Wong Margaret Wan Nar, Qin Ling, Lee Kwong Man, Leung Kwok Sui
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Clin Orthop Relat Res. 2009 Apr;467(4):1092-100. doi: 10.1007/s11999-008-0606-8. Epub 2008 Nov 6.
The fibrocartilage transition zone in the direct bone-tendon junction reduces stress concentration and protects the junction from failure. Unfortunately, bone-tendon junctions often heal without fibrocartilage transition zone regeneration. We hypothesized articular cartilage grafts could increase fibrocartilage transition zone regeneration. Using a goat partial patellectomy repair model, autologous articular cartilage was harvested from the excised distal third patella and interposed between the residual proximal two-thirds bone fragment and tendon during repair in 36 knees. We evaluated fibrocartilage transition zone regeneration, bone formation, and mechanical strength after repair at 6, 12, and 24 weeks and compared them with direct repair. Autologous articular cartilage interposition resulted in more fibrocartilage transition zone regeneration (69.10% +/- 14.11% [mean +/- standard deviation] versus 8.67% +/- 7.01% at 24 weeks) than direct repair at all times. There was no difference in the amount of bone formation and mechanical strength achieved. Autologous articular cartilage interposition increases fibrocartilage transition zone regeneration in bone-tendon junction healing, but additional research is required to ascertain the mechanism of stimulation and to establish the clinical applicability.
直接骨 - 肌腱连接部位的纤维软骨过渡区可减少应力集中,并保护连接部位免于失效。不幸的是,骨 - 肌腱连接部位愈合时常常没有纤维软骨过渡区的再生。我们推测关节软骨移植可增加纤维软骨过渡区的再生。在山羊部分髌骨切除术修复模型中,从切除的髌骨远端三分之一处获取自体关节软骨,并在36个膝关节修复过程中将其置于残留的近端三分之二骨碎片和肌腱之间。我们在术后6周、12周和24周评估了修复后的纤维软骨过渡区再生、骨形成和机械强度,并将其与直接修复进行比较。自体关节软骨植入在各个时间点均比直接修复产生更多的纤维软骨过渡区再生(24周时为69.10%±14.11%[平均值±标准差],而直接修复为8.67%±7.01%)。在骨形成量和获得的机械强度方面没有差异。自体关节软骨植入可增加骨 - 肌腱连接部位愈合时纤维软骨过渡区的再生,但需要进一步研究以确定刺激机制并确立其临床适用性。
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