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Saturday, March 13, 2004

Meniscus transplantation benefits younger patients

By Mary Ann Porucznik

Younger individuals who have had a total meniscectomy may benefit from a mensicus transplant, at least as a temporizing operation to diminish the symptoms of early joint arthrosis, according to the presenters of Scientific Paper 107 on Thursday.

"In these patients, few treatment options exist and the goal of meniscus transplantation in the short-term is to decrease pain and delay the progression of tibiofemoral arthrosis," said presenter Marc Rankin, MD. "Additionally, patients my have concomitant problems requiring ligament reconstruction or articular cartilage restorative procedures."

Researchers conducted a prospective evaluation of 40 consecutive meniscus transplants in 38 patients from November 1995 to March 2000. There were 18 males and 17 females, with an average age at surgery of 30 years (range: 14 to 49 years). Osteochondral autograft transfers (OAT) also were done in 13 knees; eight knees had ligament reconstructions. Four transplants failed early and the clinical outcome of the remaining 36 transplants (35 patients) was evaluated at a mean of 40 months (range: 24 to 69 months). A rigorous rating system combined subjective, clinical and weight-bearing magnetic resonance imaging (MRI) factors to determine meniscus characteristics.

Preoperatively, 31 of the 35 patients (77 percent) had pain with daily activities but at follow-up, only 6 percent had pain with daily activities. "Because the majority of patients were young and had been athletically active before their meniscectomy, the ability to return to an active lifestyle (even in terms of only light recreational activities) was an important goal," reported the researchers. "At follow-up, 77 percent of the patients had returned to light low-impact sports with no symptoms."

Associated OAT and knee ligament reconstructions improved knee function and did not increase the rate of complications.The mean displacement of the meniscus allografts in the coronal plane was 2.2 mm ( 1.5 mm; range: 0 mm to 5 mm). The mean displacement of the posterior horn of the allografts in the sagittal plane was 1.1 mm ( 2.0 mm; range: 0 mm to 9 mm. Seventeen allografts (42.5 percent) had normal characteristics; 12 (30 percent) had altered characteristics, and 11 (27.5 percent) failed.

Researchers noted that the long-term function of the meniscus transplant remains questionable, and that the transplant undergoes limited remodeling that alters the collagen fiber micro-architecture, matrix, and cellular function required for load-sharing and long-term survival.

"Meniscus transplantation is an acceptable procedure for younger patients," concluded the researchers, "producing improvement in the majority of patients in knee function and pain relief in the meniscectomized compartment. Patients with femoral condylar defects treated with a concomitant osteochondral autograft transfer also had significant improvements in pain and function, warranting the procedure. Patients should be advised that the procedure is not curative in the long-term and additional surgery may be requred."

In addition to Dr. Rankin, Frank R Noyes, MD, and Sue Barber-Westin, BS, all of Cincinnati, Ohio, participated in the research.

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Last modified 13/March/2004