半月板同种异体移植与支架：一项叙述性综述
简介
半月板损伤是年轻活跃人群最常见的膝关节内损伤。尽管优先考虑保留半月板，但复杂撕裂常需部分或全切，导致生物力学改变、接触面积减少、应力增加，加速软骨退变和骨关节炎风险。针对症状性半月板切除术后综合征，半月板同种异体移植（MAT）和半月板支架是两种重建选择。本综述发现，两者均能显著改善疼痛和功能，提高重返运动率，但无明确证据表明一种技术优于另一种。选择取决于半月…
英文摘要
BACKGROUND AND OBJECTIVE: Meniscal tears are the most common intra-articular knee injury, especially among young active individuals. While meniscal preservation is preferred, complex tears often require partial or total meniscectomy. Removing meniscal tissue alters biomechanics, reduces contact area, increases stress, and ultimately accelerates cartilage degeneration, raising the risk of osteoarthritis. To address symptomatic post-meniscectomy syndrome, meniscal allograft transplantation (MAT) and meniscal scaffolds have emerged as reconstructive options, each addressing distinct patterns of meniscal deficiency. This chapter aims to provide a narrative review of current literature on MAT and meniscal scaffolds, including advances in implant technologies and clinical outcomes. METHODS: A narrative review of the current literature on MAT and scaffolds was conducted, encompassing key studies on management, indications, patient-reported outcomes (PROs), return to sports (RTS), survival rates, failure rates, and complications. KEY CONTENT AND FINDINGS: Meniscal substitution with allografts or scaffolds improves pain and function in patients with symptomatic meniscal deficiency, with meniscal scaffolds indicated following partial meniscectomy in the presence of an intact peripheral rim, and MAT reserved for patients with subtotal or total meniscal deficiency. Clinical outcomes and return-to-sport rates for allografts and scaffolds have shown significant improvement, with no clear advantage of one surgical technique over the other. These procedures are often performed in conjunction with other procedures, such as anterior cruciate ligament reconstruction (ACLR), high tibial osteotomy (HTO), and cartilage restoration, which generally yield good outcomes. CONCLUSIONS: Symptomatic post-meniscectomy syndrome remains a challenging clinical entity. Meniscal scaffolds and MAT represent complementary, non-competing reconstructive strategies, with selection dependent on the extent of meniscal deficiency, peripheral rim integrity, and patient-specific factors. The preferred method for allograft/scaffold processing and surgical technique remains a topic of debate. Ultimately, the decision often depends on the surgeon's preference and graft availability.