Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
Am J Sports Med. 2023 Sep;51(11):2964-2974. doi: 10.1177/03635465231188527. Epub 2023 Aug 17.
The optimal treatment option for meniscus root tears is still challenging, and whether the meniscus root repair ultimately can arrest or delay osteoarthritic changes is still a concern.
PURPOSE/HYPOTHESIS: The purpose of this study was 2-fold: (1) to describe and compare histopathologic findings of 3 different therapeutic options for medial meniscus posterior root tear: nonoperative management, partial meniscectomy, and meniscus root repair; and (2) to test the hypothesis that meniscus root tears treated nonoperatively predispose to a lower risk of osteoarthritic progression compared with partial meniscectomy.
Controlled laboratory study.
Posteromedial meniscus root tears were carried out in 39 New Zealand White rabbits. Animals were randomly assigned into 3 experimental groups: partial meniscectomy after root tear (PM; n = 13), root tears treated conservatively (CT; n = 13), and transtibial root repair (RR; n = 13). Contralateral limbs were used as healthy controls. The animals were euthanized at 16 weeks postoperatively; tissue samples of femoral and tibial articular cartilage were collected and processed for macro- and microscopic assessment to detect signs of early osteoarthritis (OA). Each sample was histopathologically assessed using the Osteoarthritis Research Society International grading and staging system.
Osteoarthritic changes were the hallmark in all 3 experimental groups. The RR group had the lowest scores for cartilage damage (mean, 2.5; range, 2-3), and the PM group exhibited higher and more severe signs of OA (mean, 16; range, 9-16) compared with the CT group (mean, 5; range, 4-6). The between-group comparison revealed significant differences, as the PM group showed a significantly higher rate of macro- and microscopic osteoarthritic changes compared with the RR ( < .001) and CT ( < .001) groups. The weightbearing area of the medial femoral condyle was the most severely affected, and tidemark disruption was evident in all tissue samples.
Meniscus root repair cannot completely arrest the histopathologic progression of knee OA but leads to significantly less severe degenerative changes than partial meniscectomy and nonoperative treatment. Partial meniscectomy leads to the most severe osteoarthritic progression, while stable radial tears left in situ have lower progression compared with partial meniscectomy.
Histologic assessment is an essential tool and metric for guiding and understanding osteoarthritic features, providing insight into the disease development and progression. This study provides histopathologic evidence on osteoarthritic progression after medial meniscus posterior root repair. This knowledge can help to set more realistic expectations and can lead to the future development of augmented techniques.
半月板后根撕裂的最佳治疗选择仍具有挑战性，半月板后根修复是否最终能阻止或延缓骨关节炎的进展仍是一个关注点。
目的/假设：本研究的目的有两个：（1）描述和比较内侧半月板后根撕裂的 3 种不同治疗选择的组织病理学发现：非手术治疗、半月板部分切除术和半月板后根修复；（2）检验非手术治疗半月板后根撕裂相对于半月板部分切除术更能降低骨关节炎进展风险的假设。
对照实验室研究。
在 39 只新西兰白兔中进行后内侧半月板根撕裂。动物被随机分配到 3 个实验组：根撕裂后行半月板部分切除术（PM；n=13）、保守治疗（CT；n=13）和经胫骨根修复（RR；n=13）。对侧肢体作为健康对照。术后 16 周处死动物；采集股骨和胫骨关节软骨的组织样本进行宏观和微观评估，以检测早期骨关节炎（OA）的迹象。每个样本均采用国际骨关节炎研究协会（OARSI）分级和分期系统进行组织病理学评估。
所有 3 个实验组均出现骨关节炎改变。RR 组的软骨损伤评分最低（平均 2.5；范围 2-3），PM 组的 OA 征象较 CT 组（平均 5；范围 4-6）更高且更严重（平均 16；范围 9-16）。组间比较显示有显著差异，PM 组与 RR（<0.001）和 CT（<0.001）组相比，有更高的宏观和微观骨关节炎改变发生率。内侧股骨髁负重区最严重受累，所有组织样本均可见潮线破坏。
半月板后根修复不能完全阻止膝关节 OA 的组织病理学进展，但与半月板部分切除术和非手术治疗相比，可导致更轻微的退行性改变。半月板部分切除术导致最严重的骨关节炎进展，而稳定的原位放射状撕裂与半月板部分切除术相比进展程度较低。
组织学评估是指导和理解骨关节炎特征的重要工具和指标，为了解疾病的发展和进展提供了深入的认识。本研究提供了内侧半月板后根修复后骨关节炎进展的组织病理学证据。这些知识可以帮助设定更现实的期望，并可能导致增强技术的未来发展。
