Gao J, Wei X, Messner K
Department of Sports Medicine, Faculty of Health Sciences, Linköping University, Sweden.
Clin Orthop Relat Res. 1998 Mar(348):246-58.
In a rabbit model the healing process of the anterior attachment of the medical meniscus was observed during the first 12 weeks after sharp transection and refixation in a tibial bone channel. Evaluations of the healing tissue were histologic analysis, application of immunohistochemical methods to show collagen types and nerve regeneration, and mechanical load to failure tests. Secondary changes to knee joint cartilage, as signs of eventual dysfunction of the refixed meniscus, were evaluated by analysis of proteoglycan fragment concentration in joint fluid and histologic analysis of knee joint articular cartilage and synovium. The healing tissue between the refixed attachment and bone matured from highly cellular, nonspecific granulation tissue at 1 week, to bone, fibrocartilaginous, and fibrous tissues, which at some sites developed an insertion specific tissue arrangement within a 12-week period. However, the irregular interface between the fibrocartilaginous tissue and the underlying bone, which is typical for a normal insertion, was not reestablished. Labeling for collagen Types I and II in the newly formed insertion did not return to normal. In addition a few collagen fibers connected the refixed attachment tissue to bone. New bone formation turned the initially cancellous bone tunnel walls into more solid cortical bone. However, new bone formation did not fill the distal part of the channel. The refixed meniscal attachment underwent necrosis and was revitalized by cell ingrowth from the periphery. Nerve fibers were found in the newly formed insertion by 12 weeks. The failure load at tensile testing never reached more than 20% that of a normal attachment. Degeneration of articular cartilage and increased proteoglycan fragment in the joint fluid were common after this procedure. These data suggest that, despite the focal appearance of insertion specific tissues and healing of collagen fibers to bone, the tissue architecture of a normal meniscal insertion and a normal meniscal joint protective function were not reestablished.
在兔模型中，观察了内侧半月板前附着部在锐性横断并重新固定于胫骨骨隧道后前12周的愈合过程。对愈合组织的评估包括组织学分析、应用免疫组化方法显示胶原类型和神经再生，以及进行机械负荷至破坏试验。通过分析关节液中蛋白聚糖片段浓度以及对膝关节软骨和滑膜进行组织学分析，评估膝关节软骨的继发性改变，作为重新固定半月板最终功能障碍的迹象。重新固定的附着部与骨之间的愈合组织从1周时高度细胞化的非特异性肉芽组织，成熟为骨、纤维软骨和纤维组织，在12周内某些部位形成了特定于附着的组织排列。然而，正常附着典型的纤维软骨组织与下方骨之间的不规则界面并未重新建立。新形成的附着处I型和II型胶原的标记未恢复正常。此外，有一些胶原纤维将重新固定的附着组织与骨相连。新骨形成使最初的松质骨隧道壁变成了更坚实的皮质骨。然而，新骨形成并未填满隧道的远端部分。重新固定的半月板附着部发生坏死，并通过外周细胞向内生长而恢复活力。到12周时，在新形成的附着处发现了神经纤维。拉伸试验中的破坏负荷从未超过正常附着部的20%。此操作后，关节软骨退变和关节液中蛋白聚糖片段增加很常见。这些数据表明，尽管出现了特定于附着的组织的局灶性表现以及胶原纤维与骨的愈合，但正常半月板附着的组织结构和正常半月板的关节保护功能并未重新建立。
