Hung Victor T, Dee Derek T, McGarry Michelle H, Lee Thay Q
Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA.
Dee Sports Orthopaedics, Huntington Beach, California, USA.
Orthop J Sports Med. 2024 Sep 11;12(9):23259671241266332. doi: 10.1177/23259671241266332. eCollection 2024 Sep.
There is a lack of procedures that adequately address the subchondral bone structure and function for reconstructing osteochondral defects in the femoral condyles.
To biomechanically evaluate the tibiofemoral joint contact characteristics before and after reconstruction of femoral condylar osteochondral defects using a novel hybrid reconstructive procedure, which was hypothesized to restore the contact characteristics to the intact condition.
Controlled laboratory study.
Tibiofemoral contact areas, contact forces, and mean contact pressures were measured in 8 cadaveric knees (mean age 52 ± 11 years; 6 women, 2 men) using a custom testing system and pressure mapping sensors. Five conditions were tested for each condyle: intact, 8-mm defect, 8-mm repair, 10-mm defect, and 10-mm repair. Medial femoral condylar defects were evaluated at 30° of knee flexion and lateral condylar defects were evaluated at 60° of knee flexion, with compressive loads of 50, 100, and 150 N. The defects were reconstructed with a titanium fenestrated threaded implant countersunk in the subchondral bone and an acellular dermal matrix allograft. Repeated-measures analysis of variance with Bonferroni correction for multiple comparisons was used to compare the results between the 5 testing conditions at each load.
Medial condylar defects significantly increased mean contact pressure on the lateral side ( < .042), which was restored to the intact levels with repair. The lateral condylar defect decreased the mean contact pressure laterally while increasing the mean pressure medially. The lateral and medial mean contact pressures were restored to intact levels with the 8-mm lateral condylar defect repair. The medial mean contact pressure was restored to intact levels with the 10-mm lateral condylar defect repair. The lateral mean contact pressure decreased compared with the intact state with the lateral condylar 10-mm defect repair.
Tibiofemoral joint contact pressure was restored to the intact condition after reconstruction of osteochondral defects with dermal allograft matrix and subchondral implants for the repair of both 8- and 10-mm lateral condylar defects as well as 8-mm medial condylar defects but not completely for 10-mm medial condylar defects.
The novel hybrid procedure for osteochondral defect repair restored tibiofemoral joint contact characteristics to normal in a cadaveric model.
目前缺乏能充分处理股骨髁软骨下骨结构和功能以重建骨软骨缺损的方法。
使用一种新型混合重建方法对股骨髁骨软骨缺损重建前后的胫股关节接触特征进行生物力学评估，该方法被假定可将接触特征恢复至完整状态。
对照实验室研究。
使用定制测试系统和压力映射传感器，在8具尸体膝关节（平均年龄52±11岁；6名女性，2名男性）中测量胫股接触面积、接触力和平均接触压力。每个髁测试5种情况：完整、8毫米缺损、8毫米修复、10毫米缺损和10毫米修复。在膝关节屈曲30°时评估内侧股骨髁缺损，在膝关节屈曲60°时评估外侧髁缺损，施加50、100和150牛的压缩负荷。缺损用钛制带孔螺纹植入物埋入软骨下骨并同种异体脱细胞真皮基质重建。采用重复测量方差分析并经Bonferroni校正进行多重比较，以比较各负荷下5种测试情况之间的结果。
内侧髁缺损显著增加外侧的平均接触压力（P<0.042），修复后恢复至完整水平。外侧髁缺损使外侧平均接触压力降低，同时使内侧平均压力增加。8毫米外侧髁缺损修复后，外侧和内侧平均接触压力恢复至完整水平。10毫米外侧髁缺损修复后，内侧平均接触压力恢复至完整水平。外侧髁10毫米缺损修复后，外侧平均接触压力与完整状态相比降低。
采用同种异体真皮基质和软骨下植入物重建骨软骨缺损后，胫股关节接触压力恢复至完整状态，可修复8毫米和10毫米外侧髁缺损以及8毫米内侧髁缺损，但对于10毫米内侧髁缺损未完全恢复。
新型骨软骨缺损修复混合方法在尸体模型中将胫股关节接触特征恢复至正常。
