Brockmeyer Matthias, Liu Wei, Carretero-Hernández Marta, Zhang Yin, Madry Henning
Department of Orthopaedic Surgery, Saarland University Medical Center, Saarland University, Homburg, Saarland, Germany.
Center of Experimental Orthopaedics, Saarland University, Homburg, Saarland, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul;33(7):2487-2497. doi: 10.1002/ksa.12636. Epub 2025 Mar 25.
To address a gap in translational research by developing a preclinical sheep model of medial meniscus anterior root (MAR) repair in vivo and to compare probabilities of potential pitfalls and difficulties with humans.
Preoperative planning and surgical procedures applied to patients were adapted to adult sheep. Eight healthy, skeletally mature, female Merino ewes between 2 and 4 years of age underwent a mini-open medial parapatellar approach to both stifle joints without luxating the patella. Next, the MAR was transected in 16 knees (8 sheep) resulting in a subtype 2A tear according to the LaPrade classification, followed by a transtibial pull-out repair through a 3.2 mm diameter bone tunnel with a reinforced Mason-Allen suture and non-absorbable suture material. Animals were followed until 21 days after surgery.
The surgery time per knee ranged between 30 and 50 min (mean, 40.0 ± 7.8 min). The surgical technique was safe without intra- or post-operative complications. Solid repair is most likely if the following surgical principles are respected: (1) Selection of the MAR and the open technique allow for elegant tunnel positioning and less post-operative loading stress due to the normal extension deficit of sheep; (2) careful preparation of the MAR is mandatory; (3) considering the oval shape of the MAR attachment (MARA) results in anatomic tunnel placement; (4) robust suture placement and configuration avoids suture cut out. The probabilities of potential pitfalls and difficulties differ from the human situation.
A clinically adapted MAR repair model in adult sheep was developed following its complete transection close to the MARA, followed by an open transtibial pull-out repair. The surgical technique was safe without intra- or short-term post-operative complications. This model may be suitable to study the biomechanics and pathophysiology of meniscal root injuries and their repair.
Level IV.
通过建立内侧半月板前角（MAR）修复的临床前绵羊体内模型来填补转化研究中的空白，并比较与人类相比潜在陷阱和困难的可能性。
将应用于患者的术前规划和手术程序应用于成年绵羊。八只年龄在2至4岁之间、健康、骨骼成熟的雌性美利奴羊接受了双膝关节的微型髌旁内侧入路，未使髌骨脱位。接下来，在16个膝关节（8只绵羊）中横断MAR，根据LaPrade分类法形成2A型撕裂，随后通过直径3.2毫米的骨隧道，使用加强的梅森 - 艾伦缝线和不可吸收缝线材料进行经胫骨拉出修复。对动物进行随访直至术后21天。
每个膝关节的手术时间在30至50分钟之间（平均40.0±7.8分钟）。手术技术安全，无术中或术后并发症。如果遵循以下手术原则，最有可能实现牢固修复：（1）MAR的选择和开放技术允许优雅的隧道定位，并且由于绵羊正常的伸展受限，术后加载应力较小；（2）必须仔细准备MAR；（3）考虑到MAR附着点（MARA）的椭圆形形状可实现解剖学隧道放置；（4）牢固的缝线放置和配置可避免缝线脱出。潜在陷阱和困难的可能性与人类情况不同。
在成年绵羊中建立了一种临床适用的MAR修复模型，先在靠近MARA处完全横断MAR，然后进行开放经胫骨拉出修复。手术技术安全，无术中或短期术后并发症。该模型可能适合研究半月板根部损伤及其修复的生物力学和病理生理学。
四级。
