Three-dimensional finite-element analysis of aggravating medial meniscus tears on knee osteoarthritis
Three-dimensional finite-element analysis of aggravating medial meniscus tears on knee osteoarthritis
复制标题
膝骨关节炎内侧半月板撕裂加重的三维有限元分析
DOI：
10.1016/j.jot.2019.06.007
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发表时间：
2020-01-01
影响因子：
6.6
通讯作者：
Jiang, Qing
中科院分区：
文献类型：
--
作者：
Li, Lan;Yang, Longfei;Jiang, Qing
背景：膝关节骨性关节炎发生过程中内侧半月板损伤的生物力学变化尚未见报道。本研究的目的是确定加重内侧半月板退行性撕裂对膝关节骨关节炎的进展，通过有限元simulationmethod.Methods的效果：使用磁共振成像和计算机断层扫描图像相结合的全膝关节的三维数字模型。创建了四种类型的内侧半月板撕裂，以代表恶化的退行性半月板病变。每个半月板撕裂的半月板切除术也用于模拟。在平衡站立姿势下，对健康膝关节、损伤膝关节和手术后膝关节的骨组织、软骨和半月板的压缩和剪切应力进行了评估，并对半月板挤压进行了研究。根据有限元模拟结果，分别计算了峰值剪主应力、峰值压主应力、随着半月板撕裂范围的扩大，半月板挤压程度逐渐增大（股骨内侧从7.333 MPa增加到15.14 MPa，胫骨内侧从6 MPa增加到20.94 MPa）。在所有测试中，瓣和复合撕裂的应力和半月板挤出位移均较高。斜撕裂也有生物力学的变化，应力和半月板挤出在膝关节，但他们的水平是温和的。结论与损伤侧半关节相比，健康侧半关节的应力峰值增大。随着半月板损伤程度的加重，其生物力学的变化更为明显。晚期退行性损伤导致应力增加，更可能导致膝关节出现症状性临床表现，加速骨关节炎的进展。此外，我们还发现半月板损伤导致对侧关节应力集中。我们还发现，半月板切除术可导致更严重的生物力学变化，虽然这种技术可以在一段时间内缓解疼痛，但它增加了骨关节炎（OA）发生的风险。本文的翻译潜力：很明显，半月板病变可导致膝关节骨关节炎，但半月板损伤期间的生物力学变化尚未探讨。通过有限元模拟，我们评估了内侧退变半月板撕裂加重过程中应力的变化及其与膝关节骨性关节炎发展过程的关系。本研究有助于更好地了解OA的症状和病理变化。为OA的预防和治疗提供了一些潜在的方向。
Background: The biomechanical change during the medial meniscus damage in the process of knee osteoarthritis has not been explored. The purpose of this study was to determine the effect of aggravating medial meniscus degenerative tear on the progress of knee osteoarthritis through the finite-element simulation method.Methods: The three-dimensional digital model of a total-knee joint was obtained using a combination of magnetic resonance imaging and computed tomography images. Four types of medial meniscus tears were created to represent the aggravating degenerative meniscus lesions. Meniscectomy of each meniscal tear was also utilized in the simulation. The compression and shear stress of bony tissue, cartilage, and meniscus were evaluated, and meniscus extrusion of the healthy knee, postinjured knee, and postmeniscectomy knee were investigated under the posture of balanced standing.Results: Based on the results of finite-element simulation, the peak shear principal stress, peak compression principal stress, and meniscus extrusion increased gradually as the meniscus tears' region enlarged progressively (from 7.333 MPa to 15.14 MPa on medial femur and from 6 MPa to 20.94 MPa on medial tibia). The higher stress and larger meniscus extrusion displacement in all tests were observed in the flap and complex tears. The oblique tears also had a biomechanical variation of stress and meniscus extrusion in the knee joint, but their level was milder. Both the peak value of the stress and meniscus displacement increased after the meniscectomy.Conclusion In contrast to the damaged hemijoint, the stress applied on the healthy lateral hemijoint increased. The change of biomechanics was more obvious with the aggravation of meniscus injury. The advanced degenerative damage resulted in increasing stress that was more likely to cause symptomatic clinical manifestation in the knee joint and accelerate the progress of osteoarthritis. Moreover, we found that the meniscus injury caused higher stress concentration on the contralateral side of the joint. We also discovered that the meniscectomy can lead to more serious biomechanical changes, and although this technique can relieve pain over a period of time, it increased the risk of osteoarthritis (OA) occurrence.The translational potential of this article: It is clear that the meniscal lesions can cause osteoarthritic knee, but the biomechanical change during the meniscus damage period has not been explored. We have evaluated the variation of stress during the aggravating medial degenerative meniscus tears and the relationship in the process of knee OA through finite-element simulation. This study does favour to obtain a better understanding on the symptoms and pathological changes of OA. It also may provide some potential directions for the prophylaxis and treatment of OA.