ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1034

 

Safety, Feasibility, and Radiographic Outcomes of the Anterior Meniscal Takedown Technique to Approach Chondral Defects on the Tibia and Posterior Femoral Condyle: A Matched Control Study

Gergo Merkely, MD, Boston, MA UNITED STATES
Tom Minas, MD, Chestnut Hill, MA UNITED STATES
Takahiro Ogura, MD, Funabashi, Chiba JAPAN
Jakob Ackermann, MD, Boston, MA UNITED STATES
Alexandre B. Mestriner, MD, São Paulo, SP BRAZIL
Andreas H. Gomoll, MD, New York, NY UNITED STATES

Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical Center, Boston, MA, UNITED STATES

FDA Status Not Applicable

Summary

The surgical technique of anterior meniscal take-down and refixation is a safe and effective procedure to facilitate exposure of otherwise difficult to access chondral defects on the tibial plateau and/or posterior femoral condyle

Abstract

Background

The visualization and approach of cartilage defects located on the tibial plateau and/or posterior femoral condyle can be challenging. Take-down of the anterior meniscus to facilitate exposure with subsequent re-attachment with transosseous sutures is being performed clinically, however, clinical evidence is lacking to support the safety of this technique regarding meniscus integrity and function.
The aim of this study was, therefore, to investigate whether meniscal extrusion develops after patients undergo meniscus takedown and transosseous refixation during autologous chondrocyte implantation (ACI).

Methods

We analyzed data from 124 patients with a mean follow-up of 6.8 ± 2.5 years. Sixty-two patients who underwent (ACI) with anterior meniscus takedown and refixation by the senior surgeon, [TM], were compared with a matched control group of patients who underwent ACI without meniscus takedown. Patients were matched by age, gender, BMI, defect size and affected compartment. Meniscal extrusion was investigated by measuring the absolute value and the relative percentage of extrusion (RPE) on 1.5-T magnetic resonance images (MRI) at final follow-up. The number of menisci with radial displacement greater or lesser than 3 mm was determined. In cases where a preoperative MRI was available, both pre- and post-operative meniscal extrusion was evaluated (n = 30) in those patients undergoing meniscal takedown.

Results

There was no significant difference in either absolute meniscus extrusion, RPE, or extrusion rate in patients with and without meniscus takedown. Among patients with meniscal takedown and both pre- and post-operative MRI scans, absolute meniscus extrusion, RPE and extrusion rate showed no significant differences.

Conclusion

In conclusion, our matched cohort study identified overall low meniscus extrusion rates that were not different between patients with and without meniscal takedown during cartilage repair with ACI. Meniscal takedown and subsequent transosseous refixation is a safe and effective technique for exposure of the tibial plateau and posterior femoral condyle.