Nyland John, Campbell Kirk, Kalloub Alaa, Strauss Eric J, Kuban Katrina, Caborn David N M
Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA.
Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203-2188, USA.
Arch Orthop Trauma Surg. 2018 Mar;138(3):361-367. doi: 10.1007/s00402-017-2849-x. Epub 2017 Dec 2.
Tissue excision in the setting of a meniscal tear has been shown to dramatically increase peak contact stresses in the affected tibiofemoral joint compartment, leading to the development of degenerative changes and osteoarthritis.
PURPOSE/HYPOTHESIS: The current in vitro study utilized a porcine model to evaluate the effectiveness of segmental medial meniscal grafting following partial meniscectomy. The study hypothesis was that the procedure would normalize medial tibofemoral joint compartment pressure magnitudes, areas, and locations relative to an intact meniscus.
Controlled laboratory study.
Using pressure film, medial tibiofemoral joint compartment peak, and mean pressure magnitudes, peak pressure location and peak pressure area were determined using 12 potted, fresh frozen, porcine knee specimens. Data were collected at three different knee flexion angles (90°, 45°, and 0°) for three conditions: intact medial meniscus, following resection of the central third of the medial meniscus, and following segmental medial meniscal grafting. For each condition, the potted femur was positioned horizontally in a bench vise clamp, while a 20 pound (88.96 N) axial compression force was manually applied for a 60 s duration by the primary investigator through the base of the potted tibia using a digital force gauge.
Loss of the central 1/3 of the medial meniscus resulted in significant increases in the mean and peak pressures of the medial tibiofemoral joint compartment and decreased peak pressure area. Segmental meniscal grafting of the central third defect closely recreated the contact pressures and loading areas of the native, intact medial meniscus.
From a static, time zero biomechanical perspective, segmental medial meniscus grafting of a partially meniscectomized knee restored mean pressure, peak pressure, and mean peak contact pressure areas of the medial tibiofemoral joint compartment back to levels observed in the intact medial meniscus at different knee flexion angles. In-vivo analysis under dynamic conditions is necessary to verify the healing efficacy and ability of the healed segmental medial meniscal allograft to provide long-term knee joint homeostasis when confronted with dynamic shear, rotatory, and combined, higher magnitude physiologic loading forces.
半月板撕裂时进行组织切除已被证明会显著增加患侧胫股关节间室的峰值接触应力，从而导致退行性改变和骨关节炎的发展。
目的/假设：当前的体外研究利用猪模型评估部分半月板切除术后节段性内侧半月板移植的有效性。研究假设是该手术将使内侧胫股关节间室压力大小、面积以及相对于完整半月板的位置恢复正常。
对照实验室研究。
使用压力膜，对12个盆栽的新鲜冷冻猪膝关节标本测定内侧胫股关节间室的峰值和平均压力大小、峰值压力位置以及峰值压力面积。在三种情况下，于三个不同的膝关节屈曲角度（90°、45°和0°）收集数据：内侧半月板完整、内侧半月板中央三分之一切除后以及节段性内侧半月板移植后。对于每种情况，将盆栽股骨水平放置在台虎钳夹中，由主要研究者通过使用数字测力计，经盆栽胫骨底部手动施加20磅（88.96 N）的轴向压缩力，持续60秒。
内侧半月板中央三分之一缺失导致内侧胫股关节间室的平均和峰值压力显著增加，且峰值压力面积减小。中央三分之一缺损的节段性半月板移植紧密重现了天然完整内侧半月板的接触压力和负荷区域。
从静态、零时生物力学角度来看，部分半月板切除膝关节的节段性内侧半月板移植将内侧胫股关节间室的平均压力、峰值压力以及平均峰值接触压力面积恢复到在不同膝关节屈曲角度下完整内侧半月板所观察到的水平。需要在动态条件下进行体内分析，以验证愈合后的节段性内侧半月板同种异体移植物在面对动态剪切、旋转以及更高强度的联合生理负荷力时的愈合效果和维持膝关节长期稳态的能力。
