Franciozi Carlos E, Mameri Enzo S, Schumacher Felipe C, Credidio Marcos V, Kubota Marcelo S, Luzo Marcus V
Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Hospital do Coração, São Paulo, Brazil.
Video J Sports Med. 2023 Nov 6;3(6):26350254231195085. doi: 10.1177/26350254231195085. eCollection 2023 Nov-Dec.
Meniscal radial tears are associated with altered contact mechanics, as they have the potential to disrupt the meniscal hoop stress mechanism. In prior studies, radial tears are associated with higher grade of cartilage damage, as well as higher rate and severity of meniscal extrusion in knees with a radial tear relative to other types of tears. Improved understanding of the meniscus biological potential together with modern developments in surgical technique has paved the way for the current emphasis on repairing even radial tears.
Large or complete radial tears of the meniscus without prohibitive joint space narrowing or severe cartilage damage.
A hybrid technique of meniscal radial repair is described, combining (1) 2 transtibial pullout cinch-loop sutures, (2) 2 inside-out vertical rip-stop sutures and 2 oblique sutures in a "cross-tag" configuration, and (3) 1 horizontal mattress all-inside suture. The repair is biologically augmented with a notch marrow-venting procedure.
Recent evidence has demonstrated significant biomechanical benefit in terms of increased load to failure and construct strength when adding transtibial tunnel augmentation to radial repairs. In addition, rip-stop sutures decrease the chance of cut-out relative to nonreinforced repairs. Those biomechanical advancements are reflected in excellent patient-reported outcomes as well as healing rates following radial repair.
DISCUSSION/CONCLUSION: We present a hybrid technique encompassing the most biomechanically effective novel radial repair techniques, backed by excellent clinical outcomes following radial repair in the current literature.
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.
半月板放射状撕裂与接触力学改变有关，因为它们有可能破坏半月板环向应力机制。在先前的研究中，放射状撕裂与更高等级的软骨损伤相关，并且相对于其他类型的撕裂，放射状撕裂的膝关节中半月板挤出的发生率和严重程度更高。对半月板生物学潜能的进一步了解以及手术技术的现代发展为当前强调修复甚至放射状撕裂铺平了道路。
半月板的大型或完全放射状撕裂，且无严重的关节间隙狭窄或严重软骨损伤。
描述了一种半月板放射状修复的混合技术，该技术结合了：（1）2条经胫骨拉出的收紧环缝线；（2）2条由内向外的垂直防撕裂缝线和2条呈“交叉标签”构型的斜向缝线；（3）1条全关节内水平褥式缝线。通过切口骨髓通气程序对修复进行生物学增强。
最近的证据表明，在放射状修复中增加经胫骨隧道增强时，在增加失效负荷和结构强度方面具有显著的生物力学益处。此外，相对于未加强的修复，防撕裂缝线降低了缝线穿出的几率。这些生物力学进展反映在患者报告的出色结果以及放射状修复后的愈合率上。
讨论/结论：我们提出了一种混合技术，该技术包含了最具生物力学效果的新型放射状修复技术，目前文献中放射状修复后的出色临床结果为其提供了支持。
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，作者已随本提交物包含患者的豁免声明或其他书面批准形式以供发表。
