Where Are We in 2018 Thomas Carter MD Phoenix AZ Disclosure I have disclosures and this information can be found in the AAOS Disclosure Program online at ID: 935740
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Slide1
Meniscus Transplantation:Where Are We in 2018
Thomas Carter MD
Phoenix, AZ
Slide2Disclosure
I have disclosures and this
information can be found in the
:
AAOS Disclosure Program online
at
www.aaos.org
Slide3WHY?Does partial meniscectomy result in knee osteoarthritis: systematic review Petty and Lubowitz
Arthroscopy 2011;27:419-24
5 studies with total 853 patients
8 to 16 years’ follow-up
radiographic changes in 20-60%
Slide4Indicationssymptoms localized to involved compartment (joint effusion may affect this)
not indicated if asymptomatic
make certain chondromalacia
due to meniscus excision
Slide5Slide6Slide7Chondromalaciainsurance companies say grade 2 or lessclinical benefit even with grade 3
consensus is if grade 4 not indicated
isolated defect is not a contraindication
Slide8Indicationsage 50-55 years old (consider physiologic age)
address other pathology
(
ligaments,alignment,cartilage
)
not a substitute for arthroplasty
reasonable patient expectations
Slide9Meniscus and
Osteotomy
not uniform agreement
as to when to perform
agreed that it should
not be as great of a
correction as for DJD
Slide10Not All Grafts Are Alike
Slide11Surgical Techniques 1. No bone
2. Bone
-plugs
-bridge
dovetail slot
Dovetail
Slide12Basic science studies say bone fixation of horns is betterMany clinical studies state no difference
Bone vs. No Bone
Slide13Meniscal
Root Tears
Hoop stresses only reestablished
if horns attached adequately
Slide14Slide15Slide16Slide17regardless of bone or no bone make sure horns are anchoredif no bone: recommend transosseous
fixation similar to meniscal root repair
my preference
-bone plugs medial
-dovetail lateral
Graft Fixation
Slide18Slide19Technical pearls- make contralateral portal first- vital to see entire root attachment (debride
tibial
spine, partial MCL release)
- if no
meniscal
rim remains be careful not
to entrap capsule while suturing
(may not be able to use all-inside sutures)
-rarely are more than 8 sutures are needed
Slide20Slide210-4 weeks ROM 0-90 partial weight bearing4 weeks full weight bearing and stationary bike3-4 months “running”
5-6 months “full” activities
Rehab
Slide22Clinical Outcomes Meta-analysisevidence that it provides pain relief and improved function
10 year graft survival rates of 70-80%
radiographic results are encouraging
as to slowing progression, but
not scientifically confirmed
Slide23Meniscal allograft transplantation: 10 year follow-up
Carter and
Rabago
Arthroscopy 2012;28:suppl 1:e17-18
40 of initial 47 recipients (85%)
(cryopreserved grafts)
32 (80%) symptoms improved
33 (82%) graft survivorship
(7 partial excisions-4 after 7yrs)
Slide24Meniscal allograft transplantation: 20 year follow-up Carter and Brown AAOS 2018
48 of initial 56 recipients (85.7%)
27/48 patients had no additional surgeries, with a graft survivorship of 56.2% at 20 years
13 had partial meniscectomy
- 4 by 7 years and 7 by 10 years
8 had knee arthroplasty
-average 14 year post-op
Slide25Conclusionsstringent patient selection for success
(not for asymptomatic or advanced DJD)
technically challenging
significant improvement in clinical
outcomes can be achieved
the ability to deter arthritis is still
of question
Slide26THANK YOU