Meniscal Transplantation in a 25-Year-Old: How to Make It Work! My - - PowerPoint PPT Presentation

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Dec 22, 2023 362 likes •735 views

Meniscal Transplantation in a 25-Year-Old: How to Make It Work! My Outcomes, Its the Right Answer Thomas Carter MD Phoenix, AZ Disclosure I have disclosures and this information can be found in the : AAOS Disclosure Program online at

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Meniscal Transplantation in a 25-Year-Old: How to Make It Work! My Outcomes, It’s the Right Answer

Thomas Carter MD Phoenix, AZ

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Disclosure

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

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Biomechanically, medial MAT improves stress distribution

Normal meniscus Meniscectomy Meniscal Allograft

Courtesy Drs Verma and Farr

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Indications

symptoms localized to involved

compartment (joint effusion may affect this)

not indicated if asymptomatic
make certain chondromalacia

due to meniscus excision

address other pathology

(ACL, alignment, cartilage)

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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

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By Whom?

Need to have experience with:

meniscus repairs
meniscal root repairs
ACL reconstructions
osteotomies

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Surgical Techniques

1. No bone
2. Bone
plugs
bridge

dovetail slot Dovetail

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Bone vs. No Bone

basic science studies show

better to anchor horns with bone

many authors report soft tissue

fixation has the same clinical

utcomes as using bone
don’t forget about graft itself

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Meniscal Root Tears

hoop stresses only reestablished if horns attached adequately

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Suture only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation

Abat et al. Am J Sports Med 2012;40:1591-6

88 meniscal allograft

33 sutures only 55 bone plugs

minimum follow-up 3 years

(range 36-48 mths)

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Abat et al.

extrusion > 3 mm
suture 72.2%
bone 30.9%
repair retears
suture 21.4%
bone 7.3%

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Anterior horn- only sutures

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Suturing

typically 8-10 are all that are needed
stabilize posterior segment first
place suture at junction of posterior 1/3

and anterior 2/3 (reduction suture)

then suture at junction of posterior 2/3

and anterior 1/3

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Rehab

0-4 weeks ROM 0-90° partial weight

bearing

4 weeks full weight bearing and

bicycling

3 – 4 months “running”
5/6 months until typically

functionally recovered

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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

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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

it does not stop arthritis

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Meniscal 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)

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IMREF Group 2015 Consensus Statement

n Practice of Meniscal Allograft

Transplantation

Getgood A, et al. AJSM 2017:1195-1205

Good article for those of you having desire to learn more about meniscal allografts from those of us with significant experience

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