Partial weight-bearing and range of motion limitation significantly reduce the loads at medial meniscus posterior root repair sutures in a cadaveric biomechanical model

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-09-17 DOI:10.1002/ksa.12465

Matthias Sukopp, Nina Schwab, Jonas Schwer, Julian Frey, Jonas Walter Metzger, Anita Ignatius, Mario Perl, Firooz Salami, Daniel Vogele, Thomas Kappe, Andreas Martin Seitz

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Abstract

Purpose

The aim of this study was to investigate the influence of medial meniscus posterior root avulsion (MMPRA) before and after surgical treatment on the biomechanics of the knee joint, including suture repair forces during daily and crutch-assisted gait movements.

Methods

MMPRA were investigated in eight human cadaver knee joint specimens by a dynamic knee joint simulator with daily (normal gait, gait with additional rotational movement, standing up, sitting down) and rehabilitation-associated movements (crutch-assisted gait with limited flexion range of motion [30°] and 30% [toe-touch weight-bearing, TTWB] and 50% of body weight [partial weight-bearing, PWB]) with simulated physiologic muscle forces. Each specimen was tested in intact, torn and repaired (transtibial suture) state. The biomechanical parameters were: medial mean contact pressure and area, knee joint kinematics, medial displacement of the posterior meniscus horn and loading on the anchoring suture.

Results

Significant reduction of the contact area due to the avulsion was observed in all movements except for PWB and sitting down. MMPRA repair significantly increased the contact areas during all movements, bringing them to levels statistically indistinguishable from the initial state. MMPRA resulted in a medial displacement up to 12.8 mm (sitting down) and could be reattached with a residual displacement ranging from 0.7 mm (PWB) to 5.7 mm (standing up), all significantly (p < 0.001) reduced compared to the torn state. The mean peak anchoring suture load increased from TTWB (77 N), PWB (91 N) to normal gait (194 N), gait rotation (207 N), sitting (201 N; p < 0.01) and to standing up (232 N; p = 0.03).

Conclusion

Surgical treatment of MMPRA allows restoration of physiological knee joint biomechanics. Crutch-assisted movements reduce the loading of the repair suture, thus likewise the risk for failure. From a biomechanical point of view, crutch-assisted movements are recommended for the early rehabilitation phase after MMPRA repair.

Level of Evidence

Level V.

Abstract Image

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在尸体生物力学模型中，部分负重和活动范围限制可明显减轻内侧半月板后根修复缝合处的负荷。

目的：本研究旨在探讨内侧半月板后根撕脱术（MMPRA）手术治疗前后对膝关节生物力学的影响，包括日常和拐杖辅助步态运动中的缝合修复力：通过膝关节动态模拟器对 8 个人体尸体膝关节标本的 MMPRA 进行了研究，包括日常运动（正常步态、带有额外旋转运动的步态、站立、坐下）和康复相关运动（拐杖辅助步态，有限的屈曲运动范围 [30°]，30% [趾触负重，TTWB] 和 50% 体重 [部分负重，PWB]），以及模拟生理肌肉力量。每个样本都在完整、撕裂和修复（经胫骨缝合）状态下进行了测试。生物力学参数包括：内侧平均接触压力和面积、膝关节运动学、后半月板角的内侧位移以及锚定缝线的负荷：结果表明：除PWB和坐下外，所有运动中均可观察到由于撕脱造成的接触面积显著减少。在所有运动中，MMPRA修复都能明显增加接触面积，使其达到与初始状态无统计学差异的水平。MMPRA导致的内侧位移达12.8毫米（坐下），可重新连接的残余位移范围为0.7毫米（公共汽车站立）至5.7毫米（站立），均有明显差异（p 结论：MMPRA修复术可使MMPRA在所有运动中的接触面积明显增加，使其与初始状态达到统计学上无差别的水平：MMPRA的手术治疗可恢复膝关节的生理生物力学。拐杖辅助运动减少了修复缝合线的负荷，从而同样降低了失败的风险。从生物力学的角度来看，建议在 MMPRA 修复术后的早期康复阶段使用拐杖辅助运动：证据等级：V 级。

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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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).