Saygi Baransel, Yildirim Yakup, Berker Nadire, Ofluoglu Demet, Karadag-Saygi Evrim, Karahan Mustafa
PTT Hospital, Department of Orthopaedic Surgery, Istanbul, Turkey.
Arthroscopy. 2005 Dec;21(12):1468-72. doi: 10.1016/j.arthro.2005.09.006.
Menisci are known to have receptors mainly concentrated at the anterior and posterior horns. Although they are purported to send afferent impulses to the central nervous system, this function has not been thoroughly evaluated. The purpose of the study was to investigate whether stimulation of the menisci initiates a cortical response. The reaction of the end organ to the reflex arc is also evaluated.
Prospective case series.
Fourteen patients with normal medial menisci were included in the study. Different parts of the knee joint (the posterior horn and the body of the medial meniscus, the medial femoral condyle, the capsule, and the joint space) were electrically stimulated by a probe during arthroscopy. The cortical response was monitored with somatosensory-evoked potentials (SEPs). The compound muscle action potentials (CMAPs) of the semimembranosus, quadriceps, and biceps femoris muscles were also monitored with electroneuromyography (ENMG).
Among the stimulated parts, only the posterior horn of the meniscus produced cortical responses. No response was obtained with stimulation of the medial femoral condyle, the body of the medial meniscus, the capsule, or the joint space. Stimulation of the posterior horn of the medial meniscus produced a measurable amount of CMAP latency for the semimembranosus muscle, but not for the quadriceps and biceps femoris muscles.
Stimulation of the posterior horn of the medial meniscus produces reproducible cortical SEPs and results in ENMG-verified response of the semimembranosus muscle where no response of the semimembranosus muscle is detected with stimulation of the other parts of the knee.
The knowledge that only the horns of the medial meniscus have mechanoreceptors in the medial compartment of the knee helps to understand patients' signs and symptoms in medial compartment disease.
已知半月板的受体主要集中在前角和后角。尽管据称它们会向中枢神经系统发送传入冲动，但这一功能尚未得到充分评估。本研究的目的是调查刺激半月板是否会引发皮层反应。同时也评估终末器官对反射弧的反应。
前瞻性病例系列研究。
14名内侧半月板正常的患者纳入本研究。在关节镜检查期间，用探针对膝关节的不同部位（内侧半月板后角和体部、股骨内侧髁、关节囊和关节间隙）进行电刺激。用体感诱发电位（SEP）监测皮层反应。还用肌电图（ENMG）监测半膜肌、股四头肌和股二头肌的复合肌肉动作电位（CMAP）。
在受刺激的部位中，只有半月板后角产生了皮层反应。刺激股骨内侧髁、内侧半月板体部、关节囊或关节间隙均未获得反应。刺激内侧半月板后角可使半膜肌的CMAP潜伏期出现可测量的变化，但股四头肌和股二头肌未出现。
刺激内侧半月板后角可产生可重复的皮层SEP，并导致半膜肌出现经ENMG证实的反应，而刺激膝关节其他部位时未检测到半膜肌的反应。
了解到膝关节内侧间室中只有内侧半月板的角部具有机械感受器，有助于理解内侧间室疾病患者的体征和症状。
