Huang Arthur, Hull M L, Howell Stephen M
Biomedical Engineering Program, Department of Mechanical Engineering, University of California, Davis 95616, USA.
J Orthop Res. 2003 May;21(3):459-64. doi: 10.1016/S0736-0266(02)00201-2.
This study addressed the question of whether the level of compressive load would affect the conclusions from statistical analyses aimed at determining how well a lateral meniscal autograft restores tibial contact (as indicated by the maximum contact pressure, mean pressure, and contact area) to that of the intact knee. If statistical analyses indicated that normal tibial contact was not restored with a higher, more physiologic load, then a secondary question was whether an autograft surgically implanted with bone plugs would improve tibial contact compared to that in a meniscectomized knee. Nine, fresh-frozen human cadaveric knees were subjected to a low, non-physiologic compressive load of 400 N and a higher, more physiologic compressive load of 1200 N under three conditions (lateral meniscus intact, lateral meniscus removed and reimplanted as an autograft, and lateral meniscus removed). Contact pressure on the lateral plateau was measured with pressure sensitive film at 0 degrees, 15 degrees, 30 degrees, and 45 degrees of flexion. At 400 N, p-values from statistical analyses indicated that both the maximum and mean pressures with the autograft were comparable to those of the intact knee (p> or =0.685). However, at 1200 N, p-values from statistical analyses indicated that both the maximum and mean pressures with the autograft were significantly greater than those of the intact knee (p< or =0.0001). Therefore studies designed to evaluate tibial contact pressure for a meniscal transplant should use a higher, more physiologic compressive load, because lower loads overestimate the transplant's effectiveness. Although none of the contact variables was restored to normal when the compressive load was increased to 1200 N, all of the contact variables were more normal than those of the meniscectomized knee. Thus, lateral meniscal allografts implanted using bone plugs can significantly improve contact pressure relative to a meniscectomized knee at the time of implantation.
本研究探讨了压缩负荷水平是否会影响旨在确定外侧半月板自体移植能在多大程度上恢复胫骨接触（以最大接触压力、平均压力和接触面积表示）至完整膝关节水平的统计分析结论。如果统计分析表明在更高、更接近生理负荷的情况下无法恢复正常胫骨接触，那么第二个问题是与半月板切除的膝关节相比，植入骨栓的自体移植是否能改善胫骨接触。九个新鲜冷冻的人体尸体膝关节在三种情况下（外侧半月板完整、外侧半月板切除并作为自体移植重新植入、外侧半月板切除）分别承受400 N的低、非生理压缩负荷和1200 N的高、更生理压缩负荷。使用压敏膜在0度、15度、30度和45度屈曲时测量外侧平台的接触压力。在400 N时，统计分析的p值表明自体移植的最大压力和平均压力均与完整膝关节相当（p≥0.685）。然而，在1200 N时，统计分析的p值表明自体移植的最大压力和平均压力均显著高于完整膝关节（p≤0.0001）。因此，旨在评估半月板移植胫骨接触压力的研究应使用更高、更生理的压缩负荷，因为较低负荷会高估移植的有效性。尽管当压缩负荷增加到1200 N时，没有一个接触变量恢复到正常水平，但所有接触变量都比半月板切除的膝关节更接近正常。因此，植入骨栓的外侧半月板异体移植在植入时相对于半月板切除的膝关节可显著改善接触压力。
