Bone-Plug Versus Soft Tissue Fixation of Medial Meniscal Allograft Transplants: A Biomechanical Study
Bone-Plug Versus Soft Tissue Fixation of Medial Meniscal Allograft Transplants: A Biomechanical Study
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DOI：
10.1177/0363546519870179
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发表时间：
2019-08-27
影响因子：
4.8
通讯作者：
Gomoll, Andreas H.
中科院分区：
文献类型：
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作者：
Ambra, Luiz Felipe;Mestriner, Alexandre Barbieri;Gomoll, Andreas H.
背景：对于同种异体内侧半月板移植，单纯软组织固定和骨塞法移植是否能提供同等的固定和恢复载荷分布仍存在争议。以前关于这一主题的研究没有通过使用大小匹配、侧向匹配和间隔匹配的半月板移植来重现临床情况。假设：这两种技术都将提供半月板移植的同等固定，并恢复与自然膝关节相似的载荷分布和接触压力。研究设计：对照实验室研究。方法：采用TekScan传感器，在700-N轴向载荷下，对9个新鲜冷冻的人身体膝关节在3个屈曲角度(0度、30度和60度)的4种内侧半月板测试条件(自然半月板、半月板全切除、骨塞固定和软组织固定)下的平均接触压力、平均接触面积和峰值接触压力进行评估。结果：内侧半月板切除后，在所有屈曲角度下，接触面积明显减小，接触压力明显增加(P<；.0001)。与自然状态相比，软组织固定组在屈曲0度和30度时的平均接触压力显著升高，平均接触面积显著降低(P<；0.05)，而骨塞固定组的平均接触压力和平均接触面积无显著差异。两种研究条件下的峰值接触压力没有显著差异。结论：内侧半月板全切除导致膝关节内载荷分布明显恶化。同种异体内侧半月板移植可使负荷参数恢复到接近正常状态。与软组织固定相比，骨塞技术显示出更好的胫股接触压力。
Background: It is controversial whether soft tissue fixation only and bone-plug techniques for medial meniscal allograft transplantation provide equivalent fixation and restoration of load distribution. Prior studies on this topic did not re-create the clinical situation with use of size-, side-, and compartment-matched meniscal transplants. Hypothesis: Both techniques will provide equivalent fixation of the meniscal transplant and restore load distribution and contact pressures similar to those of the native knee. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen human cadaveric knees underwent mean contact pressure, mean contact area, and peak contact pressure evaluation in 4 medial meniscal testing conditions (native, total meniscectomy, bone-plug fixation, and soft tissue fixation) at 3 flexion angles (0 degrees, 30 degrees, and 60 degrees) using Tekscan sensors under a 700-N axial load. Results: Medial meniscectomy resulted in significantly decreased contact area and increased contact pressure compared with the native condition at all flexion angles (P < .0001). Compared with the native state, soft tissue fixation demonstrated significantly higher mean contact pressure and lower mean contact area at 0 degrees and 30 degrees of flexion (P < .05), while bone-plug fixation showed no significant difference. There was no significant difference in peak contact pressure between study conditions. Conclusion: Total medial meniscectomy leads to significantly worsened load distribution within the knee. Medial meniscal allograft transplantation can restore load parameters close to those of the native condition. The bone-plug technique demonstrated improved tibiofemoral contact pressures compared with soft tissue fixation.