The medial compartment of the knee joint is the articulation between the medial femoral condyle and the medial tibial plateau, interposed by the medial meniscus. The medial compartment is more congruent than the lateral due to the concave medial tibial plateau shape, and is the primary weight-bearing compartment in varus alignment. It is stabilised medially by the superficial and deep MCL, the posteromedial capsule, and the semimembranosus corner.
Medial compartment osteoarthritis is the most common pattern of tibiofemoral arthritis, producing medial knee pain, varus deformity, and bone-on-bone contact visible as joint space loss on standing X-rays. High tibial osteotomy corrects varus deformity and offloads the medial compartment in younger active patients. Unicompartmental knee replacement selectively resurfaces the medial compartment when the lateral and patellofemoral compartments are preserved. Medial meniscal tears are the most common knee meniscal injury, assessed by MRI and managed arthroscopically.
Progressive cartilage loss in the medial tibiofemoral compartment produces medial knee pain and varus deformity, managed with physiotherapy, injection, and ultimately unicompartmental or total knee replacement in those with severe disease and failed conservative management.
Valgus stress fracturing of the medial tibial plateau (Schatzker type IV-VI) produces articular depression requiring CT-guided surgical reduction and fixation to restore the medial compartment articular surface and prevent posttraumatic arthrosis.
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