The lateral compartment of the knee is the articulation between the lateral femoral condyle and the lateral tibial plateau, separated by the lateral meniscus. The lateral tibial plateau is slightly convex (in contrast to the concave medial plateau), making it more mobile and less congruent. The lateral compartment bears less load than the medial in neutral alignment, typically 30-40% of total tibiofemoral force.
Isolated lateral compartment osteoarthritis is uncommon but occurs in valgus knee alignment and after lateral meniscectomy. Posterolateral corner injuries, including lateral meniscal tears and popliteofibular complex disruptions, involve the posterolateral aspect of this compartment. Distal femoral osteotomy corrects valgus deformity by offloading the lateral compartment. Unicompartmental lateral knee replacement for isolated lateral OA is technically demanding due to the convex tibial plateau requiring careful sizing and balancing.
Degenerative cartilage loss in the lateral tibiofemoral compartment from valgus alignment or prior lateral meniscectomy produces lateral knee pain and valgus deformity, managed with physiotherapy, bracing, distal femoral varus osteotomy in younger patients, or lateral unicompartmental knee replacement.
Valgus axial loading fractures the convex lateral tibial plateau (Schatzker type I-III), producing lateral compartment depression requiring CT assessment and surgical elevation and bone grafting to restore the articular surface and prevent valgus deformity.
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