2015 ISAKOS Biennial Congress ePoster #1631

Meniscus Allograft Transplantation with Soft Tissue Technique: Our Experience After 7 Years

Vincenzo Condello, MD, Negrar, Verona ITALY
Roberto Giovarruscio, MD, Rome ITALY
Nogah Shabshin, MD, Tel Aviv ISRAEL
Vincenzo Madonna, MD, Verona ITALY
Claudio Zorzi, MD, Verona, Veneto ITALY

Ospedale Sacro Cuore, Negrar, Verona, ITALY

FDA Status Cleared

Summary: The purpose of this study is to evaluate the efficacy of meniscus allograft transplantation (MAT) using arthroscopic soft tissue technique in preventing knee degeneration and in relieving pain. The importance of the surgical technique together with associated surgery evaluated clinically and by MRI are the main topics of the study

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Abstract:

OBJECTIVES
Any significant loss of meniscal function either through injury or meniscectomy alters the biomechanical of the normal knee, eventually resulting pain recurrent \ effusions, and eventually osteoarthritis. The purpose of this study was to evaluate the efficacy of meniscus allograft transplantation (MAT) in improving pain and function.

Methods

Since 2005 more than 80 patients have been treated with MAT in our unit. At present time 36 of them underwent follow-up clinical and MR evaluation. They represent our study population (mean age: 38 years, M:F=29:7; left:right=20:16; lateral:medial meniscus=18:18). All patients except one, have a history of at least one previous surgery, in 28 meniscectomy or meniscal suture. In 23 patients MAT has been associated to one or more surgical procedures: ACL reconstruction (10), chondral or osteochondral treatment (9), tibial osteotomy (5). MAT was performed with an arthroscopic technique without bone plug. Multiple intrarticular sutures were used: the anterior and posterior horns were fixed together on the anterior tibial cortex in the lateral meniscus while they were fixed separately in the medial one. The allograft was cryo-preserved; meniscal size was predicted with a regression formula based on gender, height and weight. Clinical evaluation was conducted at an average of 4.1 yrs with Lysholm, IKDC, VAS, Koos and Tegner scores. MRI evaluation was performed during the final follow-up.

MRI was evaluated for the morphology of the new-meniscus and the interface with the remnant, retear, root tear, meniscus extrusion, advanced osteoarthritis and visualiztion of the tunnels, bone marrow edema and other findings that could explain loss of function or pain.

Results

Good to excellent results both in terms of functionality and pain relief and with a statistically significant improvement were observed in all the scores at follow-up as compared to preoperative baseline. Lysholm score improved by 27.5 points (p-value=0.0000); IKDC score by 19.95 points (p-value=0.0001); VAS score by 30.08 points (p-value=0.0000); Koos score by 17.23 points (p-value=0.0004) and Tegner score by 0.97 points (p-value=0.0137). The following adverse events included: 2 de novo lesions of the transplanted meniscus treated with meniscal suture or meniscectomy; 1 detachment of the anterior horn treated with meniscal regularization and suture; 1 joint stiffness treated with arthroscopic arthrolysis. MRI evaluation: normal postoperative meniscus-graft interphase is sharp. The graft demonstrates higher signal than the native rim. The tunnels are well seen as “ghost holes”, Findings that could explain pain and limited range of motion included advanced OA with bone marrow edema, anterior and posterior root tears with extrusion, Cyclops lesion in the notch, new and re-tears of the graft. Metal artifacts may obscure the area of interest and a metal protocol should be used

Conclusions

MAT may improve pain and functionality and can be a useful therapeutic option for the treatment of a symptomatic meniscectomized knee. MRI is useful for evaluation of the transplanted knee and diagnose the source of pain and limited motion.