadavers of the south indian population. Marmara Medical Journal 2010;23:270-5.
19. 19. Jordan MR. Lateral meniscal variants: evaluation and treatment. J Am Acad Orthop Surg 1996;4:191-200.
20. 20. Chiang H, Jiang CC. Discoid lateral meniscus: clinical manifestations and arthroscopic treatment. J Formos Med Assoc 2003;102:17-22.
21. 21. Saygi B, Yildirim Y, Senturk S, Ramadan SS, Gundes H. Accessory lateral discoid meniscus. Knee Surg Sports Traumatol Arthrosc 2006;14:1278-80.
22. 22. Davidson D, Letts M. Glasgow R. Discoid meniscus in children: Treatment and outcome. Can J Surg 2003;46:350-8.
23. 23. Fleissner PR, Ellert RE. Discoid lateral meniscus. Am J Knee Surg 1999;12:125-31.
24. 24. Aichroth PM, Patel DV, Marx CL. Congenital discoid lateral meniscus in children. A follow-up study and evolution of management. J Bone Joint Surg 1991;73:932-6.