Meniscal allograft transplantation using a novel all-arthroscopic technique with specifically designed instrumentation

Abstract

Abstract. The present study describes a novel all-arthroscopic technique for medial and lateral meniscal allograft transplantation (MAT). Surgical instruments were specifically designed to assist in the all-arthroscopic approach for MAT. The bone plug attachment technique, either the arthroscopic-assisted or all-arthroscopic approach, attaches bone plugs to the anterior and posterior horns. In the present study, two sets of surgical implements were designed: One to produce bone plugs of predefined sizes in the anterior and posterior horns of the allograft meniscus (bone plug implements) and a second to create bone tunnels in the receptor tibial plateau to hold the bone plugs (bone tunnel implements). The present study demonstrated that an all-arthroscopic approach to MAT was feasible. Furthermore, the specifically designed surgical instruments allowed for consistent preparation of grafts and recipient tissues, contributing to a standardized approach to MAT. The present findings indicate that an all-arthroscopic approach to MAT may be achievable. They also provide the incentive for future clinical studies to directly compare the outcomes and to initiate the standardization of the procedure to optimize MAT and maximize patient outcomes and quality of life.

Transplante meniscal: aloenxertia e substituição sintética

“…Após um processo de triagem para exclusão de doenças do doador, como HIV e Hepatites B e C, certifica-se que a peça está totalmente estéril 25,26,27 . Os principais bancos de enxertos meniscais são o NHS Blood and Transplant Tissue Services (Liverpool, Inglaterra) e JRF Ortho (Colorado, EUA) 28 .…”

“…Os objetivos do transplante é minimizar os sintomas articulares e melhorar a função, sendo que os pacientes são instruídos a respeito do retorno prematuro às atividades físicas de alto impacto pode prejudicar o implante. São fatores de contraindicações: artrose difusa, achatamento do platô tibial ou côndilo femoral, formação significativa de osteófitos no compartimento articular, grau IV da classificação de Outerbridge, subluxação tibiofemoral não tratada, artrite, sinovite, infecção prévia do joelho, atrofia muscular, doenças autoimunes, obesidade e imaturidade óssea 22,27,28 .…”

Peripheral fixation of meniscal allograft does not reduce coronal extrusion under physiological load

“…However, meniscus extrusion still remains a significant problem common to the aforementioned techniques [11]. Most recent techniques have attempted to employ different root fixation techniques again with the attempt of reducing extrusion [12][13][14][15][16].…”

Biomechanical Comparison of Meniscal Allograft Root Fixation Techniques: Anterograde Interference Bone Plug Fixation Yields Favorable Results Compared to Transosseous Suture Fixation Alone

“…The first MAT was performed in 1984, and since then various surgical techniques have been developed including arthroscopic-assisted methods. 6 The role of MAT is to restore knee biomechanics and prevent or delay osteoarthritis. 7 To restore chondroprotective function the meniscal allograft needs to be adequately sized and attached to the tibial plateau.…”