Zhang Kaijia, Li Lan, Yang Longfei, Shi Jianping, Zhu Liya, Liang Huixin, Wang Xingsong, Yang Xianfeng, Jiang Qing
State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China.
School of Mechanical Engineering, Southeast University, Nanjing, China.
J Orthop Translat. 2019 Jan 21;18:20-31. doi: 10.1016/j.jot.2018.12.004. eCollection 2019 Jul.
The objective of this study is to investigate the biomechanics on the knee components caused by degenerative and radial meniscal tears and resultant meniscectomy.
A detailed finite element model of the knee joint with bones, cartilages, menisci and main ligaments was constructed from a combination of computed tomography and magnetic resonance images. Degenerative and radial tears of both menisci and resultant medial meniscectomy were used and two different kinds of simulations, the vertical and the anterior load, mimicking the static stance and slight flexion simulations, were applied on the model. The compressive and shear stress and meniscus extrusion were evaluated and compared.
Generally, both degenerative and radial tears lead to increased peak compressive and shear stress of both cartilages and menisci and large meniscus extrusion, and the medial meniscal tear induced larger value of stress and extrusion than the lateral meniscal tear. The peak stress and meniscus extrusion further elevated after the medial meniscus meniscectomy. Distribution of stress was shifted from the intact hemi joint to the injured hemi joint with either medial or lateral meniscal tear.
Our finite element model provides a realistic three-dimensional knee model to investigate the effects of degenerative and radial meniscal tears and resultant meniscectomy on the stress distribution of the knee. The stress was increased in meniscal tears and increased significantly when meniscectomy was performed. Increased meniscus extrusion may explain the mechanism for higher stress on the components of the knee.
Meniscal tears are the most common damage associated to the menisci, and meniscectomy is often performed to relieve the pain and instability of the knee. The results of our study indicated increased stress on cartilages and menisci, which may lead to early onset of osteoarthritis. This may guide surgeons to preserve more of the meniscus when performing meniscectomy.
本研究旨在探讨退行性和放射状半月板撕裂以及由此导致的半月板切除术对膝关节部件的生物力学影响。
结合计算机断层扫描和磁共振图像构建了一个包含骨骼、软骨、半月板和主要韧带的膝关节详细有限元模型。使用半月板的退行性和放射状撕裂以及由此导致的内侧半月板切除术，并在模型上应用两种不同的模拟，即垂直载荷和前向载荷，分别模拟静态站立和轻微屈曲模拟。评估并比较了压缩应力、剪切应力和半月板挤出情况。
一般来说，退行性和放射状撕裂均会导致软骨和半月板的峰值压缩应力和剪切应力增加以及半月板大量挤出，并且内侧半月板撕裂引起的应力和挤出值比外侧半月板撕裂更大。内侧半月板切除术后，峰值应力和半月板挤出进一步升高。无论是内侧还是外侧半月板撕裂，应力分布都从完整的半关节转移到了受损的半关节。
我们的有限元模型提供了一个逼真的三维膝关节模型，用于研究退行性和放射状半月板撕裂以及由此导致的半月板切除术对膝关节应力分布的影响。半月板撕裂时应力增加，半月板切除术后应力显著增加。半月板挤出增加可能解释了膝关节部件上应力较高的机制。
半月板撕裂是半月板最常见的损伤，半月板切除术常被用于缓解膝关节的疼痛和不稳定。我们的研究结果表明软骨和半月板上的应力增加，这可能导致骨关节炎的早期发作。这可能会指导外科医生在进行半月板切除术时保留更多的半月板。
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