Department of Orthopaedic Surgery, Otto-von-Guericke University, 39120Magdeburg, Germany.
Arthroscopy. 2010 Mar;26(3):358-65. doi: 10.1016/j.arthro.2009.08.013. Epub 2010 Jan 1.
The purpose of this biomechanical study was to investigate the potential effect of a nonanatomic repair of the meniscal horn attachment on the resultant circumferential tension in a large animal model and to show that the circumferential tension of the meniscus affects the local stress of the cartilage.
All investigations were done in the medial compartment of porcine knees. First, the anterior horn attachment of the meniscus was mechanically separated from the surrounding tibial bone and fitted with a force transducer (n = 8). The femorotibial joint was loaded in compression at different flexion angles, and the resultant tension at the horn attachment was recorded. The measurements were done with the horn attachment at its anatomic position and repeated with the horn attachment being displaced medially or laterally by 3 mm. In the second part the local deformation of the cartilage under a femorotibial compressive load was measured at different levels of meniscal hoop tension (n = 5).
A nonanatomic position of the horn attachment had a significant effect on the resultant tension (P < .01). Placing the horn attachment 3 mm medially decreased the tension at the horn attachment by 49% to 73%, depending on flexion angle and femorotibial load. The opposite placement resulted in a relative increase in the tension by 28% to 68%. Lower levels of meniscal hoop tension caused increased deformation of the cartilage (P < .05), indicating increased local stress.
A nonanatomic position of the horn attachment strongly affects conversion of femorotibial loads into circumferential tension. There is a narrow window for a functionally sufficient repair of meniscal root tears.
Although clinical inferences are limited because the specimens used were from a different species, there seems to be only a narrow window for a mechanically sufficient repair of root tears.
本生物力学研究旨在探讨半月板horn 附着体非解剖修复对大型动物模型中环周张力的潜在影响，并证明半月板的环周张力会影响软骨的局部应力。
所有研究均在猪膝关节的内侧间室进行。首先，将半月板的前horn 附着体从周围胫骨骨上机械分离，并安装力传感器（n = 8）。在不同的屈曲角度下对髌股关节进行压缩加载，并记录horn 附着体的总张力。在horn 附着体处于解剖位置时进行测量，并重复测量将 horn 附着体向内侧或外侧移位 3mm 的情况。在第二部分中，在半月板环周张力的不同水平下，测量软骨在髌股压缩负荷下的局部变形（n = 5）。
horn 附着体的非解剖位置对总张力有显著影响（P <.01）。将 horn 附着体向内侧移位 3mm 可使horn 附着体的张力降低 49%至 73%，具体取决于屈曲角度和髌股负荷。相反的放置方式会使张力相对增加 28%至 68%。半月板环周张力较低会导致软骨变形增加（P <.05），表明局部应力增加。
horn 附着体的非解剖位置会强烈影响髌股负荷向环周张力的转化。半月板根部撕裂的功能修复有一个很窄的窗口。
虽然由于使用的标本来自不同的物种，临床推论受到限制，但似乎只有一个很窄的窗口可以进行机械上足够的根部撕裂修复。
