Bartsch Anna, Anderson Forrest L, Neubauer Markus, Vel Monica S, Sherman Seth L
Department of Orthopaedic Surgery, School of Medicine, Stanford University, Redwood City, California, USA.
Department of Physical Medicine and Rehabilitation, School of Medicine, Stanford University, Redwood City, California, USA.
Video J Sports Med. 2023 Sep 11;3(5):26350254231195090. doi: 10.1177/26350254231195090. eCollection 2023 Sep-Oct.
The medial and lateral menisci act as shock absorbers for the knee joint by converting and redistributing axial load into circumferential hoop stresses. Disruptions of these hoop stresses occur in the setting of meniscal deficiency and lead to long-term degenerative changes. Therefore, maintaining the distinctive composition and organization of the menisci is essential. In selective cases of meniscal deficiency, meniscus allograft transplantation can be a valuable treatment option.
Meniscus transplantation should be considered in patients with symptomatic meniscal deficiency, without the presence of advanced degenerative pathologies, who have failed all conservative treatments.
We can divide the surgery into 4 steps: (1) graft preparation, (2) arthroscopic joint preparation, (3) allograft attachment preparation, and (4) graft fixation.
Meniscus allograft transplantation yields good to excellent results in up to 85% of cases. Improvement of pain and knee function occurs in approximately 70% of the patients at 10 years. The associated complications are mainly joint stiffness, early osteoarthritis, and incomplete healing accompanied by graft failure. Graft failure is the most feared complication, yet shows good results over the midterm.
The bone plug technique we have shown here is a hybrid approach combining soft tissue and bone fixation techniques. It provides synergistic advantages with good osseous integration and is minimally invasive through arthroscopy without true arthrotomy. In our experience, this approach elegantly eases the complexity of this demanding surgery while yielding excellent results for patients.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
内侧和外侧半月板通过将轴向负荷转化并重新分配为圆周环向应力，起到膝关节减震器的作用。这些环向应力的破坏发生在半月板缺失的情况下，并导致长期的退行性改变。因此，维持半月板独特的组成和结构至关重要。在选择性半月板缺失病例中，半月板同种异体移植可能是一种有价值的治疗选择。
对于有症状的半月板缺失、无晚期退行性病变且所有保守治疗均失败的患者，应考虑半月板移植。
我们可将手术分为4个步骤：（1）移植物准备，（2）关节镜下关节准备，（3）同种异体移植物附着准备，以及（4）移植物固定。
半月板同种异体移植在高达85%的病例中产生良好至优异的效果。约70%的患者在10年时疼痛和膝关节功能得到改善。相关并发症主要是关节僵硬、早期骨关节炎以及伴有移植物失败的不完全愈合。移植物失败是最令人担忧的并发症，但中期效果良好。
我们在此展示的骨栓技术是一种结合软组织和骨固定技术的混合方法。它具有良好的骨整合协同优势，通过关节镜微创操作，无需真正的关节切开术。根据我们的经验，这种方法巧妙地简化了这项高要求手术的复杂性，同时为患者带来优异的效果。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
