Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM - UNIFESP), São Paulo, Brazil.
Uniklinik Balgrist, Zūrich, Germany.
Am J Sports Med. 2024 Sep;52(11):2775-2781. doi: 10.1177/03635465241264211. Epub 2024 Aug 30.
Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.
Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.
Controlled laboratory study.
Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint.
Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( = .008 and < .001, respectively), increased peak contact pressure at 30° ( = .04), and decreased mean contact area in all flexion angles compared with the native condition ( < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( = .002 and = .003, respectively) and increased contact area at 30° and 60° ( = .003 and = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( > .05).
The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status.
Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.
关于半月板同种异体移植（MAT）何时在生物力学上优于部分切除外侧半月板的数据尚缺乏。
采用骨桥技术的外侧 MAT 可恢复胫骨股骨关节的负荷分布和接触压力，使其达到高于部分外侧半月板切除术的水平。
对照实验室研究。
在 1600 N 轴向负荷下，对 11 个新鲜冷冻的人体尸体膝关节进行 5 种外侧半月板测试条件（正常、后角 1/3 切除术、后角 2/3 切除术、全切除术、MAT）和 3 个屈曲角度（0°、30°和 60°）评估。压力传感器用于获取胫骨股骨关节内的接触压力、接触面积和峰值接触压力。
与完整状态相比，有限的（1/3 和 2/3）外侧后角半月板部分切除术并没有显著增加平均和峰值接触压力，也没有显著减少接触面积。全切除术在 0°和 30°时显著增加平均接触压力（= 0.008 和 < 0.001），在 30°时显著增加峰值接触压力（= 0.04），与正常状态相比，在所有屈曲角度下平均接触面积均减小（< 0.01）。与全切除术相比，外侧 MAT 在 0°和 30°时显著改善了平均接触压力（= 0.002 和 = 0.003），并在 30°和 60°时增加了接触面积（= 0.003 和 = 0.009），尽管与正常半月板相比，同种异体移植物后接触面积仍然显著减小（24.1%）（P = 0.015）。然而，同种异体移植与有限的部分半月板切除术相比并没有导致更好的胫骨股骨接触生物力学（> 0.05）。
外侧半月板的外周部分对尸体模型中胫骨股骨关节接触压力分布的贡献最大。全切除术显著增加了尸体模型中的平均和峰值接触压力，并减少了接触面积。外侧 MAT 恢复了接近正常的接触生物力学，但并不优于部分半月板切除状态。
外科医生应尝试保留外侧后角半月板的外周边缘。半月板同种异体移植似乎改善了，但并未使全外侧半月板切除术后的平均接触压力和接触面积正常化。
