Perez-Blanca Ana, Espejo-Baena Alejandro, Amat Trujillo Daniel, Prado Nóvoa María, Espejo-Reina Alejandro, Quintero López Clara, Ezquerro Juanco Francisco
Biomechanics Laboratory, Department of Mechanical Engineering, University of Malaga, Malaga, Spain.
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Malaga, Spain.
Arthroscopy. 2016 Apr;32(4):624-33. doi: 10.1016/j.arthro.2015.08.040. Epub 2015 Nov 4.
To compare the effects of lateral meniscus posterior root avulsion left in situ, its repair, and meniscectomy on contact pressure distribution in both tibiofemoral compartments at different flexion angles.
Eight cadaveric knees were tested under compressive 1000 N load for 4 lateral meniscus conditions (intact, posterior root avulsion, transosseous root repair, and total meniscectomy) at flexion angles 0°, 30°, 60°, and 90°. Contact area and pressure distribution were registered using K-scan pressure sensors inserted between menisci and tibial plateau.
In the lateral compartment, root detachment decreased contact area (P = .017, 0° and 30°; P = .012, 60° and 90°) and increased mean (P = .012, all angles) and maximum (P = .025, 0° and 30°; P = .017, 60°; P = .012, 90°) pressures relative to intact condition. Repair restored all measured parameters close to intact at 0°, but effectiveness decreased with flexion angle, yielding no significant effect at 90°. Meniscectomy produced higher decreases than root avulsion in contact area (P = .012, 0° and 90°; P = .05, 30° and 60°) and increases in mean (P = .017, 0° and 30°; P = .018, 90°) and maximum pressure (P = .012, 0°; P = .036, 30°). In the medial compartment, lesion changed the contact area at high flexion angles only, while meniscectomy induced greater changes at all angles.
Lateral meniscus posterior root avulsion generates significant alterations in contact area and pressures at lateral knee compartment for flexion angles between full extension and 90°. Meniscectomy causes greater disorders than the avulsion left in situ. Transosseous repair with a single suture restores these alterations to conditions close to intact at 0° and 30° but not at 60° and 90°.
Altered contact mechanics after lateral meniscus posterior root avulsion might have degenerative consequences. Transosseous repair with one suture should be revised to effectively restore contact mechanics at high flexion angles.
比较外侧半月板后根撕脱后原位保留、修复及半月板切除术对不同屈膝角度下胫股关节两腔室接触压力分布的影响。
对8具尸体膝关节在1000 N压缩负荷下进行测试，针对4种外侧半月板情况（完整、后根撕脱、经骨隧道修复及全半月板切除术），屈膝角度分别为0°、30°、60°和90°。使用插入半月板与胫骨平台之间的K型扫描压力传感器记录接触面积和压力分布。
在外侧腔室，相对于完整状态，后根撕脱减少了接触面积（0°和30°时P = 0.017；60°和90°时P = 0.012），并增加了平均压力（所有角度P = 0.012）和最大压力（0°和30°时P = 0.025；60°时P = 0.017；90°时P = 0.012）。修复在0°时使所有测量参数恢复至接近完整状态，但随着屈膝角度增加有效性降低，在90°时无显著效果。半月板切除术导致接触面积的减少幅度大于后根撕脱（0°和90°时P = 0.012；30°和60°时P = 0.05），平均压力（0°和30°时P = 0.017；90°时P = 0.018）和最大压力（0°时P = 0.012；30°时P = 0.036）增加。在内侧腔室，损伤仅在高屈膝角度时改变接触面积，而半月板切除术在所有角度均引起更大变化。
外侧半月板后根撕脱在完全伸直至90°的屈膝角度范围内，会使外侧膝关节腔室的接触面积和压力产生显著改变。半月板切除术比原位撕脱造成的紊乱更大。单缝线经骨隧道修复可在0°和30°时将这些改变恢复至接近完整状态，但在60°和90°时则不能。
外侧半月板后根撕脱后接触力学改变可能具有退变后果。应改进单缝线经骨隧道修复方法，以有效恢复高屈膝角度时的接触力学。
