A retinaculum-sparing surgical approach preserves porcine stifle joint cartilage in an experimental animal model of cartilage repair.
A retinaculum-sparing surgical approach preserves porcine stifle joint cartilage in an experimental animal model of cartilage repair.
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DOI：
10.1186/s40634-017-0083-7
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发表时间：
2017-12-01
影响因子：
1.8
通讯作者：
Madry, Henning
中科院分区：
文献类型：
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作者：
Bonadio, Marcelo B;Friedman, James M;Madry, Henning
背景技术背景：本研究比较了传统的髌旁支持带牺牲关节切开术和保留支持带的关节切开术在猪后膝关节作为软骨修复模型。手术暴露10头尤卡坦猪后膝关节的股骨粗隆，采用传统的内侧髌旁入路，切开支持带并脱位髌骨（n=5）或微创（MIS）保留髌骨支持带的入路（n=5）。经典和MIS入路均提供了足够的入路，可轻松创建软骨缺损。在每个滑车中创建四个全层、4 mm圆形全层软骨缺损。两种手术入路均未观察到术中并发症。术后立即允许所有猪完全负重和全活动范围，并在2 - 3周之间实施安乐死。与MIS方法相比，传统方法与软骨磨损增加相关。两名盲法评估者根据改良的ICRS软骨损伤分类对缺损周围的软骨进行大体评估。传统入路软骨评分明显低于MIS入路组（3.2 vs 0.8，p=0.01; 2.8 vs 0，p=0.005）。结论：MIS入路对肱骨髁软骨损伤小，恢复负重能力快。作为猪模型中的关节切开术入路，MIS上级传统入路。
BACKGROUND: This study compares a traditional parapatellar retinaculum-sacrificing arthrotomy to a retinaculum-sparing arthrotomy in a porcine stifle joint as a cartilage repair model.FINDINGS: Surgical exposure of the femoral trochlea of ten Yucatan pigs stifle joint was performed using either a traditional medial parapatellar approach with retinaculum incision and luxation of the patella (n=5) or a minimally invasive (MIS) approach which spared the patellar retinaculum (n=5). Both classical and MIS approaches provided adequate access to the trochlea, enabling the creation of cartilage defects without difficulties. Four full thickness, 4 mm circular full-thickness cartilage defects were created in each trochlea. There were no intraoperative complications observed in either surgical approach. All pigs were allowed full weight-bearing and full range of motion immediately postoperatively and were euthanized between 2 and 3 weeks. The traditional approach was associated with increased cartilage wear compared to the MIS approach. Two blinded raters performed gross evaluation of the trochlea cartilage surrounding the defects according to the modified ICRS cartilage injury classification. The traditional approach cartilage received a significantly worse score than the MIS approach group from both scorers (3.2 vs 0.8, p=0.01 and 2.8 vs 0, p=0.005 respectively).CONCLUSION: The MIS approach results in less damage to the trochlear cartilage and faster return to load bearing activities. As an arthrotomy approach in the porcine model, MIS is superior to the traditional approach.