Matthias Brockmeyer, Wei Liu, Marta Carretero-Hernández, Yin Zhang, Henning Madry
{"title":"绵羊内侧半月板前根修复的临床前模型。第2部分。手术策略，技术考虑，要点和陷阱。","authors":"Matthias Brockmeyer, Wei Liu, Marta Carretero-Hernández, Yin Zhang, Henning Madry","doi":"10.1002/ksa.12636","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To address a gap in translational research by developing a preclinical sheep model of medial meniscus anterior root (MAR) repair in vivo and to compare probabilities of potential pitfalls and difficulties with humans.</p><p><strong>Methods: </strong>Preoperative planning and surgical procedures applied to patients were adapted to adult sheep. Eight healthy, skeletally mature, female Merino ewes between 2 and 4 years of age underwent a mini-open medial parapatellar approach to both stifle joints without luxating the patella. Next, the MAR was transected in 16 knees (8 sheep) resulting in a subtype 2A tear according to the LaPrade classification, followed by a transtibial pull-out repair through a 3.2 mm diameter bone tunnel with a reinforced Mason-Allen suture and non-absorbable suture material. Animals were followed until 21 days after surgery.</p><p><strong>Results: </strong>The surgery time per knee ranged between 30 and 50 min (mean, 40.0 ± 7.8 min). The surgical technique was safe without intra- or post-operative complications. Solid repair is most likely if the following surgical principles are respected: (1) Selection of the MAR and the open technique allow for elegant tunnel positioning and less post-operative loading stress due to the normal extension deficit of sheep; (2) careful preparation of the MAR is mandatory; (3) considering the oval shape of the MAR attachment (MARA) results in anatomic tunnel placement; (4) robust suture placement and configuration avoids suture cut out. The probabilities of potential pitfalls and difficulties differ from the human situation.</p><p><strong>Conclusion: </strong>A clinically adapted MAR repair model in adult sheep was developed following its complete transection close to the MARA, followed by an open transtibial pull-out repair. The surgical technique was safe without intra- or short-term post-operative complications. This model may be suitable to study the biomechanics and pathophysiology of meniscal root injuries and their repair.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A new preclinical sheep model of medial meniscus anterior root repair. Part 2. Surgical strategy, technical considerations, pearls and pitfalls.\",\"authors\":\"Matthias Brockmeyer, Wei Liu, Marta Carretero-Hernández, Yin Zhang, Henning Madry\",\"doi\":\"10.1002/ksa.12636\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To address a gap in translational research by developing a preclinical sheep model of medial meniscus anterior root (MAR) repair in vivo and to compare probabilities of potential pitfalls and difficulties with humans.</p><p><strong>Methods: </strong>Preoperative planning and surgical procedures applied to patients were adapted to adult sheep. Eight healthy, skeletally mature, female Merino ewes between 2 and 4 years of age underwent a mini-open medial parapatellar approach to both stifle joints without luxating the patella. Next, the MAR was transected in 16 knees (8 sheep) resulting in a subtype 2A tear according to the LaPrade classification, followed by a transtibial pull-out repair through a 3.2 mm diameter bone tunnel with a reinforced Mason-Allen suture and non-absorbable suture material. Animals were followed until 21 days after surgery.</p><p><strong>Results: </strong>The surgery time per knee ranged between 30 and 50 min (mean, 40.0 ± 7.8 min). The surgical technique was safe without intra- or post-operative complications. Solid repair is most likely if the following surgical principles are respected: (1) Selection of the MAR and the open technique allow for elegant tunnel positioning and less post-operative loading stress due to the normal extension deficit of sheep; (2) careful preparation of the MAR is mandatory; (3) considering the oval shape of the MAR attachment (MARA) results in anatomic tunnel placement; (4) robust suture placement and configuration avoids suture cut out. The probabilities of potential pitfalls and difficulties differ from the human situation.</p><p><strong>Conclusion: </strong>A clinically adapted MAR repair model in adult sheep was developed following its complete transection close to the MARA, followed by an open transtibial pull-out repair. The surgical technique was safe without intra- or short-term post-operative complications. 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A new preclinical sheep model of medial meniscus anterior root repair. Part 2. Surgical strategy, technical considerations, pearls and pitfalls.
Purpose: To address a gap in translational research by developing a preclinical sheep model of medial meniscus anterior root (MAR) repair in vivo and to compare probabilities of potential pitfalls and difficulties with humans.
Methods: Preoperative planning and surgical procedures applied to patients were adapted to adult sheep. Eight healthy, skeletally mature, female Merino ewes between 2 and 4 years of age underwent a mini-open medial parapatellar approach to both stifle joints without luxating the patella. Next, the MAR was transected in 16 knees (8 sheep) resulting in a subtype 2A tear according to the LaPrade classification, followed by a transtibial pull-out repair through a 3.2 mm diameter bone tunnel with a reinforced Mason-Allen suture and non-absorbable suture material. Animals were followed until 21 days after surgery.
Results: The surgery time per knee ranged between 30 and 50 min (mean, 40.0 ± 7.8 min). The surgical technique was safe without intra- or post-operative complications. Solid repair is most likely if the following surgical principles are respected: (1) Selection of the MAR and the open technique allow for elegant tunnel positioning and less post-operative loading stress due to the normal extension deficit of sheep; (2) careful preparation of the MAR is mandatory; (3) considering the oval shape of the MAR attachment (MARA) results in anatomic tunnel placement; (4) robust suture placement and configuration avoids suture cut out. The probabilities of potential pitfalls and difficulties differ from the human situation.
Conclusion: A clinically adapted MAR repair model in adult sheep was developed following its complete transection close to the MARA, followed by an open transtibial pull-out repair. The surgical technique was safe without intra- or short-term post-operative complications. This model may be suitable to study the biomechanics and pathophysiology of meniscal root injuries and their repair.
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).
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