Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up

Abstract

In a prospective study, we evaluated the clinical results of 23 patients with a cryopreserved non-tissue-antigen matched meniscal transplant at a follow-up of from two to five years. These early results were satisfactory in 20 patients.

Transplantation of Viable Meniscal Allograft

“…However, because the lateral meniscus plays a greater role in stress protection, a lateral meniscectomy can result in a painful knee more rapidly, leading to the higher number of knees treated with transplantation of a lateral meniscal allograft with a shorter mean follow-up time 2 . The overall rate of failure of the viable meniscal allografts in our study is consistent with previously published mediumterm and long-term data on deep-frozen and cryopreserved allografts fixed with a bone-plug or soft-tissue technique 4,5,7 . Our overall failure rate of 21% is, however, clearly lower than the failure rates of deep-frozen, irradiated allografts (failure rate, 44%) or lyophilized allografts 4,28 .…”

“…However, it cannot be concluded that a high tibial osteotomy should be performed in association with medial meniscal transplantation in a limb with normal axial alignment. Rather, it can be concluded that transplantation of a medial meniscal allograft in a varus-aligned knee should be combined with a high tibial osteotomy since varus malalignment is an absolute contraindication to transplantation of a medial meniscal allograft 5,18,[25][26][27][28] . Overall, twenty-one of the 100 viable allografts in our study failed at a mean of 5.4 ± 3.3 years.…”

“…This rating system has been used to determine knee function in previous reviews of the results of meniscal allografting procedures and of fresh osteochondral allograft procedures in combination with meniscal allografting 15,18,19 . Since meniscal allografting specifically relieves pain and improves function, the pain score and functional score of the modified HSS system were used for the evaluation of the clinical outcome and for the survival analysis [4][5][6][7] . The involved knee joint was evaluated by experienced examiners preoperatively and on a yearly basis postoperatively.…”

“…Therefore, meniscal tissue should be preserved whenever possible. When the meniscus has been completely lost, transplantation of a meniscal allograft has been a therapeutic option with favorable results, in terms of pain reduction and functional improvement, in the medium and long term [4][5][6][7] . These improvements are presumably due to an increase in contact area and thus a decrease in contact peak stress compared with a meniscectomized knee [8][9][10][11] .…”

Meniscal Allograft Transplantation: Where are we Standing?

“…In most patients, some degree of joint space narrowing has to be expected but in some cases this narrowing is less than 1 mm [6]. In general, studies have demonstrated a trend of advancing cartilage deterioration overtime that correlates with MAT failure, even when cartilage lesions have been addressed with a cartilage-preserving procedure [10,75]. Although the majority of studies found no protective effect of MAT on knee cartilage [6,7,9], there are also several investigations both in animal models [76][77][78] and humans [31,33,73,75] reporting on the chondroprotective effects of MAT on knee cartilage.…”