Center for Stem Cells and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
J Orthop Res. 2022 May;40(5):1097-1103. doi: 10.1002/jor.25146. Epub 2021 Aug 5.
The recently developed arthroscopic centralization for lateral meniscal extrusion has obtained satisfactory short-term clinical and radiological results and improves the meniscus biomechanical properties. However, the effectiveness of treatment for meniscus extrusion after partial meniscectomy still requires elucidation. This study investigated the effect of centralization with modifications from a mechanical viewpoint. Porcine knee joints (N = 6) were set in a universal tester under the following conditions: (1) Intact; (2) Meniscectomy: Inner half of the posterior half meniscus was removed; (3) Extrusion: Posterior meniscus was dislocated laterally by transecting the posterior root and the meniscotibial ligament; (4) Centralization-1: Centralization procedure using one anchor; (5) Centralization-2: Centralization procedure using two anchors; and (6) Centralization-ad: Centralization with capsular advancement using two anchors. Load distributions and contact pressure in the meniscus and tibial cartilage were evaluated with an axial compressive force of 200 N. After meniscectomy, the tibial cartilage load increased and that of the medial margin of the posterior part of the meniscus decreased. When the meniscus was extruded, the load was concentrated only on the tibial cartilage. Centralization-1 increased the load on the meniscus, while Centralization-2 further increased the meniscus load but decreased the tibial cartilage load. Centralization-ad further decreased the load on the tibial plateau. The average contact pressure of the tibial cartilage was significantly higher in the Extrusion group than in the Intact group or the Centralization-ad group. From a biomechanical viewpoint, centralization with capsular advancement was the most effective of the tested procedures for treatment for an extruded meniscus after partial meniscectomy.
最近发展起来的关节镜下外侧半月板中央化治疗外侧半月板外突已获得满意的短期临床和影像学结果，并改善了半月板生物力学特性。然而，对于半月板部分切除术后半月板外突的治疗效果仍需要阐明。本研究从力学角度探讨了中央化治疗的效果。将猪膝关节（N=6）置于万能试验机下，进行以下条件下的实验：（1）完整；（2）半月板切除术：切除后半月板的内半部分；（3）外突：切断后半月板根部和半月板胫骨韧带使后半月板向外侧脱位；（4）中央化-1：使用一个锚定物进行中央化程序；（5）中央化-2：使用两个锚定物进行中央化程序；（6）中央化-ad：使用两个锚定物进行囊袋推进中央化。在 200N 的轴向压缩力下，评估半月板和胫骨软骨的负荷分布和接触压力。半月板切除术后，胫骨软骨的负荷增加，后半月板内侧缘的负荷减少。当半月板外突时，负荷仅集中在胫骨软骨上。中央化-1 增加了半月板的负荷，而中央化-2 进一步增加了半月板的负荷，但减少了胫骨软骨的负荷。中央化-ad 进一步降低了胫骨平台的负荷。与完整组或中央化-ad 组相比，外突组胫骨软骨的平均接触压力显著升高。从生物力学角度看，与其他测试方法相比，囊袋推进中央化是治疗半月板部分切除术后半月板外突最有效的方法。
