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Meniscus Transplantation: Where Are We in 2018

Meniscus Transplantation: 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 www.aaos.org.

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Meniscus Transplantation: Where Are We in 2018

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  1. Meniscus Transplantation:Where Are We in 2018 Thomas Carter MD Phoenix, AZ

  2. Disclosure I have disclosures and this information can be found in the: AAOS Disclosure Program online at www.aaos.org

  3. WHY?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%

  4. Indications • symptoms localized to involved compartment (joint effusion may affect this) • not indicated if asymptomatic • make certain chondromalacia due to meniscus excision

  5. Chondromalacia • insurance companies say grade 2 or less • clinical benefit even with grade 3 • consensus is if grade 4 not indicated • isolated defect is not a contraindication

  6. Indications • age 50-55 years old  • (consider physiologic age)     • address other pathology (ligaments,alignment,cartilage) • not a substitute for arthroplasty • reasonable patient expectations

  7. Meniscus and Osteotomy • not uniform agreement • as to when to perform • agreed that it should • not be as great of a • correction as for DJD

  8. Not All Grafts Are Alike

  9. Surgical Techniques 1. No bone 2. Bone -plugs -bridge dovetail slot Dovetail

  10. Bone vs. No Bone • Basic science studies say bone fixation of horns is better • Many clinical studies state no difference

  11. Meniscal Root Tears Hoop stresses only reestablished if horns attached adequately

  12. Graft Fixation • regardless of bone or no bone make sure horns are anchored • if no bone: recommend transosseous fixation similar to meniscal root repair • my preference -bone plugs medial -dovetail lateral

  13. Technical pearls - make contralateral portal first - vital to see entire root attachment (debridetibial 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

  14. Rehab • 0-4 weeks ROM 0-90 partial weight bearing • 4 weeks full weight bearing and stationary bike • 3-4 months “running” • 5-6 months “full” activities

  15. Clinical Outcomes Meta-analysis • evidence 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

  16. Meniscal allograft transplantation: 10 year follow-upCarter and RabagoArthroscopy 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)

  17. Meniscal allograft transplantation: 20 year follow-upCarter 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

  18. Conclusions • stringent 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

  19. THANK YOU

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