Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study

Luiz Felipe Ambra, Alexandre Barbieri Mestriner, Jakob Ackermann, Enzo S. Mameri, Andreas H. Gomoll
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Abstract

Background:Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.Hypothesis:Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.Study Design:Controlled laboratory study.Methods:Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint.Results:Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( P = .008 and P < .001, respectively), increased peak contact pressure at 30° ( P = .04), and decreased mean contact area in all flexion angles compared with the native condition ( P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( P = .002 and P = .003, respectively) and increased contact area at 30° and 60° ( P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( P > .05).Conclusion:The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status.Clinical Relevance:Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.
连续切除外侧半月板后角并随后进行半月板同种异体移植后的负荷分布:生物力学研究
背景:关于半月板同种异体移植(MAT)何时在生物力学上优于部分切除的外侧半月板,目前尚缺乏相关数据。假设:采用骨桥技术进行外侧半月板同种异体移植,可使胫股关节的负荷分布和接触压力恢复到优于部分外侧半月板切除术的水平。研究设计:实验室对照研究。方法:在1600 N轴向负荷下,在3个屈曲角度(0°、30°和60°)对11个新鲜冷冻的人体尸体膝关节进行5种外侧半月板测试评估(原生、三分之一后角半月板切除术、三分之二后角半月板切除术、全半月板切除术、MAT)。结果显示:有限(三分之一和三分之二)部分外侧后角半月板切除术与完好状态相比,平均和峰值接触压力没有显著增加,接触面积也没有显著减少。与原生状态相比,全部半月板切除术明显增加了 0° 和 30° 的平均接触压力(P = .008 和 P <.001),增加了 30° 的峰值接触压力(P = .04),并减少了所有屈曲角度的平均接触面积(P <.01)。与全半月板切除术相比,侧半月板移植术明显改善了0°和30°的平均接触压力(P = .002 和 P = .003,分别为0.002和P = .003),增加了30°和60°的接触面积(P = .003 和 P = .009,分别为0.003和P = .009),但与原生半月板相比,侧半月板移植术后的接触面积仍明显较小(24.1%)(P = 0.015)。结论:在尸体模型中,外侧半月板的外周部分对整个胫骨股骨关节的接触压力分布做出了最重要的贡献。半月板全切除术明显增加了尸体模型的平均和峰值接触压力,并减少了接触面积。侧向MAT恢复了接近正常的接触生物力学,但并不优于半月板部分切除的状态。临床意义:外科医生应尝试保留后外侧半月板的外周边缘。相对于全侧半月板切除术,半月板异体移植似乎能改善平均接触压力和接触面积,但不能使其恢复正常。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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