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Meniscus Allograft Transplantation 半月板同种异体移植
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101186
Garrett R. Jackson, Clayton W. Nuelle
The meniscus is crucial in maintaining appropriate knee joint biomechanics, providing shock absorption, load transmission, and joint stability. Meniscal injuries can lead to articular cartilage degenerative changes, knee instability, early-onset osteoarthritis, and subsequent knee arthroplasty if left untreated. Meniscus allograft transplantation has emerged as a viable option for patients with symptomatic meniscal deficiency that is unamendable to repair. This review provides a comprehensive overview of the currently available evidence on surgical techniques and clinical outcomes following meniscus allograft transplantation.
半月板在维持适当的膝关节生物力学、提供减震、负荷传递和关节稳定性方面是至关重要的。半月板损伤可导致关节软骨退行性改变,膝关节不稳定,早发性骨关节炎,如果不及时治疗则会导致膝关节置换术。同种异体半月板移植已成为无法修复的半月板缺陷患者的可行选择。本文综述了目前关于半月板同种异体移植手术技术和临床结果的证据。
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引用次数: 0
All-Inside, Inside-Out, and Outside-In Meniscus Repair Techniques and Outcomes 全内,内外,外内半月板修复技术和结果
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101182
Mikalyn T. DeFoor , Benjamin J. Wie , Senah E. Stephens , Kevin F. Bonner
The benefits of meniscus repair are clear when performed in the optimal patient population and tear characteristics. Fundamental principles of meniscus repair remain the same regardless of the fixation technique, including anatomic reduction, circumferential compression and biological stimulation. With the advancement of contemporary all-inside devices, all-inside techniques have gained significant popularity with their ease of use and shorter operative times without the need for an open exposure. The inside-out repair generally remains the gold standard for larger, more extensive or complex meniscus tears due to the greater versatility and allowing for more points of fixation with less iatrogenic damage to the meniscus. Both all-inside and inside-out techniques can be used for middle and posterior third zone meniscal tears. Outside-in repair techniques are generally reserved for the anterior one-third of the meniscus. High strength nonabsorbable braided suture or tape has become the standard for meniscus repair. Contemporary suture passing devices have been developed in more recent years, which may allow for the placement of circumferential compression sutures but with the potential downside of having intra-articular knot stacks on the meniscus. Although outcomes are generally positive, they will vary based on clinical factors including tear pattern, chronicity, tissue quality and knee stability. Complications may occur with each technique, but recurrent tearing or failure is the most common, even in the setting of optimal indications. Orthopaedic sports medicine surgeons should become proficient with a comprehensive armamentarium of meniscal repair techniques to optimize meniscus preservation, especially in younger patients.
在最佳患者群体和撕裂特征中进行半月板修复的好处是显而易见的。不论采用何种固定技术,半月板修复的基本原则都是相同的,包括解剖复位、周向压迫和生物刺激。随着当代全内装置的进步,全内技术因其易于使用和缩短手术时间而无需开放暴露而获得了显著的普及。由于更大、更广泛或更复杂的半月板撕裂,内向外修复通常仍然是金标准,因为它具有更大的通用性,允许更多的固定点,并且对半月板的医源性损伤更少。全内和由内到外技术均可用于中后第三区半月板撕裂。由外至内的修复技术通常用于半月板前三分之一。高强度不可吸收的编织缝合或胶带已成为半月板修复的标准。近年来,现代缝合装置已经发展起来,它可能允许放置环向压缩缝合线,但有潜在的缺点,即在半月板上有关节内结堆积。虽然结果通常是积极的,但它们会因临床因素而异,包括撕裂模式、慢性、组织质量和膝关节稳定性。每种技术都可能出现并发症,但反复撕裂或失败是最常见的,即使在最佳适应症的设置。骨科运动医学外科医生应熟练掌握全面的半月板修复技术,以优化半月板保存,特别是在年轻患者中。
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引用次数: 0
Horizontal Cleavage and Radial Meniscus Tears: A Review of Treatment Options, Surgical Techniques, and Outcomes 水平劈裂和桡骨半月板撕裂:治疗方案、手术技术和结果的综述
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101185
Jelle P. van der List , David C. Flanigan
The meniscus plays an important role in resisting and distributing axial loads and has a chondroprotective function. Meniscus injuries are common with an estimated lifetime prevalence of 9% to 12%. Over the last decade, the knowledge and awareness around meniscus injuries has increased and there is better understanding on the consequences of different treatment of meniscus injuries. These were historically often treated with nonoperative treatment or partial or subtotal meniscectomy, but developments in diagnosis, surgical techniques and outcomes have changed this paradigm. Horizontal cleavage tears are often located in the medial meniscus and benefit from meniscus repair as this decreases the peak stresses on the cartilage. Radial tears are most often located in the lateral meniscus – excluding posterior horn medial meniscus tears – and lead to complete loss of meniscus function and should also be treated with meniscus repair. In this overview article, the epidemiology, different treatment options, surgical techniques, rehabilitation and surgical outcomes of horizontal cleavage and radial meniscus tears are discussed.
半月板在抵抗和分配轴向载荷中起着重要的作用,并具有软骨保护功能。半月板损伤很常见,估计终生患病率为9%至12%。在过去的十年中,关于半月板损伤的知识和意识有所增加,对半月板损伤的不同治疗方法的后果有了更好的理解。历史上通常采用非手术治疗或半月板部分或次全切除术,但诊断、手术技术和结果的发展改变了这种模式。水平劈裂撕裂通常位于内侧半月板,并受益于半月板修复,因为这减少了软骨的峰值应力。桡骨撕裂通常位于外侧半月板(不包括后角内侧半月板撕裂),导致半月板功能完全丧失,也应采用半月板修复治疗。本文综述了半月板撕裂的流行病学、不同的治疗方案、手术技术、康复和手术效果。
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引用次数: 0
Meniscus Tears Associated with ACL Injuries: The Multicenter Orthopaedic Outcomes Network (MOON) Experience 与前交叉韧带损伤相关的半月板撕裂:多中心矫形预后网络(MOON)经验
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101188
Sercan Yalcin , Andrew J. Sheean , Morgan H. Jones , Kurt P. Spindler , MOON Knee Group
Anterior cruciate ligament (ACL) tears are frequently associated with meniscus tears. This further impairs knee biomechanics and worsens the knee instability of patients, and thus, has implications on the outcomes of treatment of ACL injuries. The Multicenter Orthopedics Outcome Network (MOON) is a prospective observational cohort reported on the outcomes of ACL reconstruction and associated injuries such as meniscus tears and also is the first prospective cohort reporting on the success of meniscus treatment at the time of ACL reconstruction. MOON reported that successful repair of the medial meniscus at the time of ACL reconstruction would yield improved pain scores at 10-years, small incomplete tears, particularly on the lateral meniscus, could be left alone and any meniscus procedure prior to the index ACL reconstruction would result with poorer outcomes. This article aims to summarize the epidemiology, treatment and outcomes of treatment of associated meniscus tears reported at different follow-up periods by MOON.
前交叉韧带(ACL)撕裂经常与半月板撕裂有关。这进一步损害了膝关节的生物力学,加重了患者的膝关节不稳定性,因此影响了前交叉韧带损伤的治疗结果。多中心骨科结果网络(MOON)是一个前瞻性观察队列,报道了ACL重建和相关损伤(如半月板撕裂)的结果,也是第一个报道ACL重建时半月板治疗成功的前瞻性队列。MOON报道,在重建前交叉韧带时成功修复内侧半月板可以改善10年疼痛评分,小的不完整撕裂,特别是外侧半月板撕裂,可以不加处理,在重建前进行任何半月板手术都会导致较差的结果。本文旨在总结MOON在不同随访时期报道的相关半月板撕裂的流行病学、治疗方法和治疗结果。
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引用次数: 0
Biomechanics of the Meniscus and Meniscal Injury 半月板和半月板损伤的生物力学
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101180
Daniel J. Cognetti , Asheesh Bedi
The menisci play a fundamental role in knee joint biomechanics, facilitating load distribution, joint stability, lubrication, and proprioception. Injury to the meniscus disrupts these functions, leading to altered joint mechanics, increased contact pressures, and a heightened risk of osteoarthritis. This review explores the biomechanical properties of the meniscus, the consequences of root, radial and horizontal cleavage tears and how treatment strategies influence contact mechanics and long-term joint health. While the evidence strongly supports repair over meniscectomy whenever feasible, challenges remain in managing degenerative tears and preventing osteoarthritis progression. Advances in surgical techniques and rehabilitation strategies continue to refine treatment approaches, focusing on maximizing repair strength while allowing for controlled early mobilization. A deeper understanding of meniscal biomechanics is essential for optimizing surgical treatment, guiding rehabilitation and promoting long-term joint health.
半月板在膝关节生物力学中起着基础作用,促进负荷分布、关节稳定性、润滑和本体感觉。半月板损伤破坏了这些功能,导致关节力学改变,接触压力增加,骨关节炎风险增加。这篇综述探讨了半月板的生物力学特性,根部、径向和水平劈裂撕裂的后果,以及治疗策略如何影响接触力学和长期关节健康。尽管有证据强烈支持在可行的情况下修复半月板切除术,但在管理退行性撕裂和防止骨关节炎进展方面仍然存在挑战。手术技术和康复策略的进步继续完善治疗方法,重点是最大限度地修复力量,同时允许可控的早期活动。更深入地了解半月板生物力学对于优化手术治疗、指导康复和促进长期关节健康至关重要。
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引用次数: 0
Operative Techniques: Orthobiologics in the Treatment/Augmentation of Meniscal Injuries 手术技术:半月板损伤的矫形术治疗/增强
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101187
Kyla A. Petrie , Aniket Pratapneni , Justin Jabara , Drew A. Lansdown
The meniscus provides an important structural and functional role in the knee, and loss of meniscal tissue to injury can worsen the progression of osteoarthritis. Surgeons are continually trying to find ways to improve healing rates of meniscus tears during operative repairs, one of which include orthobiologics such as platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC), fibrin clots, and intercondylar notch microfracture. Each of these orthobiologic therapies attempt to increase the number of growth factors in the knee that may positively impact meniscus healing after repair. This review will discuss the evidence surrounding each of these orthobiologics in relation to operative meniscal repair as well as PRP in nonoperative meniscus tear management.
半月板在膝关节中起着重要的结构和功能作用,半月板组织的损伤可使骨关节炎的进展恶化。外科医生一直在努力寻找提高半月板撕裂手术修复的治愈率的方法,其中包括矫形术,如富血小板血浆(PRP)、骨髓浓缩物(BMAC)、纤维蛋白凝块和髁间切迹微骨折。每一种骨科疗法都试图增加膝关节生长因子的数量,这可能会对半月板修复后的愈合产生积极影响。这篇综述将讨论这些骨科与半月板手术修复以及PRP非手术半月板撕裂治疗相关的证据。
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引用次数: 0
Table of Contents (pick up from previous issue w/updates) 目录(选自上一期的内容和更新)
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1053/S1048-6666(25)00037-0
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引用次数: 0
Arthroscopic Partial Meniscectomy 关节镜半月板部分切除术
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101181
Justin J. Ernat
Partial meniscectomy is a reasonable treatment option for appropriately selected patients with meniscal tears. In young patients with unstable or nonviable tears, partial meniscectomy can be effective in relieving mechanical symptoms and the pain. In older patients with degenerative tears, the data is variable as to whether partial meniscectomy is more effective than nonoperative treatments. However, the risks of surgery and arthritic progression and/or conversion to knee arthroplasty is reportedly low. Therefore, meniscectomy should be considered a viable treatment option for patients that have failed nonoperative measures. Technical measures that can improve the efficiency, effectiveness, and prognosis of partial meniscectomy include optimizing the ability to valgus stress the knee with the operative room set up, lengthening of the superficial medial collateral ligament, counseling patients on the risks of extrusion when identified, and performing vertical or horizontal resections (as opposed to subtotal meniscectomy) when possible.
半月板部分切除术是一个合理的治疗选择,适当选择患者半月板撕裂。对于年轻的撕裂不稳定或不能存活的患者,半月板部分切除术可以有效地缓解机械症状和疼痛。在老年退行性撕裂患者中,半月板部分切除术是否比非手术治疗更有效的数据是可变的。然而,据报道手术、关节炎进展和/或转化为膝关节置换术的风险很低。因此,对于非手术治疗失败的患者,半月板切除术应被视为一种可行的治疗选择。可以提高半月板部分切除术的效率、效果和预后的技术措施包括:在手术室设置时优化膝关节外翻应力的能力,延长浅内侧副韧带,在确定挤压风险时向患者提供咨询,并在可能的情况下进行垂直或水平切除(与半月板次全切除术相反)。
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引用次数: 0
Epidemiology: Prevalence, Incidence, and Implications of Ramp Lesions 流行病学:Ramp病变的流行、发病率和影响
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1016/j.oto.2025.101183
C. Onyeukwu , R. Vieider , E. Krakora , R. Cristiani , V. Musahl
Meniscal ramp lesions are defined as longitudinal peripheral tears in the medial meniscus where the meniscocapsular and meniscotibial ligaments connect to the posterior horn. Meniscal ramp lesions are commonly associated with ACL tears but can easily be overlooked due to low sensitivity of diagnosis via MRI and their location posterior to the posterior horn of the medial meniscus. Left untreated, ramp lesions can lead to pain, decreased knee function, altered knee kinematics, and a decreased quality of life. Due to the impact meniscal ramp lesions can have on a patients' overall function, it is recommended to have a high index of suspicion for meniscal ramp lesions. Also, it is imperative to establish and utilize a posteromedial portal to directly probe the posterior horn of the medial meniscus when investigating the presence and stability of meniscal ramp lesions. Treatment options for meniscal ramp lesions can be non-operative, biological treatment, or meniscal repair with suture fixation. Non-operative management can be considered for stable lesions, while different operative techniques including inside-out, and all-inside repair have been described for meniscal ramp lesions requiring surgical fixation. Overall, Meniscus ramp lesions show good healing potential, as an excellent healing rate of 89% after meniscus ramp lesion repair has been reported and biological treatment such as trephination or rasping has also been shown to have positive results, whether done in isolation for more stable lesions or done in conjunction with suture fixation.
半月板斜坡病变定义为内侧半月板纵向外周撕裂,半月板囊和半月板胫韧带连接后角。半月板斜坡病变通常与前交叉韧带撕裂有关,但由于MRI诊断敏感性低且其位置位于内侧半月板后角后方,因此很容易被忽视。如果不及时治疗,斜坡病变可导致疼痛、膝关节功能下降、膝关节运动改变和生活质量下降。由于半月板斜坡病变对患者整体功能的影响,建议对半月板斜坡病变有高度的怀疑指数。此外,在调查半月板斜坡病变的存在和稳定性时,必须建立和利用后内侧门静脉直接探测内侧半月板后角。半月板斜坡病变的治疗选择可以是非手术、生物治疗或半月板缝合固定修复。对于稳定的病变,可以考虑非手术治疗,而对于需要手术固定的半月板斜坡病变,已经描述了不同的手术技术,包括由内而外和全内修复。总体而言,半月板斜坡病变显示出良好的愈合潜力,据报道,半月板斜坡病变修复后的良好治愈率为89%,生物治疗(如穿孔术或刮刀术)也显示出积极的结果,无论是单独进行更稳定的病变还是与缝合固定联合进行。
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引用次数: 0
Contributors (pick up from previous issue w/updates) 贡献者(从以前的问题和更新中挑选)
IF 0.2 Q4 ORTHOPEDICS Pub Date : 2025-06-01 DOI: 10.1053/S1048-6666(25)00038-2
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引用次数: 0
期刊
Operative Techniques in Orthopaedics
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