Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.
Am J Sports Med. 2012 Nov;40(11):2604-9. doi: 10.1177/0363546512458574. Epub 2012 Sep 12.
Posterior horn detachment (PHD) lesions of the lateral meniscus are commonly associated with acute anterior cruciate ligament (ACL) tears. Multiple surgeons have advocated for repair of this lesion at the time of ACL reconstruction. However, the biomechanical consequences of this lesion and its subsequent repair have not been evaluated.
The PHD lesion of the lateral meniscus will lead to increased tibiofemoral contact pressures, and repair of this lesion to bone via a tibial tunnel can restore normal contact pressures during simulated gait.
Controlled laboratory study.
Lateral compartment contact pressures were measured via a sensor on the tibial plateau in 8 cadaver knees with the knee intact, after sectioning the posterior horn of the lateral meniscus to simulate PHD, and after repairing the injury. The repair was performed using an ACL tunnel guide to drill a tunnel from the anteromedial tibia to the posterior horn attachment site. Dynamic pressure data were continuously collected using a conductive ink pressure sensing system while each knee was moved through a physiological gait flexion cycle.
Posterior horn detachment caused a significant increase in tibiofemoral peak contact pressure from 2.8 MPa to 4.2 MPa (P = .03). After repair of the lesion to bone was performed through a transtibial tunnel, the peak contact pressure was 2.9 MPa. Posterior horn detachment also significantly decreased the maximum contact area over which tibiofemoral pressure is distributed from 451 mm(2) in the intact state to 304 mm(2) in the detached state. Repair of the PHD lesion increased the maximum contact area to 386 mm(2), however, this area was also significantly less than in the intact state (P = .05).
Posterior horn detachment of the lateral meniscus causes increased peak tibiofemoral contact pressure. The peak pressure can be reduced to a normal level with repair of the lesion to bone via a transtibial tunnel.
Posterior horn detachment of the lateral meniscus is a lesion often associated with an acute ACL tear. Debate exists concerning the importance of repairing PHD lesions at the time of ACL reconstruction. The data provided in this study may influence surgeons' management of the lesion.
外侧半月板后角撕裂（PHD）通常与急性前交叉韧带（ACL）撕裂有关。多位外科医生主张在 ACL 重建时修复该损伤。然而，该损伤及其随后修复的生物力学后果尚未得到评估。
外侧半月板的 PHD 损伤会导致胫骨股骨接触压力增加，通过胫骨隧道将该损伤修复至骨可以在模拟步态时恢复正常接触压力。
对照实验室研究。
在 8 个尸体膝关节中，通过胫骨平台上的传感器测量外侧间室接触压力，膝关节完整，外侧半月板后角切开模拟 PHD 后，以及修复损伤后。使用 ACL 隧道导向器从胫骨前内侧向半月板后角附着点钻一个隧道来进行损伤修复。使用导电油墨压力传感系统连续采集动态压力数据，每个膝关节在生理步态弯曲周期中移动。
后角撕裂导致胫骨股骨峰值接触压力从 2.8 MPa 显著增加到 4.2 MPa（P =.03）。通过经胫骨隧道将损伤修复至骨后，峰值接触压力为 2.9 MPa。后角撕裂还显著降低了胫骨股骨压力分布的最大接触面积，从完整状态的 451 mm²减少到分离状态的 304 mm²。修复 PHD 损伤增加了最大接触面积至 386 mm²，但也显著小于完整状态（P =.05）。
外侧半月板后角撕裂会导致胫骨股骨峰值接触压力增加。通过经胫骨隧道将损伤修复至骨，可以将峰值压力降低至正常水平。
外侧半月板后角撕裂是一种常与急性 ACL 撕裂相关的损伤。关于在 ACL 重建时修复 PHD 损伤的重要性存在争议。本研究提供的数据可能会影响外科医生对该损伤的处理。
