Background:Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.Hypothesis:Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.Study Design:Controlled laboratory study.Methods:Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint.Results:Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( P = .008 and P < .001, respectively), increased peak contact pressure at 30° ( P = .04), and decreased mean contact area in all flexion angles compared with the native condition ( P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( P = .002 and P = .003, respectively) and increased contact area at 30° and 60° ( P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( P > .05).Conclusion:The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status.Clinical Relevance:Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.

中文翻译：

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外侧半月板后角连续切除和随后的同种异体半月板移植后的负荷分布：生物力学研究


背景：缺乏关于半月板同种异体移植（MAT）何时在生物力学上优于部分切除外侧半月板的数据。假设：使用骨桥技术的外侧 MAT 可以将胫股关节的负载分布和接触压力恢复到优于部分切除外侧半月板的水平。研究设计：对照实验室研究。方法：在 5 种外侧半月板测试条件（天然、三分之一后角半月板切除术、三分之二后角半月板切除术、全半月板切除术）下对 11 个新鲜冷冻的人体膝关节进行评估、MAT）在 1600 N 轴向载荷下以 3 个弯曲角度（0°、30° 和 60°）。使用压力传感器获取胫股关节内的接触压力、接触面积和峰值接触压力。结果：有限（三分之一和三分之二）部分外侧后角半月板切除术显示平均和峰值接触压力也没有显着增加与完整状态相比，接触面积没有明显减少。全半月板切除术显着增加了 0° 和 30° 处的平均接触压力（分别为 P = .008 和 P < .001），增加了 30° 处的峰值接触压力（P = .04），并减少了所有屈曲的平均接触面积与原始条件相比的角度 ( P < .01)。与全半月板切除术相比，横向 MAT 在 0° 和 30° 处显着改善了平均接触压力（分别为 P = .002 和 P = .003），并且在 30° 和 60° 处增加了接触面积（P = .003 和 P = .009）分别），尽管 MAT 后接触面积相对于原生半月板仍然显着较小（24.1%）（P = 0.015）。然而，与有限的部分半月板切除术相比，同种异体移植并没有产生更好的胫股接触生物力学（P > .05）。结论：在尸体模型中，外侧半月板的周边部分对整个胫股关节接触压力的分布做出了最重要的贡献。全半月板切除术显着增加了尸体模型中的平均和峰值接触压力并减少了接触面积。外侧 MAT 使接触生物力学恢复接近正常，但并不优于部分半月板切除状态。临床相关性：外科医生应尝试保留后外侧半月板的周边边缘。相对于全外侧半月板切除术，半月板同种异体移植似乎有所改善，但并未使平均接触压力和接触面积正常化。