Dataset Information

Segmental Meniscus Allograft Transplantation.

ABSTRACT: Meniscal tears treated with partial meniscectomies have been shown to significantly increase contract pressures within the tibiofemoral joint, and a complete focal meniscal deficiency may render the entirety of the meniscus functionally incompetent. Although various techniques of meniscal transplantation have been described, these techniques may require the excision of a considerable amount of healthy meniscal tissue. Furthermore, failures continue to frequently occur. Therefore, attempts to restoring normal knee kinematics and biomechanical forces are essential. Segmental meniscus allograft transplantations may offer the advantage of a robust repair by both maintaining knee biomechanics and biology while maximizing preservation of native meniscal tissue. Also, most meniscal deficiency involves only a portion of the meniscus, and thus we developed this technique to segmentally transplant only the deficient portion. The purpose of this Technical Note is to describe a technique of segmental medial meniscus allograft transplantation in a patient with focal medial meniscus deficiency.

SUBMITTER: Seiter MN

PROVIDER: S-EPMC7953169 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Segmental Meniscus Allograft Transplantation.

Seiter Max N MN Haber Daniel B DB Ruzbarsky Joseph J JJ Arner Justin W JW Peebles Annalise M AM Provencher Matthew T MT

Arthroscopy techniques 20210208 3

Meniscal tears treated with partial meniscectomies have been shown to significantly increase contract pressures within the tibiofemoral joint, and a complete focal meniscal deficiency may render the entirety of the meniscus functionally incompetent. Although various techniques of meniscal transplantation have been described, these techniques may require the excision of a considerable amount of healthy meniscal tissue. Furthermore, failures continue to frequently occur. Therefore, attempts to res ...[more]

PMID: 33738204

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Project description:PurposeTo determine the extent of variability in meniscus size and anthropometric data between donors (supply) and patients (demand), to evaluate potential factors that may contribute to size discrepancies, and to determine whether the discrepancies lead to longer patient wait times.MethodsLateral and medial meniscal measurements, anthropometric data, and time to match a donor graft were extracted from a tissue supplier database. The frequency and distribution of meniscus size were analyzed. Body mass index (BMI), relative meniscus area, body mass to meniscus area index, and height to meniscus area index were compared between patient and donor pools via χ2 tests and independent samples t-test. The effect of size on time to match was analyzed using analysis of variance and post-hoc Tukey test.ResultsThe lateral meniscus patient population showed a greater frequency of larger size requirements compared to the donor population (P < .001) and the medial meniscus patient population showed a higher frequency of smaller meniscus size requirements (P < .001). The medial meniscus analysis showed significantly smaller meniscus areas (P < .001) in the patient population contributing to the observed trend of an increased body mass to meniscus area index and height to meniscus area index. The time to match a donor meniscus was affected by the patient meniscus size.ConclusionsThis analysis demonstrates variations in frequency of meniscus sizes between donor and patient populations. This variation is attributed to differences in anthropometric data between patient and donor populations. This work identifies a mismatch between demand and supply for certain patient sizes contributing to longer times to match.Clinical relevanceThis work associated donor and patient mismatches with longer wait times. This can be useful for patient counseling as well as provide a framework to determine whether there are solutions within the current meniscus donor pool that can be used to meet this clinical need.

Project description:PurposeTo investigate the clinical outcomes following meniscus allograft transplantation (MAT) to replace removed discoid lateral meniscus using intact lateral meniscus obtained from patients undergoing total knee arthroplasty for medial compartment osteoarthritis.MethodsPediatric patients who underwent MAT secondary to partial or total meniscectomy due to discoid lateral meniscus between August 2010 and November 2018 were identified. Lateral menisci with bone blocks were transplanted arthroscopically. The demographic data, range of motion, meniscal allograft failure, which was defined as removal of an implanted meniscus, and complications were recorded. The Lysholm score and the Kellgren-Lawrence (KL) grade on radiographs were evaluated preoperatively and at final follow-up. The Knee injury and Osteoarthritis Outcome Score was evaluated in the final follow-up.ResultsEight patients who were symptomatic after discoid lateral meniscectomy were included. Donated allografts were harvested from adult patients aged between 64 and 78 years (mean 70.5 years). The mean age at previous meniscectomy and MAT were 10.5 and 18.1 years, respectively. All patients were followed up for a mean time of 5.2 years, and there were no cases of meniscus failure and complication. The Lysholm score significantly improved from preoperative to the final follow-up. Preoperatively, 6 and 2 knees were of KL grades II and III, respectively. At final follow-up, no increased KL grade was observed in 5 patients; however, an increase by 1 grade was observed in 2 patients and an increase by 2 grades was observed in 1 patient. The Knee injury and Osteoarthritis Outcome Scores at the final follow-up were 87.2 for pain, 87.9 for symptoms, 95.4 for activities of daily living, 79.4 for sports, and 65.6 for quality of life.ConclusionsOlder lateral meniscus allografts obtained from knees of adult patients undergoing total knee arthroplasty and transplanted into younger patients with defects from discoid lateral meniscectomy resulted in improved Lysholm scores but no improvement in Tegner scores or knee motion. KL grades were unchanged in 5 of the 8 patients at the final follow-up.Level of evidenceIV, therapeutic case series.

Dataset Information

Segmental Meniscus Allograft Transplantation.

Publications

Segmental Meniscus Allograft Transplantation.

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