Sukopp Matthias, Schwab Nina, Schwer Jonas, Frey Julian, Metzger Jonas Walter, Ignatius Anita, Perl Mario, Salami Firooz, Vogele Daniel, Kappe Thomas, Seitz Andreas Martin
Institute of Orthopaedic Research and Biomechanics, University Hospital Ulm, Ulm, Germany.
Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1645-1657. doi: 10.1002/ksa.12465. Epub 2024 Sep 17.
The aim of this study was to investigate the influence of medial meniscus posterior root avulsion (MMPRA) before and after surgical treatment on the biomechanics of the knee joint, including suture repair forces during daily and crutch-assisted gait movements.
MMPRA were investigated in eight human cadaver knee joint specimens by a dynamic knee joint simulator with daily (normal gait, gait with additional rotational movement, standing up, sitting down) and rehabilitation-associated movements (crutch-assisted gait with limited flexion range of motion [30°] and 30% [toe-touch weight-bearing, TTWB] and 50% of body weight [partial weight-bearing, PWB]) with simulated physiologic muscle forces. Each specimen was tested in intact, torn and repaired (transtibial suture) state. The biomechanical parameters were: medial mean contact pressure and area, knee joint kinematics, medial displacement of the posterior meniscus horn and loading on the anchoring suture.
Significant reduction of the contact area due to the avulsion was observed in all movements except for PWB and sitting down. MMPRA repair significantly increased the contact areas during all movements, bringing them to levels statistically indistinguishable from the initial state. MMPRA resulted in a medial displacement up to 12.8 mm (sitting down) and could be reattached with a residual displacement ranging from 0.7 mm (PWB) to 5.7 mm (standing up), all significantly (p < 0.001) reduced compared to the torn state. The mean peak anchoring suture load increased from TTWB (77 N), PWB (91 N) to normal gait (194 N), gait rotation (207 N), sitting (201 N; p < 0.01) and to standing up (232 N; p = 0.03).
Surgical treatment of MMPRA allows restoration of physiological knee joint biomechanics. Crutch-assisted movements reduce the loading of the repair suture, thus likewise the risk for failure. From a biomechanical point of view, crutch-assisted movements are recommended for the early rehabilitation phase after MMPRA repair.
Level V.
本研究旨在探讨内侧半月板后根撕脱（MMPRA）手术治疗前后对膝关节生物力学的影响，包括日常和借助拐杖步态运动期间的缝合修复力。
通过动态膝关节模拟器，对8个尸体膝关节标本进行MMPRA研究，模拟日常（正常步态、附加旋转运动的步态、站立、坐下）和康复相关运动（屈曲活动范围受限[30°]且为30%体重[足尖触地负重，TTWB]以及50%体重[部分负重，PWB]的借助拐杖步态），并施加模拟的生理肌肉力。每个标本在完整、撕裂和修复（经胫骨缝合）状态下进行测试。生物力学参数包括：内侧平均接触压力和面积、膝关节运动学、后半月板角的内侧位移以及锚固缝线的负荷。
除PWB和坐下外，在所有运动中均观察到由于撕脱导致接触面积显著减小。MMPRA修复在所有运动中均显著增加了接触面积，使其达到与初始状态在统计学上无显著差异的水平。MMPRA导致内侧位移达12.8毫米（坐下时），修复后残余位移范围为0.7毫米（PWB）至5.7毫米（站立时），与撕裂状态相比均显著（p < 0.001）减小。平均峰值锚固缝线负荷从TTWB（77牛）、PWB（91牛）增加到正常步态（194牛）、步态旋转（207牛）、坐下（201牛；p < 0.01）以及站立（232牛；p = 0.03）。
MMPRA的手术治疗可恢复膝关节的生理生物力学。借助拐杖的运动可减轻修复缝线的负荷，从而降低失败风险。从生物力学角度来看，建议在MMPRA修复后的早期康复阶段进行借助拐杖的运动。
V级。
