Meniscal Allografts: Indications and Outcomes (original) (raw)
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Clinical evaluation of arthroscopic-assisted allograft meniscal transplantation
Annals of the Academy of Medicine, Singapore, 2008
A meniscal deficient knee is at risk of early degenerative osteoarthritis. Allograft meniscal transplantation has been used to treat the meniscus deficiency to alleviate pain symptoms and to delay progression to arthritis. This case series aims to assess the postoperative outcomes of patients who have undergone meniscal allograft transplantation in our hospital. This is a prospective clinical review of prospectively collected data of our Meniscal Transplantation Programme from 2004 to 2007. Twelve meniscal allografts were implanted in 12 males with symptomatic knees, using arthroscopically assisted techniques. Preoperative and postoperative assessments were conducted using the Visual Analogue Scale (VAS), Tegner Activity Level Scale, Lysholm Knee Scoring Scale, and 2000 International Knee Documentation Committee (IKDC) scoring systems. The mean age was 26.7 years with a mean follow-up of 17 months (range, 5 to 37). The VAS score for pain improved from 5.5 (3- 10) to 1.4 (0-2) [P <...
Meniscal transplantation: procedures, outcomes, and rehabilitation
Orthopedic Research and Reviews
Meniscal allograft transplantation (MAT) is a possible treatment option for patients with joint pain after meniscectomy. It is necessary that the joint be aligned and stable. Current evidence shows that MAT improves pain and mechanical function in the mid to long term with patients reporting significantly improved outcomes at up to 15 years following surgery. Studies on survivorship showed up to 76% graft survival at 10 years. Recent studies have suggested a chondroprotective effect, but there is, at present, no evidence to support MAT in the prevention of osteoarthritis. This review article reported the current evidence for MAT showing support for fresh frozen, nonirradiated allografts. However, further research is required to determine the ideal indications for MAT, the optimal graft fixation method, and the safest rehabilitation protocol.
Current Meniscal Allograft Transplantation
Sports Medicine and Arthroscopy Review, 2004
Meniscal allograft transplantation is now gradually transforming from an interesting alternative in meniscal restoration algorithms to a reliable treatment of unicompartmental knee pain after meniscectomy. The past decade has allowed refinements in sizing, preservation, and fixation of the meniscal allograft. Current techniques focus on adherence to biomechanical principles in attempting to duplicate the force transfer of an intact meniscal tibial plateau construct. Although intermediate term outcome results are promising in regards to pain relief, the long term objective of articular cartilage preservation remains a goal.
The American journal of sports medicine, 2016
Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2015
To provide a systematic review of the literature regarding five topics in meniscal allograft transplantation (MAT): optimal timing for transplantation, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. A systematic literature search was conducted using the PubMed (MEDLINE), ScienceDirect, and EBSCO-CINAHL databases. Articles were classified only in one topic, but information contained could be reported into other topics. Information was classified according to type of study (animal, in vitro human, and in vivo human) and level of evidence (for in vivo human studies). Specific inclusion criteria were determined for the outcomes and prevention of osteoarthritis topics. Twenty-four studies were finally included: two optimal timing, seven outcomes, three return to competitive sport, 16 MAT and associated procedures, and 5 MAT and prevention of osteoarthritis (some studies were categorized in more than one topic). These studies corresponded to 2 an...
Arthroscopically Assisted Meniscal Allograft Transplantation
Operative Techniques in Sports Medicine, 2005
Meniscal allograft transplantation (MAT) is performed in the United States in ever-increasing numbers. Various techniques have been described since the initial transplantation was performed more then 20 years ago. Decreased pain and improved knee function are attainable with proper patient selection, identification, and correction of all concomitant malalignment and instability, and intervention earlier in the disease process. This article reviews the indications for MAT and offers a basic treatment algorithm for managing concomitant cartilage lesions, instability, and misalignment. The author's preferred arthroscopic technique using individual bone plugs for both medial and lateral MAT and freshfrozen allograft is described. This technique stresses the low morbidity of the approach and the re-establishment of the anatomic bony attachments of the anterior and posterior horns of the meniscus. Oper Tech Sports Med 13:227-232.
Clinical Outcomes Following Isolated Lateral Meniscal Allograft Transplantation
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
Purpose: The purpose of our study was to determine the clinical outcomes following isolated lateral meniscal allograft transplantation. Methods: Thirty-two patients were retrospectively reviewed following isolated lateral meniscal allograft transplantation. Twenty-five were available for subjective follow-up, and 17 were available for a complete physical examination and postoperative radiographs. The average duration of follow-up was 3.3 years (range, 2 to 6 years), and the average age of the subjects was 30 years (range, 19 to 45 years). In all, 17 patients had bony fixation and 8 had suture fixation of the anterior and posterior horns of the meniscal allograft. Results: Ninety-six percent of patients believed that their overall function and activity level were improved following surgery. Short Form-36 (SF-36) physical and mental component summary scores for these subjects were higher than age-and sex-matched scores from the US population. Joint space narrowing of the transplanted lateral compartments was not significantly different when compared with the joint space narrowing of the lateral compartment of the contralateral knee. In addition, preoperative and postoperative radiographic joint space measurements of the involved lateral compartment were significantly associated with subjective assessment, symptoms, sports activity score, Lysholm score, and final International Knee Documentation Committee (IKDC) rating at latest follow-up. Finally, patients fixed with the bony technique had significantly better range of motion, according to IKDC criteria at latest follow-up, compared with the suture fixation group. Conclusions: Our results suggest that isolated meniscal allograft transplantation can be a beneficial procedure in properly selected symptomatic patients with a lateral meniscus-deficient knee. The data also suggest that earlier meniscal transplantation, before the onset of significant joint space narrowing, may result in improved outcomes. Finally, bony fixation may have a significant advantage over suture fixation, particularly with regard to knee range of motion. Level of Evidence: Level IV, therapeutic case series.
Meniscal Allograft Transplantation Does Not Prevent or Delay Progression of Knee Osteoarthritis
PLOS ONE, 2016
Background Meniscal tears are common knee injuries. Meniscal allograft transplantation (MAT) has been advocated to alleviate symptoms and delay osteoarthritis (OA) after meniscectomy. We investigated (1) the long-term outcome of MAT as a treatment of symptomatic meniscectomy, (2) most important factors affecting survivorship and (3) OA progression. Methods From 1989 till 2013, 329 MAT were performed in 313 patients. Clinical and radiographic results and MAT survival were evaluated retrospectively. Failure was defined as conversion to knee arthroplasty (KA) or total removal of the MAT. Results Mean age at surgery was 33 years (15-57); 60% were males. No-to-mild cartilage damage was found in 156 cases, moderate-to-severe damage in 130. Simultaneous procedures in 118 patients included cartilage procedures, osteotomy or ACL-reconstruction. At a mean follow-up of 6.8 years (0.2-24.3years), 5 patients were deceased and 48 lost (14.6%), 186 MAT were in situ (56.5%) whilst 90 (27.4%) had been removed, including 63 converted to a KA (19.2%). Cumulative allograft survivorship was 15.1% (95% CI:13.9-16.3) at 24.0 years. In patients <35 years at surgery, survival was significantly better (24.1%) compared to ≥35 years (8.0%) (p = 0.017). In knees with no-to-mild cartilage damage more allografts survived (43.0%) compared to moderate-to-severe damage (6.6%) (p = 0.003). Simultaneous osteotomy significantly deteriorated survival (0% at 24.0 years) (p = 0.010). 61% of patients underwent at least one additional surgery (1-11) for clinical symptoms after MAT. Consecutive radiographs showed significant OA progression at a mean of 3.8 years (p<0.0001). Incremental Kellgren-Lawrence grade was +1,1 grade per 1000 days (2,7yrs).