Wilson W, van Rietbergen B, van Donkelaar C C, Huiskes R
Department of Biomedical Engeneering, Eindhoven University of Technology, Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
J Biomech. 2003 Jun;36(6):845-51. doi: 10.1016/s0021-9290(03)00004-6.
Results of both clinical and animal studies show that meniscectomy often leads to osteoarthritic degenerative changes in articular cartilage. It is generally assumed that this process of cartilage degeneration is due to changes in mechanical loading after meniscectomy. It is, however, not known why and where this cartilage degeneration starts. Load induced cartilage damage is characterized as either type (1)--damage without disruption of the underlying bone or calcified cartilage layer--or type (2), subchondral fracture with or without damage to the overlying cartilage. We asked the question whether cartilage degeneration after meniscectomy is likely to be initiated by type (1) and/or type (2) cartilage damage. To investigate that we applied an axisymmetric biphasic finite element analysis model of the knee joint. In this model the articular cartilage layers of the tibial and the femoral condyles, the meniscus and the bone underlying the articular cartilage of the tibia plateau were included. The model was validated with data from clinical studies, in which the effects of meniscectomy on contact areas and pressures were measured. It was found that both the maximal values and the distributions of the shear stress in the articular cartilage changed after meniscectomy, and that these changes could lead to both type (1) and type (2) cartilage damage. Hence it likely that the cartilage degeneration seen after meniscectomy is initiated by both type (1) and type (2) cartilage damage.
临床研究和动物研究的结果均表明，半月板切除术常常会导致关节软骨发生骨关节炎性退变。一般认为，这种软骨退变过程是由于半月板切除术后机械负荷的改变所致。然而，目前尚不清楚这种软骨退变为何会发生以及始于何处。负荷诱导的软骨损伤可分为两种类型：（1）型——不破坏下方骨或钙化软骨层的损伤；或（2）型——伴有或不伴有上方软骨损伤的软骨下骨折。我们提出了一个问题，即半月板切除术后的软骨退变是否可能由（1）型和/或（2）型软骨损伤引发。为了对此进行研究，我们应用了膝关节的轴对称双相有限元分析模型。在该模型中，纳入了胫骨和股骨髁的关节软骨层、半月板以及胫骨平台关节软骨下方的骨。该模型通过临床研究数据进行了验证，在这些临床研究中测量了半月板切除术对接触面积和压力的影响。研究发现，半月板切除术后关节软骨中的剪切应力最大值和分布均发生了变化，并且这些变化可能导致（1）型和（2）型软骨损伤。因此，半月板切除术后出现的软骨退变很可能是由（1）型和（2）型软骨损伤共同引发的。
