The medial tibiofemoral compartment is the primary load-bearing compartment of the knee, accepting 60-70% of axial load in neutral alignment. Its concave tibial plateau and the medial meniscus make it more congruent than the lateral compartment, and it is supported medially by the superficial and deep MCL, the posterior oblique ligament and the semimembranosus. Medial compartment OA is the most common form of knee osteoarthritis, producing the varus alignment of the bowlegged knee from medial joint space narrowing.
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Medial compartment osteoarthritis shows as joint space loss on standing radiographs with medial knee pain and varus deformity. High tibial osteotomy (HTO) unloads the compartment by correcting varus alignment in younger active patients. Unicompartmental knee arthroplasty (UKA) for isolated medial disease preserves the ACL and more normal knee kinematics, giving faster rehabilitation than total knee replacement. Typical UKA selection criteria are disease limited to the medial compartment, an intact ACL and a correctable varus deformity. Medial meniscal tears are the most common meniscal injury in this compartment and are assessed by MRI.
Progressive medial joint space narrowing producing varus alignment managed with HTO for younger active patients and UKA or TKA for older patients.
Fracture of the medial plateau (Schatzker type IV), often from high-energy varus force and associated with ligament injury; usually needs reduction and fixation to restore the joint surface.
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