Current clinical practices do not adequately regenerate the meniscus of the knee secondary to a tear. Complete or partial meniscus removal leads to degenerative changes within the joint. Tissue engineering of the meniscus promises a potent solution. Before embarking on tissue engineering of the meniscus, it is crucial to have a thorough comprehension of the biomechanical role that this tissue fulfills and how the structure of meniscus is uniquely suited to that purpose. To better understand this, we have examined the meniscus, as well as associated tissues, within the body. For the first time, the knee meniscus is rigorously compared to ligament, tendon, and cartilage, and inferences are drawn on how mechanical stimulation may be used to channel growth in the meniscus. We have examined in detail the loading conditions that these tissues experience in vivo and how each is uniquely adapted to its loading environment. These tissues are capable of achieving some degree of remodeling because of mechanical stimuli. By understanding the mechanisms that can stimulate and promote regeneration in related tissues, we hope to harness that knowledge to achieve the goal of meniscal regeneration.
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