H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study
H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study
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H 成形术修复技术改善后外侧半月板根部相邻径向撕裂修复后胫股接触力学：一项生物力学研究
DOI：
10.1016/j.arthro.2021.02.017
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发表时间：
2021-07-02
影响因子：
4.7
通讯作者：
Li, Wei-Ping
中科院分区：
文献类型：
--
作者：
Zhang, Zheng-Zheng;Luo, Huan;Li, Wei-Ping
目的：比较经胫骨拔出缝合术、缝合锚定缝合术、侧侧缝合术和H成形术4种不同缝合方式的胫股接触力学。方法：选取24例人身体膝关节标本。每个外侧半月板的状态(完整、径向撕裂和修复)都在1000-N的轴向压缩载荷下进行测试，分别为屈曲0度、30度、60度和90度。测试了四种不同的修复技术，即经胫骨拔出、缝合锚定、侧侧修复和H成形术。用TekScan传感器测量胫股外侧和内侧间隙的平均接触压力、峰值接触压力和接触面积。结果：与后外侧半月板根部相邻的放射状撕裂在各个角度上均可显著减小接触面积，增加外侧室的平均接触压力和峰值接触压力(P<；0.05)。与撕裂状态相比，所有修复组的接触力学性能均有改善(P<0.05)，但在所有屈曲角度下，仅H修复组的平均接触压力、最大接触压力和接触面积与完整状态相比差异无统计学意义(P>0.05)。结论：半月板后外侧根邻近径向撕裂后，采用H成形术修复后，股-股接触力学性能得到改善，恢复至正常水平。附加的垂直床垫缝合线起到了“稳定器”的作用，在分配垂直胫股压力时提供了一个更稳定的环境。与相应的撕裂条件相比，其他3种修复技术也显著改善了胫股外侧接触力学。临床意义：这项研究的结果表明，H成形术可以将生物力学特性恢复到完整状态。由于这是一项零时间身体研究，因此在临床实践中应谨慎使用结果。
Purpose: To compare the time-zero tibiofemoral contact mechanics among the 4 different suturing repairs: transtibial pullout suture repair, suture anchor repair, side-to-side repair, and H-plasty repair. Methods: Twenty-four human cadaveric knees were included. Each lateral meniscus condition (intact, radial tear, and repair) was tested under a 1000-N axial compressive load at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. Four different repair techniques, transtibial pullout, suture anchor, side-to-side, and H-plasty repair technique, were tested. Tibiofemoral mean and peak contact pressure and contact area in the lateral and medial compartments were measured by Tekscan sensors. Results: Radial tears adjacent to the posterior lateral meniscus root produced significantly decreased contact area and increased mean and peak contact pressures in the lateral compartment across all angles (P < .05). All repair groups could improve the contact mechanics relative to the torn condition (P .05), but only H-plasty repair showed no significant difference in the mean and peak contact pressure and contact area compared with that of the intact state at all flexion angles (P .05). Conclusions: The results showed that the tibiofemoral contact mechanics after adjacent radial tears of the posterior lateral meniscal root were improved to the intact level by H-plasty repair at time-zero. The additional vertical mattress sutures act as "stabilizers" to provide a more stable environment in distributing vertical tibiofemoral pressure. The other 3 repair techniques also significantly improved lateral tibiofemoral contact mechanics relative to the corresponding tear conditions. Clinical Relevance: The results of this study suggest that H-plasty repair can restore the biomechanical properties to the intact state. Since it was a time-zero cadaveric study, the results should be carefully used in clinical practices.