Segmental Meniscus Allograft Transplantation.
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ABSTRACT:
SUBMITTER: Seiter MN
PROVIDER: S-EPMC7953169 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Partial meniscectomy or failed meniscus repair can lead to pain, dysfunction, and cartilage degradation due to increased contact forces. Meniscus transplantation can lead to favorable outcomes and cartilage preservation with careful patient selection. Limited data exist on segmental meniscus allograft transplantation, with promising results using synthetic grafts and early animal and biomechanical studies on segmental allograft transplantation, showing similar results to full meniscus allograft transplantation. This article presents a technique for arthroscopic segmental medial meniscus allograft transplant and a brief review of the literature.
| S-EPMC8626707 | biostudies-literature
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.
| S-EPMC10300528 | biostudies-literature
Project description:Lateral meniscus tears are commonly encountered by orthopaedic surgeons. Despite efforts to repair and preserve the meniscus, meniscectomy is occasionally required to treat irreparable tears. The resulting lateral meniscus deficiency leads to increased tibiofemoral contact pressures and ultimately early osteoarthritic changes in the knee. Lateral meniscal allograft transplant (LMAT) has been proposed as a way to restore the lateral meniscus-deficient knee to its native form. Although several techniques for LMAT have been proposed, osseous fixation has demonstrated increased stability, improved outcomes, and improved long-term survival. This article presents a technique for LMAT using bone plugs and standard arthroscopic portals.
| S-EPMC5622462 | biostudies-literature
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.
| S-EPMC8689213 | biostudies-literature
Project description:Surgical strategies for knee joint preservation are numerous, with the procedure(s) of choice for a given patient dependent on the status of the articular cartilage, meniscus, overall alignment, and ligamentous stability. For patients with large, isolated, osteochondral defects of the articular cartilage of the femoral condyle, osteochondral allograft transplantation (OCA) is often performed in an effort to reduce pain and improve function. Similarly, for appropriately indicated patients with symptomatic meniscus deficiency, meniscus allograft transplantation (MAT) is an excellent surgical solution. Often patients require concomitant MAT and OCA as part of a joint preservation strategy. In this Technical Note, we describe the surgical technique for performing arthroscopic-assisted concomitant lateral MAT and lateral femoral condyle OCA as part of a knee joint preservation strategy.
| S-EPMC5710720 | biostudies-literature
Project description:PurposeMeniscus tears are one of the most frequent orthopedic knee injuries, which are currently often treated performing meniscectomy. Clinical concerns comprise progressive degeneration of the meniscus tissue, a change in knee biomechanics, and an early onset of osteoarthritis. To overcome these problems, meniscal transplant surgery can be performed. However, adequate meniscal replacements remain to be a great challenge. In this research, we propose the use of a decellularized and sterilized human meniscus allograft as meniscal replacement.MethodsHuman menisci were subjected to a decellularization protocol combined with sterilization using supercritical carbon dioxide (scCO2). The decellularization efficiency of human meniscus tissue was evaluated via DNA quantification and Hematoxylin & Eosin (H&E) and DAPI staining. The mechanical properties of native, decellularized, and decellularized + sterilized meniscus tissue were evaluated, and its composition was determined via collagen and glycosaminoglycan (GAG) quantification, and a collagen and GAG stain. Additionally, cytocompatibility was determined in vitro.ResultsHuman menisci were decellularized to DNA levels of ~ 20 ng/mg of tissue dry weight. The mechanical properties and composition of human meniscus were not significantly affected by decellularization and sterilization. Histologically, the decellularized and sterilized meniscus tissue had maintained its collagen and glycosaminoglycan structure and distribution. Besides, the processed tissues were not cytotoxic to seeded human dermal fibroblasts in vitro.ConclusionsHuman meniscus tissue was successfully decellularized, while maintaining biomechanical, structural, and compositional properties, without signs of in vitro cytotoxicity. The ease at which human meniscus tissue can be efficiently decellularized, while maintaining its native properties, paves the way towards clinical use.
| S-EPMC9719875 | biostudies-literature
Project description:Chondral defects of the patellofemoral joint remain a difficult-to-treat pathology with limited long-term results. Currently available techniques to treat large or unipolar chondral defects of the patella include autologous chondrocyte implantation and osteochondral allograft transplantation. Despite the recent advances in orthobiologic adjuncts, there is no single gold-standard surgical approach to this difficult-to-treat pathology in patients who are frequently young, active, and demanding on their bodies. We describe a technique for osteochondral allograft transplantation to the patella for an isolated patellar chondral lesion (unipolar).
| S-EPMC6823814 | biostudies-literature
Project description:Introduction:We performed a survivorship analysis of patients treated with patellofemoral osteochondral allograft transplantation (OCA) using either a shell or plug technique and identified variables associated with graft failure. Methods:Consecutive patients at two institutions who underwent OCA of the patellofemoral compartment between March 1, 2001 to March 1, 2015, were retrospectively identified at minimum 2 years' follow-up. Demographic information, intraoperative findings, and postoperative data were collected. Patients were divided into two groups on the basis of surgical technique (plug group and shell group). Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on second-look arthroscopy. Logistic regression analysis was performed to identify patient- and surgery-specific variables associated with survivorship. Results:Fifty patients were identified (36 women and 14 men; mean age 37.43 ± 8.87 years). Sixteen patients received plug allografts, whereas 34 received shell allografts. Forty percent of patients underwent a concomitant meniscal, ligamentous, malalignment, or chondral procedure. Five patients in the Plug Group (31.3%) underwent reoperation at a mean 1.37 ± 1.34 years, and 28 patients (82.4%) who received Shell OCA underwent reoperation at a mean 1.94 ± 1.92 years. Two patients in the plug group had graft failure at a mean 9.17 ± 0.93 years, whereas 13 patients in the shell group had graft failure at a mean 3.81 ± 2.78 years. Patients with plug allografts demonstrated 100% and 66% survival at 5 and 9.8 years, respectively. For the shell group, survivorship was 65.8% and 37% at 5 and 10.6 years, respectively. Increasing body mass index was associated with failure for the case series overall (odds ratio 1.33, P = .020). Traumatic cause was found to be protective of failure (odds ratio = 0.02, P = .035). Conclusions:Plug OCA of the patellofemoral compartment can be an efficacious procedure with quality mid-term outcomes. Shell OCA led to high failure rates at midterm outcomes. Increasing body mass index may predispose patients to failure, whereas traumatic cause of their lesion was associated with improved outcomes. Level of Evidence:Level IV, Therapeutic case series.
| S-EPMC7120803 | biostudies-literature
Project description: Not available
| S-EPMC7486143 | biostudies-literature
Project description:3D printing technology is able to produce personalized artificial substitutes for patients with damaged menisci. However, there is a lack of thorough understanding of 3D printing-enabled (3DP-enabled) meniscus transplantation and its long-term advantages over traditional transplantation. To help health care stakeholders and patients assess the value of 3DP-enabled meniscus transplantation, this study compares the long-term cost and risk of this new paradigm with traditional transplantation by simulation. Pathway models are developed to simulate patients' treatment process during a 20-year period, and a Markov process is used to model the state transitions of patients after transplantation. A sensitivity analysis is also conducted to show the effect of quality of 3D-printed meniscus on model outputs. The simulation results suggest that the performance of 3DP-enabled meniscus transplantation depends on quality of 3D-printed meniscus. The conclusion of this study is that 3DP-enabled meniscus transplantation has many advantages over traditional meniscus transplantation, including a minimal waiting time, perfect size and shape match, and potentially lower cost and risk in the long term.
| S-EPMC6627735 | biostudies-literature