The Steadman Clinic, Vail, Colorado, USA.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Am J Sports Med. 2021 Oct;49(12):3279-3286. doi: 10.1177/03635465211036441. Epub 2021 Sep 8.
Meniscal deficiency has been reported to increase contact pressures in the affected tibiofemoral joint, possibly leading to degenerative changes. Current surgical options include meniscal allograft transplantation and insertion of segmental meniscal scaffolds. Little is known about segmental meniscal allograft transplantation.
To evaluate the effectiveness of segmental medial meniscal allograft transplantation in the setting of partial medial meniscectomy in restoring native knee loading characteristics.
Controlled laboratory study.
Ten fresh-frozen human cadaveric knees underwent central midbody medial meniscectomy and subsequent segmental medial meniscal allograft transplantation. Knees were loaded in a dynamic tensile testing machine to 1000 N for 20 seconds at 0°, 30°, 60°, and 90° of flexion. Four conditions were tested: (1) intact medial meniscus, (2) deficient medial meniscus, (3) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures, and (4) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures and 1 suture fixed through 2 bone tunnels. Submeniscal medial and lateral pressure-mapping sensors assessed mean contact pressure, peak contact pressure, mean contact area, and pressure mapping. Two-factor random-intercepts linear mixed effects models compared pressure and contact area measurements among experimental conditions.
The meniscal-deficient state demonstrated a significantly higher mean contact pressure than all other testing conditions (mean difference, ≥0.35 MPa; < .001 for all comparisons) and a significantly smaller total contact area as compared with all other testing conditions (mean difference, ≤140 mm; < .001 for all comparisons). There were no significant differences in mean contact pressure or total contact area among the intact, transplant, or transplant-with-tunnel groups or in any outcome measure across all comparisons in the lateral compartment. No significant differences existed in center of pressure and relative pressure distribution across testing conditions.
Segmental medial meniscal allograft transplantation restored the medial compartment mean contact pressure and mean contact area to values measured in the intact medial compartment.
Segmental medial meniscal transplantation may provide an alternative to full meniscal transplantation by addressing only the deficient portion of the meniscus with transplanted tissue. Additional work is required to validate long-term fixation strength and biologic integration.
半月板缺失被报道会增加受影响的胫股关节的接触压力，可能导致退行性改变。目前的手术选择包括半月板同种异体移植和半月板节段性支架植入。关于半月板节段性同种异体移植知之甚少。
评估内侧半月板节段性同种异体移植在部分内侧半月板切除术后恢复膝关节固有负荷特征的效果。
对照实验室研究。
10 个新鲜冷冻的人尸体膝关节接受中央中段内侧半月板切除术，随后进行内侧半月板节段性同种异体移植。膝关节在动态拉伸试验机上以 1000 N 的载荷加载 20 秒，在 0°、30°、60°和 90°的屈曲角度下进行测试。测试了 4 种情况：（1）完整的内侧半月板，（2）半月板缺失，（3）用 7 个半月板囊缝线固定的半月板节段移植，和（4）用 7 个半月板囊缝线和 1 个穿过 2 个骨隧道的缝线固定的半月板节段移植。亚半月板内侧和外侧压力映射传感器评估平均接触压力、峰值接触压力、平均接触面积和压力映射。两因素随机截距线性混合效应模型比较了实验条件下的压力和接触面积测量值。
半月板缺失状态的平均接触压力明显高于所有其他测试条件（平均差异，≥0.35 MPa；所有比较均 <.001），总接触面积明显小于所有其他测试条件（平均差异，≤140 mm；所有比较均 <.001）。在完整、移植或移植带隧道组之间，以及在所有比较的外侧间室中，平均接触压力或总接触面积均无显著差异。在所有测试条件下，压力中心和相对压力分布均无显著差异。
半月板节段性同种异体移植将内侧间室的平均接触压力和平均接触面积恢复到完整内侧间室测量的值。
半月板节段性移植可能通过仅用移植组织处理半月板的缺陷部分来替代全半月板移植，为患者提供一种选择。需要进一步的工作来验证长期固定强度和生物整合。
