Verdonk R, Van Daele P, Claus B, Vandenabeele K, Desmet P, Verbruggen G, Veys E M, Claessens H
Department of Physical Medicine and Orthopaedic Surgery, Gent University Hospital.
Orthopade. 1994 Apr;23(2):153-9.
The integrity of the semilunar cartilages has proved to be the best safeguard against mechanical degenerative changes. One can postulate that restoring normal congruency between the femur and tibia with intact menisci would be the ideal solution to many mechanical knee problems. Several semilunar cartilages have been transplanted with good functional results in medial and lateral compartmental meniscal disease. However, this form of chondroprotection in the load-bearing area of the femur and tibia can only be properly evaluated after 10 to 20 years of follow-up. In order to obtain functional results, meniscal allografts have to be incorporated in the knee joint by intimate meniscofemoral synovial bonding. The synovial fibroblasts must grow into the collagen meshwork of the meniscal allograft. Such ingrowth has been shown in freeze-dried and deep-frozen meniscal allografts. However, in a small number of transplants shrinking has been observed on repeat arthroscopy at 6 months. Satisfactory incorporation of meniscal allografts has been obtained with fresh allografts, but availability remains a problem when this method is used for meniscal substitution. For this reason viable meniscal allograft implantation was initiated in a series of 25 patients and the value of this method studied. The meniscal allograft can be kept in an adequate semisynthetic nutrient medium for approximately 2-3 weeks without apparent loss of viability, during which period the appropriate recipient can be selected and prepared, a thorough laboratory screening can be conducted, and the culture results and disease transmission factors can be evaluated. In this way, live transplant hazards can be avoided, resulting in a higher success rate.
半月软骨的完整性已被证明是防止机械性退变的最佳保障。可以推测，对于许多膝关节机械性问题，在半月板完整的情况下恢复股骨与胫骨之间的正常一致性将是理想的解决方案。在治疗内侧和外侧半月板疾病时，已经进行了多次半月软骨移植，功能效果良好。然而，这种在股骨和胫骨承重区域的软骨保护形式，只有在随访10至20年后才能得到恰当评估。为了获得功能效果，半月板同种异体移植必须通过紧密的半月板-股骨滑膜结合融入膝关节。滑膜成纤维细胞必须长入半月板同种异体移植的胶原网中。在冻干和深冻的半月板同种异体移植中已观察到这种长入现象。然而，在少数移植病例中，6个月时再次关节镜检查发现有萎缩现象。新鲜同种异体移植已使半月板同种异体移植获得了满意的融合，但采用这种方法进行半月板置换时，供体的可用性仍然是个问题。因此，对25例患者进行了一系列活体半月板同种异体移植，并研究了这种方法的价值。半月板同种异体移植可以在适当的半合成营养培养基中保存约2至3周而无明显的活力丧失，在此期间可以选择并准备合适的受体，进行全面的实验室筛查，并评估培养结果和疾病传播因素。通过这种方式，可以避免活体移植的风险，从而提高成功率。
