Bonanzinga Tommaso, Doro Gian Luca, Dorotei Andrea, Marcacci Maurilio
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Ann Jt. 2022 Jul 15;7:30. doi: 10.21037/aoj-20-108. eCollection 2022.
Once considered a non-fundamental structure, the menisci are now known to provide several functions within the knee, including protection of articular cartilage, load-bearing, shock absorption, joint stability, joint lubrification and joint congruity functions. Meniscal tears are one of the most common lesions in knee orthopedics, and partial or total meniscectomies are commonly performed procedures in orthopedic surgery. Despite meniscectomy is well recognized to lead improvement in clinical outcomes, it has been related to early onset knee osteoarthritis and joint degeneration which are associated with pain and functional limitations. Meniscal allograft transplantation has become a viable option for patients under 55 years old that have undergone total or near total meniscectomy and are in a painful state. This procedure can be performed using bone plugs or without bone plugs. In the bone plugs free technique allograft will be presented as a lateral meniscus with a portion of tibial plateau and is then introduced into the joint through an arthroscopic portal and fixed to the capsule with all-inside stitches. The most important aspect required to obtain good clinical results are graft size, anatomic placement and fixation, because extrusion is the most common complication related to meniscal transplantation. Although a lack of long-term follow-up (FU) studies, it has been demonstrated that lateral meniscus transplantation without bone plugs is a minimal invasive surgical procedure that improves the knee function, increases patient physical activity and reduces pain.
半月板曾被认为是一种非基本结构，现在已知其在膝关节内具有多种功能，包括保护关节软骨、承重、减震、关节稳定、关节润滑和关节匹配功能。半月板撕裂是膝关节骨科中最常见的损伤之一，部分或全半月板切除术是骨科手术中常用的手术方法。尽管半月板切除术被公认为能改善临床结果，但它与早期膝关节骨关节炎和关节退变有关，而这又与疼痛和功能受限相关。对于55岁以下接受了全半月板或近全半月板切除术且处于疼痛状态的患者，半月板同种异体移植已成为一种可行的选择。该手术可以使用骨栓进行，也可以不使用骨栓。在无骨栓技术中，同种异体移植物将呈现为带有一部分胫骨平台的外侧半月板，然后通过关节镜入口引入关节，并使用全内缝合线固定于关节囊。获得良好临床结果所需的最重要方面是移植物大小、解剖位置和固定，因为挤压是与半月板移植相关的最常见并发症。尽管缺乏长期随访研究，但已证明无骨栓外侧半月板移植是一种微创手术，可改善膝关节功能、增加患者身体活动并减轻疼痛。
