The Influence of Nonanatomical Insertion and Incongruence of Meniscal Transplants on the Articular Cartilage in an Ovine Model

Lewinski, Gabriela von; Kohn, Dieter; Wirth, Carl Joachim; Lazovic, Djordje

doi:10.1177/0363546507313089

Cited by 48 publications

(39 citation statements)

References 55 publications

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“…Precise positioning of the anterior and posterior horn seems to be mandatory for achieving an adequate pressure distribution by the meniscal implant. Placement of the posterior horn in a nonanatomic location has been shown to cause a significant increase in the normal pressure over all flexion angles [29], leading to degenerative cartilage changes that are even worse than that after meniscectomy [40]. …”

Section: Discussionmentioning

confidence: 99%

Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant

Hannink

Tienen²,

Schouten

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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PurposeTo evaluate the long-term effects of implantation of a biodegradable polymer meniscus implant on articular cartilage degeneration and compare this to articular cartilage degeneration after meniscectomy.MethodsPorous polymer polycaprolacton-based polyurethane meniscus implants were implanted for 6 or 24 months in the lateral compartment of Beagle dog knees. Contralateral knees were meniscectomized, or left intact and served as controls. Articular cartilage degeneration was evaluated in detail using India ink staining, routine histology, immunochemistry for denatured (Col2-¾M) and cleaved (Col2-¾Cshort) type II collagen, Mankin’s grading system, and cartilage thickness measurements.ResultsHistologically, fibrillation and substantial immunohistochemical staining for both denatured and cleaved type II collagen were found in all three treatment groups. The cartilage of the three groups showed identical degradation patterns. In the 24 months implant group, degradation appeared to be more severe when compared to the 6 months implant group and meniscectomy group. Significantly more cartilage damage (India ink staining, Mankin’s grading system, and cartilage thickness measurements) was found in the 24 months implant group compared to the 6 months implant group and meniscectomy group.ConclusionDegradation of the cartilage matrix was the result of both mechanical overloading as well as localized cell-mediated degradation. The degeneration patterns were highly variable between animals. Clinical application of a porous polymer implant for total meniscus replacement is not supported by this study.

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Section: Discussionmentioning

confidence: 99%

Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant

Hannink

Tienen²,

Schouten

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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“…Furthermore, due to its function as a secondary stabilizer, meniscal transplantation can reduce tibial translation and strain on the ACL to near-normal [128]. Fixation technique [35] and positioning [78, 149], as well as sizing of the meniscal transplant, appear to have important impact on the effectiveness and biomechanical result. Experimental studies of meniscal transplantation in animals have demonstrated a chondroprotective effect.…”

Section: Malalignment Loss Of Meniscal Tissue Cartilage Defects Andmentioning

confidence: 99%

Biomechanical considerations in the pathogenesis of osteoarthritis of the knee

Heijink

Gomoll

Madry

et al. 2011

Knee Surg Sports Traumatol Arthrosc

335

223

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Osteoarthritis is the most common joint disease and a major cause of disability. The knee is the large joint most affected. While chronological age is the single most important risk factor of osteoarthritis, the pathogenesis of knee osteoarthritis in the young patient is predominantly related to an unfavorable biomechanical environment at the joint. This results in mechanical demand that exceeds the ability of a joint to repair and maintain itself, predisposing the articular cartilage to premature degeneration. This review examines the available basic science, preclinical and clinical evidence regarding several such unfavorable biomechanical conditions about the knee: malalignment, loss of meniscal tissue, cartilage defects and joint instability or laxity.Level of evidence IV.

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“…Additionally, the generally good outcomes following MAT in the present study may be attributable to the surgical technique; suture fixation of the allograft to the capsule combined with trans-tibial bone tunnel suture fixation is the current preferred technique (14,43,44). Techniques using bone plug fixation risk articular cartilage damage and have been associated with a higher failure rate (45,46).…”

Section: Discussionmentioning

confidence: 78%

The Results of Meniscal Allograft Transplantation Surgery: What is Success?

Searle

Asopa

Coleman

et al. 2020

Preprint

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Background : Meniscal allograft transplantation (MAT) may improve symptoms and function, and limit premature knee degeneration in patients under 50 years with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the potential definitions of ‘success' or ‘failure’. Methods : 60 patients who underwent MAT between 2008-2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm <65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistical analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure. Results : 43 patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again. Conclusions: None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between ‘clinical failure’ and ‘surgical failure’ means these terms may need re-defining using a bespoke MAT scoring system.

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The Influence of Nonanatomical Insertion and Incongruence of Meniscal Transplants on the Articular Cartilage in an Ovine Model

Abstract: Precise anatomic positioning is mandatory for the potential chondroprotective effect of meniscal transplants.

Cited by 48 publications

References 55 publications

Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant

Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant

Biomechanical considerations in the pathogenesis of osteoarthritis of the knee

The Results of Meniscal Allograft Transplantation Surgery: What is Success?

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