Department of Orthopaedic Surgery, Scott and White Memorial Hospital, Temple, Texas, USA.
Arthroscopy. 2013 Jan;29(1):113-21. doi: 10.1016/j.arthro.2012.06.023. Epub 2012 Nov 30.
To critically evaluate the effect of marrow stimulation (MS) on the extent of healing and the local biological environment after meniscal injury in ligamentously stable knees in a rabbit model.
A reproducible 1.5-mm cylindrical defect was created in the avascular portion of the anterior horn of the medial meniscus bilaterally in 18 New Zealand White rabbits (36 knees). In right knees (MS knees), a 2.4-mm Steinman pin was drilled into the apex of the femoral intercondylar notch and marrow contents were observed spilling into the joint. Left knees served as controls. Rabbits were killed in 3 groups (n = 6 rabbits each) at 1, 4, and 12 weeks with meniscal harvest and blinded histomorphometric and histologic evaluation using an established 3-component tissue quality score (range, 0 to 6). One-week specimens were also evaluated for the presence of proregenerative cytokines using immunohistochemistry.
The mean proportion of the avascular zone defect bridged by reparative tissue was greater in MS knees than in controls at each endpoint (1 week, 55% v 30%, P = .02; 4 weeks, 71% v 53%, P = .047; 12 weeks, 96% v 77%, P = .16). Similarly, there was a consistent trend toward superior tissue quality scores in knees treated with MS compared with controls (1 week, 1.8 v 0.3, P = .03; 4 weeks, 4.3 v 2.8, P = .08; 12 weeks, 5.9 v 4.5, P = .21). No statistically significant differences, however, were observed at the 12-week endpoint. Increased staining for insulin-like growth factor I, transforming growth factor-β, and platelet-derived growth factor was observed in regenerated tissue, compared with native meniscal tissue, in all specimens at 1 week. Staining density for all growth factors was similar, however, in reparative tissue of MS and control knees.
The results of this study suggest that marrow stimulation leads to modest improvements in quality and quantity of reparative tissue bridging a meniscal defect, particularly during the early recovery period.
Clinical evaluation of marrow stimulation techniques designed to enhance healing in isolated meniscus repair surgery may be indicated.
在兔模型中，通过对稳定韧带的膝关节半月板内血供区的前角进行骨髓刺激（MS），评估其对半月板损伤后愈合范围和局部生物学环境的影响。
在 18 只新西兰白兔（36 只膝关节）双侧半月板内血供区前角创建了一个 1.5mm 圆柱形缺陷。右侧膝关节（MS 膝关节），在股骨髁间窝顶点钻入 2.4mm 的斯氏针，观察骨髓内容物溢出到关节内。左侧膝关节作为对照。每组 6 只兔子（n = 6 只）分别于 1、4 和 12 周时处死，取半月板进行盲法组织形态计量和组织学评价，采用已建立的 3 分量组织质量评分（范围 0 至 6）。还使用免疫组织化学法检测 1 周标本中再生前细胞因子的存在。
在每个时间点，MS 膝关节修复组织桥接的无血管区缺损比例均大于对照组（1 周时，55%比 30%，P =.02；4 周时，71%比 53%，P =.047；12 周时，96%比 77%，P =.16）。同样，与对照组相比，MS 治疗组的组织质量评分也呈上升趋势（1 周时，1.8 比 0.3，P =.03；4 周时，4.3 比 2.8，P =.08；12 周时，5.9 比 4.5，P =.21）。然而，在 12 周时并未观察到统计学上的显著差异。与天然半月板组织相比，所有标本在 1 周时再生组织中均观察到胰岛素样生长因子 I、转化生长因子-β 和血小板衍生生长因子的染色增加，然而，在 MS 和对照组膝关节的修复组织中，所有生长因子的染色密度均相似。
本研究结果表明，骨髓刺激可适度改善半月板缺损修复组织的质量和数量，特别是在早期恢复期间。
可能需要对旨在增强孤立性半月板修复手术愈合的骨髓刺激技术进行临床评估。
