Saltzman Bryan M, Griffin Justin W, Wetters Nathan, Meyer Maximilian A, Cole Brian J, Yanke Adam B
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthrosc Tech. 2016 Oct 11;5(5):e1161-e1171. doi: 10.1016/j.eats.2016.07.002. eCollection 2016 Oct.
In recent decades, arthroscopic meniscal allograft transplantation (MAT) has been refined as a robust option for the treatment of evolving unicompartmental tibiofemoral arthrosis in the setting of meniscal deficiency. It is imperative that the MAT be performed in a knee with anatomic stability and alignment to reduce aberrant biomechanical forces experienced by the allograft tissue to maintain its durability. Thus, in an anterior cruciate ligament (ACL)-deficient knee, ACL reconstruction (ACLR) must be performed to restore the stable knee environment for the MAT to succeed. Although these operations can be performed in staged fashion, a single-stage procedure with concomitant MAT and ACLR is an option. Its performance is technically demanding and requires careful consideration as to the intraoperative setup, incisions, graft options, surgical tools, and procedural order to properly secure the transplanted meniscal allograft and restore a functional, anatomic ACL. We present our preferred technique for concomitant arthroscopic MAT and ACLR, as well as some potential pitfalls and pearls to avoid pitfalls.
近几十年来，关节镜下半月板同种异体移植（MAT）已发展成为治疗半月板缺损情况下逐渐发展的单髁胫股关节骨关节炎的一种可靠选择。必须在具有解剖稳定性和对线良好的膝关节中进行MAT，以减少同种异体移植组织所承受的异常生物力学力，从而维持其耐用性。因此，在存在前交叉韧带（ACL）缺损的膝关节中，必须进行ACL重建（ACLR）以恢复稳定的膝关节环境，使MAT取得成功。虽然这些手术可以分期进行，但同时进行MAT和ACLR的单阶段手术也是一种选择。其操作在技术上要求很高，需要在术中设置、切口、移植物选择、手术工具和手术顺序等方面进行仔细考虑，以妥善固定移植的半月板同种异体移植物并恢复功能性、解剖学上的ACL。我们介绍我们同时进行关节镜下MAT和ACLR的首选技术，以及一些可能的陷阱和避免陷阱所需的技巧。
