The relationship between lateral meniscus shape and joint contact parameters in the knee: a study using data from the Osteoarthritis Initiative

Introduction

The meniscus has an important role in force transmission across the knee, but a detailed three-dimensional (3D) morphometric shape analysis of the lateral meniscus to elucidate subject-specific function has not been conducted. The aim of this study was to perform 3D morphometric analyses of the lateral meniscus in order to correlate shape variables with anthropometric parameters, thereby gaining a better understanding of the relationship between lateral meniscus shape and its load-bearing function.

Methods

The lateral meniscus (LM) was manually segmented from magnetic resonance images randomly selected from the Osteoarthritis Initiative (OAI) non-exposed control subcohort. A 3D statistical shape model (SSM) was constructed to extract the principal morphological variations (PMV) of the lateral meniscus for 50 subjects (25 male and 25 female). Correlations between the principal morphological variations and anthropometric parameters were tested. Anthropometric parameters that were selected included height, weight, body mass index (BMI), femoral condyle width and axial rotation.

Results

The first principal morphological variation (PMV) was found to correlate with height (r = 0.569), weight (r = 0.647), BMI (r = 0.376), and femoral condyle width (r = 0.622). The third PMV was found to correlate with height (r = 0.406), weight (r = 0.312), and femoral condyle width (r = 0.331). The percentage of the tibial plateau covered by the lateral meniscus decreases as anthropometric parameters relating to size of the subject increase. Furthermore, when the size of the subject increases, the posterior and anterior horns become proportionally longer and wider.

Conclusion

The correlations discovered suggest that variations in meniscal shape can be at least partially explained by the levels of loads transmitted across the knee on a regular basis. Additionally, as the size of the subject increases and body weight rises, the coverage percentage of the meniscus is reduced, suggesting that there would be an increase in the load-bearing by the cartilage. However, this reduced coverage percentage is compensated by the proportionally wider and longer meniscal horn.     

关节镜下不同术式治疗盘状半月板的临床疗效研究

目的:比较分析关节镜下不同术式治疗盘状半月板的临床效果。方法:选取盘状半月板患者85例,其中完全型盘状半月板47例,行完全切除术(A组)23例,行部分切除成形术(B组)24例;不完全性盘状半月板38例,行完全切除术(C组)20例,行部分切除成形术(D组)18例。术后随访观察,膝关节功能评价分别采用国际膝关节文献委员会膝关节评估表(the international knee documentation committee knee evaluation form,IKDC)和Lysholm评分进行。结果:78例患者均得到有效随访。随访时间12-18个月,平均(16.2±3.4)月。术前各组各评分均无显著差异(P0.05)。完全型盘状半月板中,A组术后IKDC和Lysholm评分分别为(92.9±9.7)分、(93.4±8.6)分,优良率为91.3%(21/23),均显著优于B组[(83.5±8.4)分、(82.7±9.2)分、70.8%(17/24)](P0.05)。C组和D组术后各指标比较无显著差异(P0.05)。结论:关节镜下不同术式治疗盘状半月板均可获得较为满意的疗效,但对于完全型盘状半月板而言,采取完全切除术治疗的患者较部分切除成形术者术后疗效具有一定优势。     

The 5.5-year results of MegaOATS--autologous transfer of the posterior femoral condyle: a case-series study

Introduction

Large osteochondral defects of the weight-bearing zones of femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle (large osteochondral autogenous transplantation system (MegaOATS)). The technique presented is a sound and feasible salvage procedure to address large osteochondral defects in weight-bearing zones.

Methods

Thirty-six patients between July 1996 and December 2000 were included. Thirty-three patients (10 females, 23 males) were evaluated by the Lysholm score and X-ray scans. A random sample of 16 individuals underwent magnetic resonance imaging analysis. The average age at the date of surgery was 34.3 (15 to 59) years, and the mean follow up was 66.4 (46 to 98) months. The mean defect size was 6.2 (2 to 10.5) cm², in 27 patients affecting the medial femoral condyle and in six patients affecting the lateral femoral condyle. Trauma or osteochondrosis dissecans were pathogenetic in 82%.

Results

The Lysholm score in all 33 individuals showed a highly significant increase from a preoperative median 49.0 points to a median 86.0 points (P ≤ 0.001). Twenty-seven patients returned to recreational sports. X-ray scans showed a rounding of the osteotomy edge in 24 patients, interpreted as a partial remodelling of the posterior femoral condyle. Preoperative osteoarthritis in 17 individuals was related to significant lower Lysholm scores (P = 0.014), but progression in 17 patients did not significantly influence the score results (P = 0.143). All 16 magnetic resonance imaging examinations showed vital and congruent grafts.

Conclusion

Patients significantly improve in the Lysholm score, in daily-life activity levels and in return to recreational sports. Thirty-one out of 33 patients were comfortable with the results and would undergo the procedure again. The MegaOATS technique is therefore recommended as a salvage procedure for young individuals with large osteochondral defects in the weight-bearing zone of the femoral condyle.     

Intercondylar notch width and inner angle of lateral femoral condyle as the risk factors for anterior cruciate ligament injury in female handball players in Herzegovina

The principal purpose of this prospective study was to examine intercondylar notch size and the value of inner angle of lateral femoral condyle as the risk factors for noncontact anterior cruciate ligament ACL injury and than to correlate them to the physical values of the athletes such as body mass index (BMI), hight, wight, etc. There are indentified two type of risk factors, external include shoes-surface interaction, type of playing surface, weather conditions and internal include anatomic, neuromuscular, biomechanical and hormonal factors that may predispose female athlets to noncontact injury of ACL. Among anatomic factors, intercondylar notch stenosis and larger inner angle of lateral condyle of femur as the factors which can cause impigement of ACL, were related to an increased risk of injury of ACL. In this study were included 51 female athlete. In the study group there were 24 female handball players with ACL tear and in control group there were 27 female handball players without any type of injury of the knee, who are practicing handball on a daily basis for at least for two years. In the first step, were gathered clinical data performed by orthopaedic surgeon. In the second step, the femoral notch width and the inner angle of lateral condyle of femur were measured on coronal MR-images. Study has shown that value of inner angle of lateral condyle of femur was significantly higher in athletes with ACL tear compared to those without. Value of width of intercondylar notch was statisticaly smaller in athletes with ACL tear, compared to those without. In the conclusion the inner angle of lateral femoral condyle is better predicting factor for ACL tear in young female handball players compared to intercondylar notch width.     

The evaluation of knee bone mineral density following open-wedge high tibial osteotomy

Examinations of bone density changes in selected knee bone ends were evaluated prospectively in a randomized group of 28 patients, aged from 41 to 65 (mean: 55.3 years), who had varus deformations of their mechanic limb axes, mean 8 degrees. The examinations were conducted during the preoperative period, 10 days, 3, 6, and 12 weeks, as well as 6 and 12 months after the procedure. A statistically significant increase in bone density was observed in the medial tibial condyle area, while a statistically insignificant decrease of bone density was noted in the medial femoral condyles. Bone density increased in the lateral tibial condyle area, whereas there were no density changes in the area of the lateral femoral condyles. The research results demonstrate that the relief achieved in ailments after high tibial osteotomies does not directly correspond to the bone density of the affected areas.     

Ontogeny and phylogeny of femoro-tibial characters in humans and hominid fossils: functional influence and genetic determinism.

Three different human femoro-tibial characters are selected as functionally relevant and derived hominid characters: femoral bicondylar angle, shape of the femoral distal epiphysis, and the tibial insertion of the lateral meniscus. The timing and mode of formation of these characters are investigated during human ontogeny and are shown to differ considerably. The available hominid fossils (Australopithecus afarensis and early Homo) are interpreted in the light of this ontogenetic analysis with the conclusion that, during hominid evolution, different modes of selection of these features must have occurred. In modern humans, the femoral bicondylar angle proves to be an epigenetic functional feature, which develops during early childhood growth. It is present in all australopithecines and we suggest that it developed following a change in their locomotor behavior and not upon a genomic change: the early practice of bipedal walking, with adducted knee joints, in the locomotor repertoire of infant australopithecines, was sufficient to promote this angle. Later in hominid evolution, the knee joint evolved from having a single insertion of the lateral meniscus on the tibia to a double one. While Australopithecus afarensis exhibits a single insertion, early Homo clearly exhibits a double insertion of the lateral meniscus on the tibia. The double insertion restricts the mobility of the meniscus on the tibial plateau, indicating a habitual practice of full extension movements of the knee joint. Among modern humans, the posterior insertion of the lateral meniscus appears early in fetal life. Consequently in early Homo, this new selected feature developed directly as a result of a genomic change. The derived shape of human distal femoral epiphysis includes a prominence of the lateral lip of the femoral trochlea, an elliptical profile of the lateral condyle, and an anteroposterior lengthening of the epiphysis. Analysis of human fetal and neonatal distal epiphyses shows that the prominence of the lateral lip of the trochlea arises before any use, and thus appears to be genetically determined. However, the postnatal development of this joint shows that this feature is also modified epigenetically by use. It is argued that the hominid femoro-patellar joint would have been reshaped following the process of genetic assimilation (Waddington [1942] Nature 3811:563-565). The prominence of the lateral lip of the femoral trochlea was probably selected following a two-staged process-first epigenetic, then genetic. Far from being a Lamarckian explanation, this concept applies precisely to adaptive characters that are induced by an external stimulus during a single lifetime and are replaced through natural selection by genetically based equivalent characters. The nature of the structures involved in the studied features is shown to be an important parameter determining their mode of development and selection.     

The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study

Introduction

Large osteochondral defects of the weight-bearing zones of femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle (large osteochondral autogenous transplantation system (MegaOATS)). The technique presented is a sound and feasible salvage procedure to address large osteochondral defects in weight-bearing zones.

Methods

Thirty-six patients between July 1996 and December 2000 were included. Thirty-three patients (10 females, 23 males) were evaluated by the Lysholm score and X-ray scans. A random sample of 16 individuals underwent magnetic resonance imaging analysis. The average age at the date of surgery was 34.3 (15 to 59) years, and the mean follow up was 66.4 (46 to 98) months. The mean defect size was 6.2 (2 to 10.5) cm², in 27 patients affecting the medial femoral condyle and in six patients affecting the lateral femoral condyle. Trauma or osteochondrosis dissecans were pathogenetic in 82%.

Results

The Lysholm score in all 33 individuals showed a highly significant increase from a preoperative median 49.0 points to a median 86.0 points (P ≤ 0.001). Twenty-seven patients returned to recreational sports. X-ray scans showed a rounding of the osteotomy edge in 24 patients, interpreted as a partial remodelling of the posterior femoral condyle. Preoperative osteoarthritis in 17 individuals was related to significant lower Lysholm scores (P = 0.014), but progression in 17 patients did not significantly influence the score results (P = 0.143). All 16 magnetic resonance imaging examinations showed vital and congruent grafts.

Conclusion

Patients significantly improve in the Lysholm score, in daily-life activity levels and in return to recreational sports. Thirty-one out of 33 patients were comfortable with the results and would undergo the procedure again. The MegaOATS technique is therefore recommended as a salvage procedure for young individuals with large osteochondral defects in the weight-bearing zone of the femoral condyle.     

血清miR-203a、miR-31-5p、miR-19b-1-5p水平与股骨颈骨折患者骨折延迟愈合的关系及其预测价值分析

摘要 目的：探讨血清微小核糖核酸（miR）-203a、miR-31-5p、miR-19b-1-5p水平与股骨颈骨折患者术后骨折延迟愈合的关系及对术后骨折延迟愈合的预测价值。方法：选择2020年1月~2022年10月在徐州医科大学附属医院行内固定治疗的292例新鲜股骨颈骨折患者为研究对象。于术后4周复查时,检测患者血清miR-203a、miR-31-5p、miR-19b-1-5p水平;并根据其骨折愈合情况分为延迟组（n=36）和愈合组（n=256）。采用多因素Logistic回归分析股骨颈骨折患者术后骨折延迟愈合的影响因素。采用受试者工作特征（ROC）曲线分析血清miR-203a、miR-31-5p、miR-19b-1-5p对股骨颈骨折患者术后骨折延迟愈合的预测价值。结果：术后4个月复查时,骨折延迟愈合发生率为12.33%。两组年龄、吸烟史、合并糖尿病组间比较,差异有统计学意义（P＜0.05）。愈合组血清miR-203a、miR-31-5p、miR-19b-1-5p水平均高于延迟组（P<0.05）。多因素Logistic回归分析结果显示,年龄≥60岁、合并糖尿病、血清miR-203a、miR-31-5p、miR-19b-1-5p水平降低是股骨颈骨折患者术后骨折延迟愈合的独立危险因素（P＜0.05）。ROC曲线结果显示,三者联合检测的曲线下面积（AUC）（0.95CI）为0.841（0.738~0.936）,高于各指标单独应用时的AUC,三者联合检测的灵敏度和特异度亦高于单一指标检测。结论：血清miR-203a、miR-31-5p、miR-19b-1-5p在股骨颈骨折术后骨折延迟愈合患者中呈低表达,是骨折延迟愈合的独立危险因素,三者联合检测对股骨颈骨折患者骨折延迟愈合具有较高的预测价值。     

关节镜治疗膝关节盘状半月板损伤的疗效及术后疼痛的影响因素研究

目的:探讨关节镜治疗膝关节盘状半月板损伤的疗效以及患者术后疼痛的原因、影响因素。方法:选取2011年7月至2013年7月我院收治的46例膝关节盘状半月板损伤的患者作为研究对象,运用统计学方法分析关节镜的手术疗效。结果:根据Lkeuchi评分标准进行评分:优29例(63.04%),良12例(26.09%),中3例(6.52%),差2例(4.35%),优良率为89.13%。两组患者性别、BMI(体质指数)之间无差异,但是疼痛与年龄、负重早晚、关节软骨损伤、术后是否冷敷均有关系,且差异具有统计学意义(P0.05)。结论:关节镜治疗膝关节盘状半月板损伤具有确切的疗效,术后疼痛与多种因素有关。     

Salvage of ischemic digits using a lateral arm fascial flap

Four patients underwent microvascular transfer of a lateral arm fascial flap to salvage severely ischemic digits by means of induction of neovascularization. The cause of the digital ischemia was direct trauma (crush injury) in one patient and chronic embolic phenomena (proximal arterial occlusion) in three patients. None of the patients had responded to traditional therapy, including treatment with one or more of the following: anticoagulation, lytic therapy, oral vasodilators, digital sympathectomy, and vein bypass grafting. Each patient underwent noninvasive (Doppler ultrasound, digital pressures, digital temperatures, vascular refill) and invasive (angiogram) vascular assessment preoperatively. After microvascular transfer of the lateral arm fascial flap, all patients reported symptomatic relief, and objective improvements were documented by both noninvasive and invasive assessment criteria. One patient developed a seroma at the donor site; another experienced a late complication of thrombosis of the flap after his wound dehisced. A 6-month follow-up evaluation demonstrated neovascular collateralization and stable improvement without regression in the remaining patients. The authors present their clinical experience and propose a treatment algorithm for patients with chronic digital ischemia.     

Load sharing between solid and fluid phases in articular cartilage: I--Experimental determination of in situ mechanical conditions in a porcine knee.

The in situ mechanical conditions of cartilage in the articulated knee were quantified during joint loading. Six porcine knees were subjected to a 445 N compressive load while cartilage deformations and contact pressures were measured. From roentgenograms, cartilage thickness before and during loading allowed the calculation of tissue deformation on the lateral femoral condyle at different times during the loading process. Contact pressures on the articular surface were measured with miniature fiber-optic pressure transducers. Results showed that the medial side of the lateral femoral condyle had higher contact pressures, as well as deformations. To begin to correlate the pressures and resulting deformations, the intrinsic material properties of the cartilage on the lateral condyle were obtained from indentation tests. Data from four normal control specimens indicated that the aggregate modulus of the medial side was significantly higher than in other areas of the condyle. These experimental measures of the in situ mechanical conditions of articular cartilage can be combined with theoretical modeling to obtain valuable information about the relative contributions of the solid and fluid phases to supporting the applied load on the cartilage surface (see Part II).     

Transconjunctival lateral canthopexy in Down's syndrome patients: a nonstigmatizing approach

In Down's syndrome patients, surgical correction of the palpebral fissure obliquity through an external approach may produce a red, slightly hypertrophic scar. A transconjunctival approach for this repair was used for 15 Down's syndrome patients aged 3 to 17 years (mean 8.7 years), and the results were compared with those in two boys aged 6 and 17 years who underwent correction by the external approach. Palpebral fissure inclinations were recorded using anthropometric measurements preoperatively and 6 months postoperatively. Inclinations were reduced significantly by either technique; however, often the precise degree of the improvement was clear only from the measurements rather than from photographs. Complications of the transconjunctival approach were few, and there were no problems with wound healing and no ocular injury. Transconjunctival lateral canthopexy is a safe, effective method that avoids a potentially stigmatizing external scar.     

Comparison of nonlinear mechanical properties of bovine articular cartilage and meniscus

Nonlinear, linear and failure properties of articular cartilage and meniscus in opposing contact surfaces are poorly known in tension. Relationships between the tensile properties of articular cartilage and meniscus in contact with each other within knee joints are also not known. In the present study, rectangular samples were prepared from the superficial lateral femoral condyle cartilage and lateral meniscus of bovine knee joints. Tensile tests were carried out with a loading rate of 5 mm/min until the tissue rupture. Nonlinear properties of the toe region, linear properties in larger strains, and failure properties of both tissues were analysed. The strain-dependent tensile modulus of the toe region, Young's modulus of the linear region, ultimate tensile stress and toughness were on average 98.2, 8.3, 4.0 and 1.9 times greater (p<0.05) for meniscus than for articular cartilage. In contrast, the toe region strain, yield strain and failure strain were on average 9.4, 3.1 and 2.3 times greater (p<0.05) for cartilage than for meniscus. There was a significant negative correlation between the strain-dependent tensile moduli of meniscus and articular cartilage samples within the same joints (r=−0.690, p=0.014). In conclusion, the meniscus possesses higher nonlinear and linear elastic stiffness and energy absorption capability before rupture than contacting articular cartilage, while cartilage has longer nonlinear region and can withstand greater strains before failure. These findings point out different load carrying demands that both articular cartilage and meniscus have to fulfil during normal physiological loading activities of knee joints.     

Contours of the hominoid lateral tibial condyle with implications for Australopithecus

Tibial condyle shape is alleged to vary among fossil tibiae attributed to Australopithecus, and has been argued to reflect functional differences of the knee. Convex anteroposterior curvature of the lateral tibial condyle in A. africanus has been interpreted to indicate a more chimpanzee-like locomotor repertoire than the flatter lateral tibial condyles of A. afarensis (Berger and Tobias, 1996, J. Hum. Evol. 30, 343). Alternatively, Latimer, Ohman, and Lovejoy (1987, Am. J. Phys. Anthropol. 74, 155) have suggested that in response to increased transarticular loads accompanied by larger body mass, joints should become flatter as size increases, both within and among species, so that the variation observed among hominin fossils reflects size alone rather than functional differences. In this study, three-dimensional surface areas of the lateral tibial condyle of humans, chimpanzees, and gorillas were computed using a Digibot II (Digibotics) laser scanner and the DataSculpt v.4.6 engineering software package to evaluate joint surface contours, and compared to two-dimensional surface area and arc and chord length measurements of the anteroposterior and mediolateral axes. Extant species measurements were then compared to those of A. afarensis (A.L. 129-1b, A.L. 288-1aq, A.L. 333x-26, A.L. 333-42) and A. africanus (Stw 514a). Results do not support the hypothesis that A. afarensis and A. africanus differ in condylar topology. They also do not support the hypothesis that joint surfaces become flatter with increased transarticular load accompanying increased body size, as curvature of the lateral tibial condyle in anteroposterior and mediolateral planes is not negatively allometric. However, femoral condylar shape is not included in this study, which may better reflect joint surface responses to increased body size. Finally, there is no basis from this study to reconstruct differences in locomotor behavior among fossil hominin taxa based on lateral tibial condyle morphology.     

病灶清除植骨联合DHS内固定治疗股骨近端囊肿

目的:探讨病灶清除植骨联合动力髋螺钉(DHS)内固定术治疗股骨近端囊肿的临床疗效及意义。方法:自2006年3月至2012年6月共有17例股骨近端囊肿患者在我院接受治疗并有完整随访,全部患者均应用病灶清除植骨联合DHS内固定术手术治疗。结果:平均随访时间18个月(14-60个月),病灶植骨处平均愈合时间7个月(6-8个月)。平均手术时间182分钟(90分钟~282分钟),术中平均出血量340 mL(100~700 mL)。切口全部一期愈合,术后病灶处均达到骨性愈合,骨密度均匀,17例均未出现骨囊肿复发及内固定断裂,未发生股骨头坏死及股骨近端骨折,按Harris髋关节功能评分标准,优良率为100%。结论:病灶清除植骨术联合DHS内固定治疗股骨近端囊肿操作简单,术中出血少,并发症少,疗效确切,是治疗股骨近端骨囊肿,降低其复发率和预防病理性骨折的一种有效方法。     

关节镜治疗膝关节盘状半月板损伤的疗效及术后疼痛的影响因素研究

目的：探讨关节镜治疗膝关节盘状半月板损伤的疗效以及患者术后疼痛的原因、影响因素。方法：选取2011年7月至2013年7月我院收治的46例膝关节盘状半月板损伤的患者作为研究对象,运用统计学方法分析关节镜的手术疗效。结果：根据Lkeuchi评分标准进行评分：优29例（63．04％）,良12例（26．09％）,中3例（6．52％）,差2例（4．35％）,优良率为89．13％。两组患者性别、BMI（体质指数）之间无差异,但是疼痛与年龄、负重早晚、关节软骨损伤、术后是否冷敷均有关系,且差异具有统计学意义（P〈0．05）。结论：关节镜治疗膝关节盘状半月板损伤具有确切的疗效,术后疼痛与多种因素有关。     

Deformation of the distal femur: a contribution towards the pathogenesis of osteochondrosis dissecans in the knee joint.

Osteochondrosis dissecans (OD) is a process of subchondral bone necrosis occurring predominantly in young individuals at specific sites. The aetiology of this disease remains controversial with mechanical processes due to trauma and/or ischaemic factors being proposed. This study aims at explaining the aetiology of OD in the knee joint as a result of the particular deformation of the condyles. A finite element analysis of the distal third of the femur was performed. A three-dimensional model was developed based on computed tomography scans of a normal femur, consisting of cortical bone, cancellous bone and articular cartilage. This model was subjected to physiological loads at 0, 30, 60 and 90 degrees of knee flexion. A complex deformation was found within each condyle as well as between the two condyles. Both medial and lateral condyles are deformed in the medio-lateral direction and at the same time compressed between the patella and the tibia in the antero-posterior direction. This effect is highest at 60 degrees of knee flexion. In both planes, the medial condyle is distorted more than the lateral one. Strain concentration in the subchondral bone facing the patella varies with flexion, especially for angles exceeding 60 degrees. The deformation of the femur in the predominant locus of OD in the medial condyle exceeds that of the lateral condyle considerably. The analysis shows that repeated vigorous exercise including extreme knee flexion may produce rapidly changing strains which in turn could ultimately be responsible for local subchondral bone collapse.     

A Missense Mutation in the Aggrecan C-type Lectin Domain Disrupts Extracellular Matrix Interactions and Causes Dominant Familial Osteochondritis Dissecans

Osteochondritis dissecans is a disorder in which fragments of articular cartilage and subchondral bone dislodge from the joint surface. We analyzed a five-generation family in which affected members had autosomal-dominant familial osteochondritis dissecans. A genome-wide linkage analysis identified aggrecan (ACAN) as a prime candidate gene for the disorder. Sequence analysis of ACAN revealed heterozygosity for a missense mutation (c.6907G > A) in affected individuals, resulting in a p.V2303M amino acid substitution in the aggrecan G3 domain C-type lectin, which mediates interactions with other proteins in the cartilage extracellular matrix. Binding studies with recombinant mutated and wild-type G3 proteins showed loss of fibulin-1, fibulin-2, and tenascin-R interactions for the V2303M protein. Mass spectrometric analyses of aggrecan purified from patient cartilage verified that V2303M aggrecan is produced and present in the tissue. Our results provide a molecular mechanism for the etiology of familial osteochondritis dissecans and show the importance of the aggrecan C-type lectin interactions for cartilage function in vivo.     

Modeling of constrained articular cartilage growth in an intact knee with focal knee resurfacing metal implant

The purpose of the present study was to develop a model to simulate the articular cartilage growth in an intact knee model with a metal implant replacing a degenerated portion of the femoral cartilage. The human knee joint was approximated with a simplified axisymmetric shape of the femoral condyle along with the cartilage, meniscus and bones. Two individually growing constituents (proteoglycans and collagen) bound to solid matrix were considered in the solid phase of the cartilage. The cartilage behavior was modeled with a nonlinear biphasic porohyperelastic material model, and meniscus with a transversely isotropic linear biphasic poroelastic material model. Two criteria (permeation and shear), both driven by mechanical loading, were considered to trigger the growth in the solid constituents. Mechanical loading with sixty heavy cycles was considered to represent daily walking activity. The growth algorithm was implemented for 90 days after implantation. The results from simulations show that both cartilage layers were more stimulated near the implant which lead to more growth of the cartilage near the defect. The method developed in the present work could be a powerful technique if more accurate material data and growth laws were available.