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Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury
Journal article   Peer reviewed

Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury

C R Clark and J A Ogden
Journal of bone and joint surgery. American volume, Vol.65(4), pp.538-547
04/1983
DOI: 10.2106/00004623-198365040-00018
PMID: 6833331

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Abstract

We studied prenatal and postnatal cadaver knees to elucidate the developmental changes that occur in the menisci prior to skeletal maturity. The medial and lateral menisci were removed from 109 fetuses ranging in age from fourteen to thirty-four weeks of gestation and from twenty-eight cadavera whose postnatal ages ranged from three months to fourteen years. Altogether 548 menisci were studied according to the same protocol, which included observation of the gross morphology, determination of the ratios of the areas of the menisci to the areas of their respective tibial plateaus and of the area of the medial to that of the lateral meniscus, and histological examination of the menisci and their ligaments. Both the medial and the lateral meniscus assumed their characteristic shapes early in prenatal development, but the prenatal menisci were very cellular and intrameniscal blood vessels were numerous. No abrupt change in development occurred after birth, but instead there were gradual changes which included decreasing vascularity that progressed from the central to the peripheral margin, growth commensurate with the enlargement of the developing femur and tibia, and changes in the configuration of the menisci to accommodate changes in the femorotibial contact areas. The lateral meniscus tended to have more developmental variation, but at no stage during development did it have a discoid shape. Throughout growth the ratios of the area of each meniscus to the area of the corresponding tibial plateau and of the area of the medial meniscus to the area of the lateral meniscus were fairly con- stant, implying relatively uniform growth of the menisci commensurate with tibial growth. The collagen-fiber arrangement within the meniscus appeared to change progressively in response to biomechanical function. CLINICAL RELEVANCE: Meniscal injuries are un- common in children. The vascularity, histological characteristics, and biochemical composition of the developing meniscus all may be responsible for this relative immunity from injury. Also, because of their vascularity and physical properties, the developing menisci may have greater reparative ability than the menisci of either adolescents or adults. These findings support the concept that every effort should be made to preserve some or all of a traumatized meniscus in children and adolescents, and to reattach peripherally detached menisci.
 Fetus - cytology Knee Joint - embryology Cartilage, Articular - cytology Knee Joint - growth & development Humans Adolescent Cartilage, Articular - growth & development Child, Preschool Adult Infant Child Cartilage, Articular - embryology

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