Suppr超能文献

骨栓与单纯缝合固定半月板移植:对模拟步态期间关节接触力学的影响

Bone Plug Versus Suture-Only Fixation of Meniscal Grafts: Effect on Joint Contact Mechanics During Simulated Gait.

作者信息

Wang Hongsheng, Gee Albert O, Hutchinson Ian D, Stoner Kirsten, Warren Russell F, Chen Tony O, Maher Suzanne A

机构信息

Hospital for Special Surgery, New York, New York, USA.

Hospital for Special Surgery, New York, New York, USA

出版信息

Am J Sports Med. 2014 Jul;42(7):1682-9. doi: 10.1177/0363546514530867. Epub 2014 Apr 28.

Abstract

BACKGROUND

Meniscus allograft transplantation (MAT) is primarily undertaken to relieve the symptoms associated with meniscal deficiencies. However, its ability to restore normal knee joint contact mechanics under physiological loads is still unclear.

PURPOSE

To quantify the dynamic contact mechanics associated with 2 commonly used fixation techniques in MAT of the medial compartment: transosseous suture fixation via bone plugs and suture-only fixation at the horns.

STUDY DESIGN

Controlled laboratory study.

METHODS

Physiological loads to mimic gait were applied across 7 human cadaveric knees on a simulator. A sensor placed on the medial tibial plateau recorded dynamic contact stresses under the following conditions: (1) intact meniscus, (2) MAT using transosseous suture fixation via bone plugs at the anterior and posterior horns, (3) MAT using suture-only fixation, and (4) total medial meniscectomy. A "remove-replace" procedure was performed to place the same autograft for both MAT conditions to minimize the variability in graft size, geometry, and material property and to isolate the effects of the fixation technique. Contact stress, contact area, and weighted center of contact stress (WCoCS) were quantified on the medial plateau throughout the stance phase.

RESULTS

Knee joint contact mechanics were sensitive to the meniscal condition primarily during the first half of the gait cycle. After meniscectomy, the mean peak contact stress increased from 4.2 ± 1.2 MPa to 6.2 ± 1.0 MPa (P = .04), and the mean contact area decreased from 546 ± 132 mm2 to 192 ± 122 mm2 (P = .01) compared with the intact meniscus during early stance (14% of the gait cycle). After MAT, the mean contact stress significantly decreased with bone plug fixation (5.0 ± 0.7 MPa) but not with suture-only fixation (5.9 ± 0.7 MPa). Both fixation techniques partially restored the contact area, but bone plug fixation restored it closer to the intact condition. The location of WCoCS in the central cartilage region (not covered by the meniscus) shifted peripherally throughout the stance phase. Bone plug fixation exhibited correction to this peripheral offset, but suture-only fixation did not.

CONCLUSION

Under dynamic loading, transosseous fixation at the meniscal horns provides superior load distribution at the involved knee compartment after meniscal transplantation compared with suture-only fixation. Particular attention should be directed to the ability of medial MAT to function during the early stance phase.

CLINICAL RELEVANCE

Transosseous fixation via bone plugs provides superior load distribution of a transplanted meniscal allograft compared with suture fixation alone at time zero.

摘要

背景

同种异体半月板移植(MAT)主要用于缓解与半月板缺损相关的症状。然而,其在生理负荷下恢复正常膝关节接触力学的能力仍不明确。

目的

量化内侧间室MAT中两种常用固定技术相关的动态接触力学:通过骨栓的经骨缝合法固定和仅在角部进行缝合法固定。

研究设计

对照实验室研究。

方法

在模拟器上对7具人类尸体膝关节施加模拟步态的生理负荷。放置在内侧胫骨平台上的传感器记录以下情况下的动态接触应力:(1)半月板完整,(2)通过前后角的骨栓采用经骨缝合法固定进行MAT,(3)采用仅缝合法固定进行MAT,(4)内侧半月板全切除术。对两种MAT情况均采用“移除-替换”程序放置相同的同种异体移植物,以尽量减少移植物大小、几何形状和材料特性的变异性,并分离固定技术的影响。在整个站立期对内侧面的接触应力、接触面积和接触应力加权中心(WCoCS)进行量化。

结果

膝关节接触力学主要在步态周期的前半段对半月板状况敏感。半月板切除术后,与早期站立(步态周期的14%)时的完整半月板相比,平均峰值接触应力从4.2±1.2MPa增加到6.2±1.0MPa(P = 0.04),平均接触面积从546±132mm²减少到192±122mm²(P = 0.01)。MAT后,采用骨栓固定时平均接触应力显著降低(5.0±0.7MPa),而仅缝合法固定时则未降低(5.9±0.7MPa)。两种固定技术均部分恢复了接触面积,但骨栓固定使其恢复得更接近完整状态。在整个站立期,WCoCS在中央软骨区域(未被半月板覆盖)的位置向周边移动。骨栓固定对这种周边偏移有矫正作用,而仅缝合法固定则没有。

结论

在动态负荷下,与仅缝合法固定相比,半月板角部的经骨固定在半月板移植后为受累膝关节间室提供了更好的负荷分布。应特别关注内侧MAT在早期站立期的功能能力。

临床意义

与仅缝合法固定相比,通过骨栓的经骨固定在零时为移植的同种异体半月板提供了更好的负荷分布。

相似文献

1
Bone Plug Versus Suture-Only Fixation of Meniscal Grafts: Effect on Joint Contact Mechanics During Simulated Gait.
Am J Sports Med. 2014 Jul;42(7):1682-9. doi: 10.1177/0363546514530867. Epub 2014 Apr 28.
2
Lateral Meniscal Graft Transplantation: Effect of Fixation Method on Joint Contact Mechanics During Simulated Gait.
Am J Sports Med. 2019 Aug;47(10):2437-2443. doi: 10.1177/0363546519860113. Epub 2019 Jul 17.
3
Lateral Meniscal Allograft Transplantation With Bone Block and Suture-Only Techniques Partially Restores Knee Kinematics and Forces.
Am J Sports Med. 2019 Aug;47(10):2427-2436. doi: 10.1177/0363546519858085. Epub 2019 Jun 28.
5
Bone-Plug Versus Soft Tissue Fixation of Medial Meniscal Allograft Transplants: A Biomechanical Study.
Am J Sports Med. 2019 Oct;47(12):2960-2965. doi: 10.1177/0363546519870179. Epub 2019 Aug 27.
7
Biomechanical Analysis of Segmental Medial Meniscal Transplantation in a Human Cadaveric Model.
Am J Sports Med. 2021 Oct;49(12):3279-3286. doi: 10.1177/03635465211036441. Epub 2021 Sep 8.

引用本文的文献

2
Meniscus Allograft Transplantation With Bone Plugs Using Knotless All-Suture Anchors and Cortical Button Suspensory Fixation.
Arthrosc Tech. 2023 Sep 11;12(10):e1707-e1714. doi: 10.1016/j.eats.2023.05.020. eCollection 2023 Oct.
3
Biomechanical Analysis Evaluating Meniscal Extrusion After Knotless Suture Anchor Fixation for Segmental Medial Meniscal Allograft Transplantation.
Orthop J Sports Med. 2023 Aug 22;11(8):23259671231182978. doi: 10.1177/23259671231182978. eCollection 2023 Aug.
4
Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation.
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4485-4491. doi: 10.1007/s00167-023-07506-9. Epub 2023 Aug 18.
5
Meniscal Allograft Transplantation: Does Surgical Technique Influence Clinical Outcomes?
Curr Rev Musculoskelet Med. 2023 May;16(5):163-172. doi: 10.1007/s12178-023-09825-3. Epub 2023 Apr 4.
6
Clinical Replacement Strategies for Meniscus Tissue Deficiency.
Cartilage. 2021 Dec;13(1_suppl):262S-270S. doi: 10.1177/19476035211060512. Epub 2021 Nov 20.
7
Preliminary biomechanical cadaver study investigating a new load-sharing knee implant.
J Exp Orthop. 2021 Aug 14;8(1):61. doi: 10.1186/s40634-021-00379-2.
8
Synthetic PVA Osteochondral Implants for the Knee Joint: Mechanical Characteristics During Simulated Gait.
Am J Sports Med. 2021 Sep;49(11):2933-2941. doi: 10.1177/03635465211028566. Epub 2021 Aug 4.
9
Lateral Meniscal Allograft Transplant: Dovetail Bone Bridge Preparation.
Arthrosc Tech. 2021 Feb 22;10(4):e969-e973. doi: 10.1016/j.eats.2020.11.008. eCollection 2021 Apr.

本文引用的文献

1
Dynamic contact stress patterns on the tibial plateaus during simulated gait: a novel application of normalized cross correlation.
J Biomech. 2014 Jan 22;47(2):568-74. doi: 10.1016/j.jbiomech.2013.11.042. Epub 2013 Dec 3.
2
Dynamic contact mechanics on the tibial plateau of the human knee during activities of daily living.
J Biomech. 2014 Jun 27;47(9):2006-12. doi: 10.1016/j.jbiomech.2013.11.003. Epub 2013 Nov 16.
3
Restoration of the meniscus: form and function.
Am J Sports Med. 2014 Apr;42(4):987-98. doi: 10.1177/0363546513498503. Epub 2013 Aug 12.
5
The effect of arthroscopic partial medial meniscectomy on tibiofemoral stability.
Am J Sports Med. 2013 Jan;41(1):73-9. doi: 10.1177/0363546512464482. Epub 2012 Nov 13.
7
Suture-only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation.
Am J Sports Med. 2012 Jul;40(7):1591-6. doi: 10.1177/0363546512446674. Epub 2012 May 11.
8
Allograft meniscus transplantation.
Sports Med Arthrosc Rev. 2012 Jun;20(2):106-14. doi: 10.1097/JSA.0b013e318246f005.
9
Surgical options for meniscal replacement.
J Am Acad Orthop Surg. 2012 May;20(5):265-72. doi: 10.5435/JAAOS-20-05-265.
10
Prospective comparative study between two different fixation techniques in meniscal allograft transplantation.
Knee Surg Sports Traumatol Arthrosc. 2013 Jul;21(7):1516-22. doi: 10.1007/s00167-012-2032-4. Epub 2012 May 3.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验