Missing
Meniscus GIII Arthritis
Allograft
Meniscus
Allograft
Meniscus After Four Months
| | INTRODUCTION
Can meniscus allografting survive in the setting of knee arthritis? We present
the findings of 45 patients (47 meniscal allografts) with significant arthrosis
to determine if the meniscus can survive in the arthritic joint of older adults.
We believe that replacing the meniscus in this patient population may help to
delay arthroplasty and improve the results of debridement alone. METHODS
Patients: Prospective data was collected for 45 patients (32 men, 13
women, mean age 48, age range 14-69, 2 patients had bilateral grafts), with pre-operative
evidence of significant arthritis. Allografts were medial in 37 (79%) and lateral
in 10 (21%). Of 47 knees, 9 were Outerbridge Class III (19%), and 38 were Class
IV (81%).
Statistics: Serial clinical exams, x-ray, MRI and
validated questionnaires for pain, activity, and function were used. No patient
was lost to follow up. Graft failure was defined as surgical removal of the allograft
or increased pain as reported by the patient. Five out of 47 allografts were considered
failures (10.6%). Statistical analysis included paired t-tests and Kaplan-Meier
survival analysis. Power analysis with a delta of 0.1, sigma of 0.18, alpha of
0.05 and N=49 demonstrates a power > 0.90.
Surgical Technique:
Surgical technique used was the "three tunnel technique" previously described
by the senior author.1 RESULTS
Statistically
significant mean improvement in self-reported measures of pain, activity and functioning
with corresponding probabilities of p=0.000, 0.008 and 0.000 using paired-t tests,
independent of age, joint space narrowing or severe mal-alignment are reported
in Table I.
Twelve of 49 menisci required a second arthroscopy for either
suture repair or partial meniscectomy, but were not considered failures because
the transplant was a success. A Kaplan-Meier analysis revealed that the mean time
to failure, adjusting for censoring, was 4.3 years. The overall failure rate was
5 of 47, or 10.6%.
All 5 patients had chronic injuries with osteochondral lesions
(classified as Grade IV Outerbridge lesions) with unremitting pain in the affected
compartment, eventually leading to arthroplasty. Table II reveals the survival
probabilities from one to five years. DISCUSSION
Meniscal allografts
survive moderately well in knees with arthritis. Most patients in this population
are pleased to gain 5-10 years if it delays arthroplasty. The role that allografts
play is difficult to parse from the benefit of the concomitant procedures performed
during arthroscopy of arthritic knees; however, recent reports have indicated
that arthroscopic debridement alone has not been satisfactory. Therefore, the
addition of the shock-absorbing meniscus may be required to provide longer-term
relief. These results compare favorably with previous reports of patients who
were younger and with less severe degenerative disease. This study demonstrate
that meniscal allograft transplantation can be used in higher-risk patients with
reasonable expectations of a successful outcome REFERENCES
1.
Stone KR, Walgenbach AW. "Meniscal Allografting: The Three-tunnel Technique."
Arthroscopy - The Journal of Arthroscopic and Related Surgery. 2003, 19(4):426-30. |
| 
Three Tunnel Technique For
Meniscus Fixation
Insertion
of Medial Meniscus Allograft
Suturing
of Medial Meniscus Allograft
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