【临床骨骼肌肉学】半月板损伤课件

1、Meniscal Tears第1页，共43页。contentanatomical and functiontissues biomechanical characteristicsMeniscal TearsA study :Meniscal Tear Biomechanics:Loads Across Meniscal Tears in Human Cadaveric Knees第2页，共43页。ANATOMYanterior viewsuperior view第3页，共43页。Clark CR, Ogden JA. Development of the menisci of the hum

2、an knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Jt Surg Am. 1983; 65:53847.which part of the meniscus is more likely to be injured?both :wedge-shaped and semi-lunar variety: size, shape, thickness, and mobility than medial menisci第4页，共43页。FUNCTIONS:

3、functioning as a shock absorberincreasing the passive stability of the knee,enhancing joint congruitydecreasing load transmission and tibiofemoral contact stressesassisting in joint lubricationaiding in knee joint proprioception.第5页，共43页。By spreading out the forces on the knee joint, the menisci pro

4、tect the articular cartilage from getting too much pressure on one small area on the surface of the joint. Without the menisci, the forces on the knee joint are concentrated onto a small area, leading to damage and degeneration of the articular cartilage, a condition called osteoarthritis.The menisc

5、i add stability to the knee joint. They convert the surface of the shinbone into a shallow socket, which is more stable than its otherwise flat surface. Without the menisci, the round femur would slide on top of the flat surface of the tibia.第6页，共43页。Not only does this tissue display complex anatomy

6、Regional variations in vascularization and cell populations of the meniscusbiomechanical characteristics第7页，共43页。Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:905. PubMed: 7081532vascularizationfully vascularized10-30%10-25%10 years oldPrenatal to shortly a

7、fter birthMuturity which part of it is not easy toheal? (is directly related to blood circulation)第8页，共43页。Biochemical ContentCells in the outer, vascularized section of the meniscus (red-red region) are spindle-shaped, display cell processes, and are more fibroblast-like in appearance. are well-sui

8、ted to maintaining a fibrous extracellular matrix rich in collagen type I.cells in the middle section (white-red region) and inner section (white-white region) are more chondrocyte-like, though they are phenotypically distinct from chondrocytes. Cells in the superficial layer of the meniscus are sma

9、ll and round. inner meniscus cells produce both collagen types I and II, and glycosaminoglycans, giving rise to a hyaline-like inner portion of the tissue. 第9页，共43页。Herwig J, Egner E, Buddecke E. Chemical changes of human knee joint menisci in various stages of degeneration. Ann Rheum Dis. 1984; 43:

10、63540. PubMed: 6548109Proctor CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Material properties of the normal medial bovine meniscus. J Orthop Res. 1989; 7:77182. PubMed: 2677284 red-red zone, collagen type I 80%other collagen variants (type II, III, IV, VI, and XVIII) present at less than 1%white-w

11、hite zone:70% of the tissue by dry weight collagen type II(60% ) collagen type I(40%) which type of the meniscal tear is more easier to happen?(transverse?vertical) 第10页，共43页。How force is transduced upon and throughout the knee meniscusFree body diagram of the forces acting on the knee meniscus duri

12、ng loading (for simplicity,only the lateral meniscus is shown). During everyday activity, the menisci are compressed by the downward force of the femur. Since the meniscus is a wedge, the femoral force is enacted at an angle, and thus a vertical component exists which is countered by the upwardforce

13、 of the tibia. Additionally, a horizontal component of the femoral force exists, which isexerted radially outward on each meniscus. This horizontal force is in turn countered by the anchoring force of the attachments at the posterior and anterior horns of the meniscus.Additionally, as this compressi

14、on occurs, circumferential stress is created along themeniscus. Therefore, the menisci function by converting compressive loads tocircumferential tensile loads. At the same time, shear forces are developed between thecollagen fibers within the meniscus while the meniscus is deformed radially.FfemFvF

15、hFtibFfem第11页，共43页。膝关节由股骨内、外侧髁和胫骨内、外侧髁以及髌骨构成，为人体最大且构造最复杂，损伤机会亦较多的关节。 第12页，共43页。结构关节囊较薄而松弛，附着于各骨关节软骨的周缘。关节囊的周围有韧带加固。前方的叫髌韧带，在髌韧带的两侧，有髌内、外侧支持带 。后方有腘斜韧带加强，内侧有胫侧副韧带，为扁带状，外侧为腓侧副韧带关节囊的滑膜层广阔，除关节软骨及半月板的表面无滑膜覆盖外，关节内所有的结构都被覆着一层滑膜。于髌下部的两侧，滑膜形成皱襞，突入关节腔内，皱襞内充填以脂肪和血管，叫做翼状襞。两侧的翼状襞向上方逐渐合成一条带状的皱襞，称为髌滑膜襞，伸至股骨髁间窝的前缘。

16、第13页，共43页。结构在关节内，生有由纤维软骨构成的半月板 ，内侧半月板大而较薄，呈“C”形，外侧半月板较小，成“o”型。半月板外缘厚，与关节囊相连内缘薄而游离。半月板下面平坦，上面凹陷，分别与胫骨，股骨的关节面相适应，增强了关节的稳固性，还可起缓冲作用。第14页，共43页。辅助结构半月板：由2个纤维软骨板构成，垫在胫骨内、外侧髁关节面上，半月板外缘厚内缘薄。 翼状襞：在关节腔内，位于髌骨下方的两侧，含有脂肪的邹襞，填充关节腔。 髌上囊和髌下深囊：位于股四头肌腱与骨面之间 加固关节的韧带 ：前后交叉韧带 腓侧副韧带 胫侧副韧带 髌韧带 第15页，共43页。第16页，共43页。第17页，共43

17、页。第18页，共43页。基本运动及特点当膝关节完全伸直时，胫骨髁间隆起与股骨髁间窝嵌锁，侧副韧带紧张，除屈伸运动外，股胫关节不能完成其他运动 当膝关节屈时，股骨两侧髁后部进入关节窝，嵌锁因素解除，侧副韧带松弛，股胫关节才能绕垂直轴作轻度的旋转运动。 膝关节运动时，半月板可发生位移，屈膝时向后移，伸膝时向前移；小腿旋转时半月板随股髁位移，一侧滑向前，另一侧滑向后 膝关节位于人体两个最长的杠杆臂之间，在承受负荷和参与运动中易于损伤，股骨和胫骨以宽大的内、外侧髁关节面增大关节的接触面积，可提高关节的稳固性和减少压强 膝关节基本运动是屈伸旋内旋外第19页，共43页。与膝关节运动相关肌肉屈：半腱肌，半膜

18、肌，缝匠肌，股二头肌，股薄肌和腓肠肌伸：股四头肌旋内：半腱肌，半膜肌，缝匠肌，股薄肌旋外：股二头肌第20页，共43页。第21页，共43页。踝关节踝关节，又名距骨小腿关节。由胫、腓骨下端的关节面与距骨滑车构成，踝关节属滑车关节，可沿通过横贯距骨体的冠状轴做背屈及跖屈运动。 第22页，共43页。第23页，共43页。第24页，共43页。踝关节的运动足跖屈：小腿三头肌，趾长屈肌，胫骨后肌，石母长屈肌，腓骨长肌和腓骨短肌足背屈：胫骨前肌，趾长伸肌和石母长伸肌足外翻：腓骨长肌和腓骨短肌足内翻：胫骨前肌，胫骨后肌，石母长屈肌和趾长屈肌第25页，共43页。EricA cadavaric study709326

19、181第26页，共43页。ContentsTHEBackgroundMaterials and MethodsResultsDiscussion第27页，共43页。Part OneBackground01第28页，共43页。MAIN CONTENTImpact of Partial and complete rupture of anterior cruciate ligament on medial meniscusinvestigate the biomechanical impact of partial and complete ACL rupture on different par

20、ts of medial meniscus第29页，共43页。Part TwoMaterials and Metheds02第30页，共43页。ACL intact (ACL-I)anteromedial bundle transection (AMB-T)posterolateral bundle transection (PLB-T)ACL complete transection (ACL-T)第31页，共43页。Axial compressive3006090 Strain on the anterior horn, body part, and posterior horn of m

21、edial meniscus were measured under 200 N axial compressivetibial load 第32页，共43页。Specimen preparationPrior to experiments, the femur and tibia were cut to approximately 30 cm from the joint line, the proximal portion of the fibula was retained and secured to the tibia at its anatomic position using a

22、 cortical screw, and soft tissues were carefully removed except quadriceps muscle and joint capsule.第33页，共43页。第34页，共43页。Group of experiments and test proceduresthe specimens were positioned at 0, 30, 60, and 90 of flexion in sequence.During the whole test, the specimens were kept at a humidity of 60

23、80% and a temperature of 25C.第35页，共43页。Part ThreeResult03第36页，共43页。Resultresponses and changes in different areas of the medial meniscus toward strain resulting from ACL injury are also unclear.abnormal strains generated from anterior posterior translation and internal/external rotation of medial fe

24、moral condyle in this extent cause rupture of medial meniscus body more easily第37页，共43页。Part FourConclusions04第38页，共43页。Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus,especially posterior horn, which may be a more critical reason for meni

25、scus injury associated with chronic ACL deficiency.第39页，共43页。ReferencesHenning CE. Current status of meniscus salvage. Clin Sports Med 1990;9:567-7 Yoon KH, Yoo JH, Kim KI. Bone contusion and associate meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture

26、. J Bone Joint Surg Am 2011;93:1510-8.6.Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001;29:226-31.Tjoumakaris FP, Donegan DJ, Sekiya JK. Partial te

27、ars of the anterior cruciate ligament: Diagnosis and treatment. Am J Orthop (Belle Mead NJ) 2011;40:92-7.第40页，共43页。EricTHANK YOU第41页，共43页。 Ihn JC, Kim SJ, Park IH. In vitro study of contact area and pressure distribution in thehuman knee after partial and total meniscectomy. Int Orthop. 193; 17(4):2

28、14-218.Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repairon intraarticular contact areas and stress in the human knee: a preliminary report. Am JSports Med. 1986; 14(4):270-275.Wojtys EM, Chan DB. Meniscus structure and function. Instr Course Lect. 2005;54:323-330.

29、Kettelkamp DB, Jacobs AW. Tibiofemoral contact area: determination and implication. JBone Joint Surg Am. 1972; 54(2):349-356.Walker PS, Erkman MJ. The role of the menisci in the transmission across the knee. Clin Orthop Relat Res. 1975; (109):184-192.Alford JW, Lewis P, Kang RW, Cole BJ. Rapid progr

30、ession of chondral disease in thelateral compartment of the knee following meniscectomy. Arthroscopy. 2005;21(12):1505-1509.Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy onanterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64(6):883-888.Fu FH, Thompson WO. Motion

31、 of the meniscus during knee flexion. In: Mow VC,Arnoczky SP, Jackson DW, eds. Knee Meniscus: Basic and Clinical Foundation. NewYork, NY: Raven Press; 1992:131-139.REFERENCE第42页，共43页。 Shoemaker SC, Markolf KL. The role of the meniscus in the anterior-posterior stability ofthe loaded anterior cruciat

32、e-deficient knee: effects of partial versus total excision. J BoneJoint Surg Am. 1986; 68(1):71-79.Arnoczky SP, Adams ME, DeHaven KE, Eyre DR, Mow VC. The meniscus. In: WooSL-Y, Buckwalter J, eds. Injury and Repair of the Musculoskeletal Soft Tissue. ParkRidge, IL: American Academy of Orthopaedic Surgeons; 1988:487-537. Mow VC, Ratcliffe A, Chern KY, Kelly MA. Structure and function relationships ofmenisci of the knee. In: Mo