Delos Demetris, Rodeo Scott A
Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA.
Instr Course Lect. 2011;60:453-60.
Meniscal tears are common orthopaedic injuries that can manifest with significant pain and mechanical symptoms. The treatment of meniscal tears has evolved from total meniscectomy to partial meniscectomy and meniscal repair. Preserving the meniscus is ideal because the loss of any portion of the meniscus can lead to significantly increased articular cartilage contact stresses compared with the intact state. However, most of the meniscus has a limited ability to heal because of poor vascularity. This has prompted a search for a better understanding of the biology of meniscal healing and methods to enhance the process. Growth factors have been shown to positively affect meniscal cell function, including platelet-derived growth factor, fibroblast growth factor, basic fibroblast growth factor, transforming growth factor-β, insulin-like growth factor, bone morphogenetic protein, hepatocyte growth factor, and vascular endothelial growth factor. In vitro studies have shown that other cytokines, including interleukin-1, tumor necrosis factor-α, and the matrix metalloproteinases, negatively affect meniscal healing. Identification of these growth factors has led to strategies to deliver serum-derived factors to the meniscus to improve healing. Platelet-rich plasma is the latest technique to be evaluated for augmenting meniscal healing. Activation of the platelets leads to the local release of growth factors from the alpha and dense granules located in the platelet cytoplasm. These growth factors have been associated with the initiation of a healing cascade leading to cellular chemotaxis, angiogenesis, collagen matrix synthesis, and cell proliferation.
半月板撕裂是常见的骨科损伤，可表现为严重疼痛和机械性症状。半月板撕裂的治疗已从全半月板切除术发展为部分半月板切除术和半月板修复术。保留半月板是理想的，因为与完整状态相比，半月板任何部分的缺失都会导致关节软骨接触应力显著增加。然而，由于血运较差，大多数半月板的愈合能力有限。这促使人们更好地理解半月板愈合的生物学机制以及增强愈合过程的方法。生长因子已被证明对半月板细胞功能有积极影响，包括血小板衍生生长因子、成纤维细胞生长因子、碱性成纤维细胞生长因子、转化生长因子-β、胰岛素样生长因子、骨形态发生蛋白、肝细胞生长因子和血管内皮生长因子。体外研究表明，其他细胞因子，包括白细胞介素-1、肿瘤坏死因子-α和基质金属蛋白酶，对半月板愈合有负面影响。这些生长因子的鉴定导致了将血清衍生因子输送到半月板以改善愈合的策略。富血小板血浆是目前评估用于增强半月板愈合的最新技术。血小板的激活导致位于血小板细胞质中的α颗粒和致密颗粒局部释放生长因子。这些生长因子与启动愈合级联反应有关，导致细胞趋化、血管生成、胶原基质合成和细胞增殖。
