Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Fort Worth Orthopaedic Surgery, Fort Worth, Texas, U.S.A..
Arthroscopy. 2017 Oct;33(10):1840-1848. doi: 10.1016/j.arthro.2017.04.013. Epub 2017 Jul 25.
To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles.
Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors.
No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged from 498 to 561 mm, 786 to 997 N/mm, and 1,990 to 2,215 N/mm, respectively.
Contact area, mean contact pressure, and peak contact pressure were not significantly different between the all-inside and inside-out repair techniques at any tested flexion angle. Both techniques adequately restored native meniscus biomechanics near an intact level.
An all-inside repair technique provided similar, native-state-restoring contact mechanics compared with an inside-out repair technique for the treatment of displaced bucket-handle tears of the medial meniscus. Thus, both techniques may adequately decrease the likelihood of cartilage degeneration.
直接比较内侧半月板内、外技术修复对多个膝关节屈曲角度下内侧胫骨平台的固有接触面积和接触压力的有效性。
12 名非配对（n=12）的男性新鲜冷冻人尸体膝关节经历了以下 5 个连续状态：（1）完整的内侧半月板，（2）MCL 撕裂和修复，（3）内侧半月板模拟桶柄样纵向撕裂，（4）内侧半月板内翻修复，和（5）内侧半月板全内修复。膝关节在 5 个膝关节屈曲角度（0°、30°、45°、60°、90°）下承受 1000N 的轴向压缩力，使用薄膜压力传感器计算接触面积、平均接触压力和峰值接触压力。
在任何屈曲角度下，内翻和全内修复技术的接触面积、平均接触压力和峰值接触压力均无显著差异（均 P>0.791）。与撕裂的半月板状态相比，内翻和全内修复技术在所有屈曲角度下均增加了接触面积（均 P<0.005 和均 P<0.037），降低了平均接触压力（均 P<0.007 和均 P<0.001），除 0°（P=0.097 和 P=0.39）外，降低了峰值接触压力（均 P<0.001，均 P<0.001），除 0°（P=0.080 和 P=0.544）外。然而，在≥45°的角度下，与完整状态和内翻技术相比，接触面积和峰值接触压力存在显著差异（均 P<0.014 和均 P<0.032）。此外，在 60°和 90°的接触面积和 90°的峰值接触压力方面，与完整状态和全内技术之间存在显著差异（均 P<0.005 和 P=0.004）。在测试的屈曲角度范围内，完整接触面积、平均接触压力和峰值接触压力的中位数分别为 498 至 561mm、786 至 997N/mm 和 1990 至 2215N/mm。
在任何测试的屈曲角度下，全内和内翻修复技术的接触面积、平均接触压力和峰值接触压力均无显著差异。两种技术均能充分恢复内侧半月板的生物力学特性，接近正常水平。
与内侧半月板桶柄样撕裂的内翻修复技术相比，全内修复技术提供了相似的、恢复原生状态的接触力学特性。因此，两种技术都可以充分降低软骨退化的可能性。
