Beamer Brandon S, Walley Kempland C, Okajima Stephen, Manoukian Ohan S, Perez-Viloria Miguel, DeAngelis Joseph P, Ramappa Arun J, Nazarian Ara
Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
Arthroscopy. 2017 Mar;33(3):617-624. doi: 10.1016/j.arthro.2016.09.004. Epub 2016 Dec 10.
To assess the changes in tibiofemoral contact pressure and contact area in human knees with a horizontal cleavage tear before and after treatment.
Ten human cadaveric knees were tested. Pressure sensors were placed under the medial meniscus and the knees were loaded at twice the body weight for 20 cycles at 0°, 10°, and 20° of flexion. Contact area and pressure were recorded for the intact meniscus, the meniscus with a horizontal cleavage tear, after meniscal repair, after partial meniscectomy (single leaflet), and after subtotal meniscectomy (double leaflet).
The presence of a horizontal cleavage tear significantly increased average peak contact pressure and reduced effective average tibiofemoral contact area at all flexion angles tested compared with the intact state (P < .03). There was approximately a 70% increase in contact pressure after creation of the horizontal cleavage tear. Repairing the horizontal cleavage tear restored peak contact pressures and areas to within 15% of baseline, statistically similar to the intact state at all angles tested (P < .05). Partial meniscectomy and subtotal meniscectomy significantly increased average peak contact pressure and reduced average contact area at all degrees of flexion compared with the intact state (P < .05).
The presence of a horizontal cleavage tear in the medial meniscus causes a significant reduction in contact area and a significant elevation in contact pressure. These changes may accelerate joint degeneration. A suture-based repair of these horizontal cleavage tears returns the contact area and contact pressure to nearly normal, whereas both partial and subtotal meniscectomy lead to significant reductions in contact area and significant elevations in contact pressure within the knee. Repairing horizontal cleavage tears may lead to improved clinical outcomes by preserving meniscal tissue and the meniscal function.
Understanding contact area and peak contact pressure resulting from differing strategies for treating horizontal cleavage tears will allow the surgeon to evaluate the best strategy for treating his or her patients who present with this meniscal pathology.
评估患有水平劈裂伤的人膝关节在治疗前后胫股接触压力和接触面积的变化。
对10个新鲜人尸体膝关节进行测试。将压力传感器置于内侧半月板下方，在膝关节屈曲0°、10°和20°时，以两倍体重加载20个循环。记录完整半月板、有水平劈裂伤的半月板、半月板修复后、部分半月板切除术（单叶）后以及次全半月板切除术（双叶）后的接触面积和压力。
与完整状态相比，在所有测试的屈曲角度下，水平劈裂伤的存在均显著增加了平均峰值接触压力，并减小了有效平均胫股接触面积（P < 0.03）。制造水平劈裂伤后，接触压力大约增加了70%。修复水平劈裂伤可使峰值接触压力和面积恢复到基线的15%以内，在所有测试角度下，统计学上与完整状态相似（P < 0.05）。与完整状态相比，部分半月板切除术和次全半月板切除术在所有屈曲程度下均显著增加了平均峰值接触压力，并减小了平均接触面积（P < 0.05）。
内侧半月板水平劈裂伤的存在会导致接触面积显著减小和接触压力显著升高。这些变化可能会加速关节退变。基于缝线的这些水平劈裂伤修复可使接触面积和接触压力恢复到接近正常水平，而部分和次全半月板切除术均会导致膝关节内接触面积显著减小和接触压力显著升高。修复水平劈裂伤可能通过保留半月板组织和半月板功能而改善临床结果。
了解不同治疗水平劈裂伤策略所导致的接触面积和峰值接触压力，将使外科医生能够评估针对患有这种半月板病变的患者的最佳治疗策略。
