Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Arthroscopy. 2023 Dec;39(12):2487-2498.e4. doi: 10.1016/j.arthro.2023.04.009. Epub 2023 May 2.
To investigate the biomechanics of the centralization augmentation using knotless soft anchors to a nonanatomical transtibial pull-out root repair in a porcine medial meniscus posterior root tear (MMPRT) model.
Porcine knee joints (N = 10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) nonanatomical root repair; (4) nonanatomical root repair with centralization using 2 anchors: anchors were inserted at the posterior medial collateral ligament (MCL) border and 10 mm anterior to the posterior MCL border; and (5) nonanatomical root repair with centralization using 3 anchors: another anchor was placed 10 mm posterior to the posterior MCL border. Contact area on the medial meniscus (MM), contact pressure in the MM and tibial cartilage, and MM extrusion were evaluated at 30°, 45°, 60°, and 90° knee flexions under 200 N compressive force.
MM extrusion at the posterior MCL border was significantly reduced after root repair with centralization using 3 anchors than after root repair alone at 30° (-0.063 mm vs 1.5 mm, P = .017), 45° (0.21 mm vs 1.7 mm, P = .018), and 60° (0.78 mm vs 2.3 mm, P = .019). There were no significant differences in MM extrusion between the root repair alone and root repair with centralization using 2 anchors at all flexion angles. The contact area in the middle and posterior MM was significantly greater after centralization with 3 anchors than after root repair alone at all flexion angles (except the posterior MM at 90°). The mean contact pressure in the tibial cartilage was significantly lower after centralization with 3 anchors than after root repair at all angles.
Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution between 30° and 60° flexion compared with nonanatomical root repair alone in a porcine model.
This biomechanical study at time zero suggests that the addition of centralization using 3 knotless anchors may reduce MM extrusion and restore the load-distributing function of the MM.
研究使用无结软锚对非解剖胫骨后拉根修复术进行中央化增强，以治疗猪内侧半月板后根撕裂（MMPRT）模型的生物力学。
使用猪膝关节（N=10）进行以下操作之一：（1）完整；（2）MMPRT；（3）非解剖根修复；（4）使用 2 个锚定物进行非解剖根修复的中央化：锚定物插入内侧副韧带（MCL）后缘和 MCL 后缘前 10mm 处；和（5）使用 3 个锚定物进行非解剖根修复的中央化：另一个锚定物放置在 MCL 后缘后 10mm 处。在 200N 压缩力下，在 30°、45°、60°和 90°膝关节屈曲下，评估内侧半月板（MM）上的接触面积、MM 和胫骨软骨内的接触压力以及 MM 挤出。
与单独进行根修复相比，使用 3 个锚定物进行中央化后，在后 MCL 边界处的 MM 挤出明显减少，在 30°（-0.063mm 与 1.5mm，P=0.017）、45°（0.21mm 与 1.7mm，P=0.018）和 60°（0.78mm 与 2.3mm，P=0.019）时。在所有弯曲角度下，单独进行根修复与使用 2 个锚定物进行中央化之间的 MM 挤出均无显著差异。与单独进行根修复相比，使用 3 个锚定物进行中央化后，MM 的中间和后部接触面积在所有弯曲角度均显著增加（除 90°时的后部 MM 外）。与根修复相比，使用 3 个锚定物进行中央化后，胫骨软骨内的平均接触压力显著降低。
与单独进行非解剖根修复相比，在猪模型中，使用 3 个无结锚钉进行中央化增强内侧半月板后根撕裂的修复可能与较低的半月板挤出和更好的 30°至 60°屈曲时的压缩载荷分布有关。
这项零时间的生物力学研究表明，使用 3 个无结锚钉进行中央化增强可能会减少 MM 挤出并恢复 MM 的分布载荷功能。
