Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A.
Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A.; Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A.
Arthroscopy. 2022 Nov;38(11):3080-3089. doi: 10.1016/j.arthro.2022.06.015. Epub 2022 Jun 27.
To compare meniscal extrusion (ME) following medial meniscus allograft transplantation (MMAT) with and without meniscotibial ligament reconstruction (MTLR).
Ten cadaveric knees were size-matched with meniscus allografts. MMAT was performed via bridge-in-slot technique. Specimens were mounted in a testing system and ME was assessed via ultrasound anterior, directly over, and posterior to the medial collateral ligament at the joint line under 4 testing conditions: (1) 0° flexion and 0 newtons (N) of axial load, (2) 0° and 1,000 N, (3) 30° and 0 N, and (4) 30° and 1,000 N. For each condition, "mean total extrusion" was calculated by averaging measurements at each position. Next, MTLR was performed using 2 inside-out sutures through the remnant allograft meniscotibial ligament and secured to the tibia using anchors. The testing protocol was repeated. Differences in ME between MMAT alone versus MMAT + MTLR were examined. Within-group differences between the measurement positions, loading states, and flexion angles also were assessed.
"Mean total extrusion" was greater following MMAT alone (2.56 ± 1.23 mm) versus MMAT + MTLR (2.14 ± 1.07 mm; P = .005) in the loaded state at 0° flexion. ME directly over the MCL was greater following MMAT alone (3.51 ± 1.00 mm) compared with MMAT + MTLR (2.93 ± 0.79 mm; P = .054). Posteriorly, in the loaded state at 0°, ME was greater following MMAT alone (2.43 ± 1.10 mm) compared with MMAT + MTLR (1.96 ± 0.99 mm; P = .010). In all conditions, ME was greater in the loaded state versus the unloaded state.
Following MMAT, the addition of MTLR significantly reduced overall ME when compared with isolated MMAT during loading at 0° of flexion in a cadaveric model; given the small absolute values of change in extrusion, clinical significance cannot be gleaned from these findings.
During medial meniscus allograft transplantation, augmentation with meniscotibial ligament reconstruction may limit meniscal extrusion and improve the biomechanical milieu of the knee joint following transplant.
比较内侧半月板同种异体移植（MMAT）后结合与不结合半月板胫束重建（MTLR）的半月板突出（ME）。
10 个尸体膝关节与半月板同种异体移植物大小匹配。采用桥接槽技术进行 MMAT。标本安装在测试系统中，在关节线处通过内侧副韧带前、直接、后，在 4 种测试条件下通过超声评估 ME：（1）0°屈曲和 0 牛顿（N）轴向载荷，（2）0°和 1000N，（3）30°和 0N，（4）30°和 1000N。对于每种情况，通过在每个位置平均测量值计算“平均总挤出量”。然后，通过穿过残留同种异体半月板胫束的 2 个内部出针和使用锚将其固定到胫骨上来进行 MTLR。重复测试方案。比较 MMAT 单独与 MMAT+MTLR 之间的 ME 差异。还评估了测量位置、加载状态和屈曲角度之间的组内差异。
在 0°屈曲的加载状态下，MMAT 单独（2.56±1.23mm）与 MMAT+MTLR（2.14±1.07mm；P=0.005）相比，“平均总挤出量”更大。与 MMAT+MTLR（2.93±0.79mm；P=0.054）相比，在 MCL 直接处，MMAT 单独（3.51±1.00mm）的 ME 更大。在后部，在 0°的加载状态下，MMAT 单独（2.43±1.10mm）的 ME 大于 MMAT+MTLR（1.96±0.99mm；P=0.010）。在所有条件下，加载状态下的 ME 大于非加载状态。
在尸体模型中，0°屈曲加载时，与单独的 MMAT 相比，MMAT 后添加 MTLR 可显著减少整体 ME；鉴于挤出量的绝对值变化较小，因此无法从这些发现中得出临床意义。
在进行内侧半月板同种异体移植时，半月板胫束重建的增强可能会限制半月板突出，并改善移植物后膝关节的生物力学环境。
