混合根部固定技术行内侧半月板同种异体移植术
简介
该文介绍了一种内侧半月板同种异体移植术（MAT）的混合根部固定技术，通过保留前后根部骨片并结合经胫骨隧道皮质纽扣固定，兼顾骨性愈合与操作灵活性。系统综述显示688例患者10年存活率74%、15年60%，术后IKDC评分改善，骨性固定较缝线固定移植物挤出略少。该技术适用于<55岁症状性半月板缺损患者，可作为临床参考术式。
英文摘要
BACKGROUND: High rates of osteoarthritis have been reported after partial and total meniscectomy, attributed to increased joint contact stresses in meniscus-deficient knees. Meniscal allograft transplantation (MAT) with hybrid root fixation has emerged as a treatment for meniscal deficiency, combining the advantages of bony and all-soft-tissue techniques. INDICATIONS: MAT is best suited for patients <55 years with symptomatic meniscal deficiency and may require correction of modifiable factors, such as obesity, malalignment, instability, or cartilage loss, before the procedure. TECHNIQUE DESCRIPTION: A size-matched fresh-frozen meniscal allograft is prepared with meticulous preservation of 1 to 2 mm bony wafers at the anterior and posterior roots to maintain meniscal length and enhance fixation. Diagnostic arthroscopy was performed to debride residual tissue and prepare a bleeding cancellous bed for graft integration. Posterior and anterior root tunnels were created using an anterior cruciate ligament tibial guide, enabling precise shuttle and anatomic graft positioning. All inside sutures are used to fixate the meniscus. Final fixation was achieved by tensioning the wafer-root sutures through transtibial tunnels and securing them over cortical buttons at 60° of knee flexion to optimize graft stability. RESULTS: Long-term outcomes of MAT are favorable, with a systematic review of 688 cases (mean age, 33 years) reporting 74% survivorship at 10 years and 60% at 15 years, improved postoperative International Knee Documentation Committee (IKDC) scores, and similar results between bony (53.8%) and suture-only (46.2%) fixation techniques. A recent meta-analysis of 25 studies found graft extrusion to be common but generally comparable between fixation methods, with some evidence suggesting slightly less extrusion with bony fixation. DISCUSSION/CONCLUSION: Hybrid root fixation for medial meniscal allograft transplantation provides increased fixation flexibility with the advantages of bone-to-bone healing. PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.