多针中央化缝合对尸体模型中内侧半月板根部修复术后半月板外突和接触压力的影响
简介
该尸体生物力学研究在9例人膝标本中模拟PMMR修复后的持续半月板挤压，比较不同数量和位置的中央化缝合对其影响。结果显示：单独在MCL后缘置入1针可降低0°内侧接触压力及60°半月板挤压；2针置于后内侧半月板交界处可降低多屈曲角度（0°、60°、120°）接触压力；3针联合使用效果更广，同时减少90°挤压。临床行半月板后根修复时，可据此权衡增加中央化缝合的获益…
英文摘要
BACKGROUND: Adding a centralization suture (CS) during repair of a posterior medial meniscus root (PMMR) tear may decrease meniscal extrusion and osteoarthritis progression. However, the number and optimal placement of CSs remain unclear. HYPOTHESIS: Increasing numbers and changing localization of CSs would not influence the degree of postoperative extrusion or joint contact pressures. STUDY DESIGN: Controlled laboratory study. METHODS: Meniscal extrusion and tibiofemoral contact pressures were assessed using a 3-dimensional motion capture system and pressure sensors in 9 human cadaveric knees. A nonanatomic root repair was created to simulate persistent meniscal extrusion after a PMMR repair. Each knee was tested under 10 conditions: (1) intact, (2) PMMR tear, (3) root repair, (4) CS at the posterior border of the medial collateral ligament (MCL) (CS1), (5) CS midway between CS 1 and CS 3 (CS2), (6) CS at the midpoint between the MCL and posterior root attachment (CS3), and (7-10) combinations of these CSs (all CSs were in addition to the root repair). Analysis of variance testing was used for analyses of pressure data and extrusion measurements. RESULTS: There was no significant difference in medial contact pressure between the intact state and the states with root repair in combination with any CS configuration (P > .05). Contact pressures were reduced compared to the root repair state for CS1 alone at 0° (P = .014); the combination of CS2 and CS3 at 0°, 60°, and 120° (P≤ .038); and the combination of all 3 CSs at 0°, 30°, and 60° of flexion (P≤ .037). Extrusion was reduced compared to the root repair state for CS1 alone at 60° (P = .043) and all 3 CSs combined at 90° of flexion (P < .009). CONCLUSION: A single CS placed at the posterior border of the MCL decreased medial contact pressures at 0° and reduced extrusion at 60° of flexion. The combined use of 2 CSs placed at the posteromedial meniscus junction reduced contact pressures across multiple flexion angles (0°, 60°, and 120°). The combination of 3 CSs reduced contact pressures at 0°, 30°, and 60° and extrusion at 90°. Until clinical studies are conducted, the benefits of additional CSs should be weighed against time and cost. CLINICAL RELEVANCE: These findings should guide surgeons on the optimal number and placement of CSs to minimize meniscal extrusion and restore medial compartment contact pressures.