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Meniscal transplantation

Sung Il Wang
In symptomatic discoid medial meniscus, partial meniscectomy is the principal treatment method and can yield promising short-term results. However, unlike the nondiscoid meniscus, discoid medial meniscus is frequently associated with horizontal cleavage tears, attributable to the presence of myxoid degeneration in the intrameniscal substance, in that it may potentially occur deteriorating long-term results because of re-tearing of remaining meniscus or secondary degeneration of cartilage of the medial compartment after meniscectomy...
October 14, 2016: Acta Orthopaedica et Traumatologica Turcica
Jorge Chahla, Chase S Dean, Justin J Mitchell, Gilbert Moatshe, Raphael Serra Cruz, Robert F LaPrade
Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency...
August 2016: Arthroscopy Techniques
Bum-Sik Lee, Seong-Il Bin, Jong-Min Kim, Jae Hyan Kim, Eic Ju Lim
PURPOSE: To determine the relationship between preoperative subluxation of the original menisci and postoperative graft subluxation after lateral meniscal allograft transplantation (MAT). METHODS: Fourteen patients who underwent isolated lateral MATs in meniscus-deficient knees with a low-grade chondral lesion (≤ICRS grade 2) were assessed. Lateral subluxation of the native meniscus before meniscectomy and those of remaining meniscal tissue before MAT were measured on mid-coronal MRI scans taken at each time point...
September 30, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Ben Parkinson, Nicholas Smith, Laura Asplin, Peter Thompson, Tim Spalding
BACKGROUND: Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined...
August 2016: Orthopaedic Journal of Sports Medicine
Gregory L Cvetanovich, Jonathan C Riboh, Annemarie K Tilton, Brian J Cole
BACKGROUND: Existing studies of autologous chondrocyte implantation (ACI) in adolescent patients have primarily reported outcomes that have not been validated for cartilage repair and have failed to include measures of general health or health-related quality of life. PURPOSE: This study assesses validated knee-specific functional outcomes and health-related quality of life after ACI in adolescent patients. STUDY DESIGN: Case series; Level of evidence, 4...
August 26, 2016: American Journal of Sports Medicine
Alan Getgood, Robert F LaPrade, Peter Verdonk, Wayne Gersoff, Brian Cole, Tim Spalding
Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes...
August 25, 2016: American Journal of Sports Medicine
Alaina M Brelin, John-Paul H Rue
Meniscus tears are commonly encountered in the athletic population and can result in significant loss of playing time. Current treatment methods for acute tears consist of meniscectomy and meniscal repair, whereas meniscal allograft transplant is reserved as a salvage procedure for symptomatic meniscectomized patients who desire a more functional knee. This review describes the postoperative rehabilitation protocol for each procedure and evaluates the outcomes in existing literature as it pertains to the athlete...
October 2016: Clinics in Sports Medicine
Jorge Chahla, Javier Olivetto, Chase S Dean, Raphael Serra Cruz, Robert F LaPrade
The lateral meniscus plays a critical role in the stability and health of the knee. Treating patients who have undergone a total lateral meniscectomy or functional equivalent is challenging, especially young and active patients. Current literature regarding meniscal tears supports that repair should be the first surgical option. Moreover, it is recommended to preserve as much meniscal tissue as possible. In cases in which a total or functional meniscectomy is a pre-existing condition, a lateral meniscal allograft transplantation is a possible option...
April 2016: Arthroscopy Techniques
Bum-Sik Lee, Seong-Il Bin, Jong-Min Kim, Won-Kyeong Kim, Jae Hyan Kim
BACKGROUND: Little is known about clinical outcomes after revision meniscal allograft transplantation (RMAT), and there are no studies on magnetic resonance imaging (MRI) evaluations during the early remodeling period. HYPOTHESIS: The objective imaging results, as determined by MRI evaluation, would be inferior to those of published data on primary meniscal allograft transplantations (MATs), although short-term clinical improvement would be achieved after RMAT. STUDY DESIGN: Case series; Level of evidence, 4...
July 25, 2016: American Journal of Sports Medicine
Aad Dhollander, Peter Verdonk, René Verdonk
BACKGROUND: A biodegradable polyurethane scaffold was designed to fulfill a challenging clinical need in the treatment of patients with painful, irreparable partial meniscal defects. HYPOTHESIS: The use of an acellular polyurethane scaffold for new tissue generation in irreparable, partial meniscal defects provides both midterm pain relief and improved functionality. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 44 patients with irreparable, partial meniscal defects (29 medial and 15 lateral) were implanted with a polyurethane scaffold in a prospective, single-arm proof-of-principle study with a minimum 5-year follow-up...
July 18, 2016: American Journal of Sports Medicine
Paul Monk, Patrick Garfjeld Roberts, Antony J R Palmer, Lee Bayliss, Reza Mafi, David Beard, Sally Hopewell, Andrew Price
BACKGROUND: Arthroscopic surgery of the knee is one of the most frequently performed orthopaedic procedures. One-third of these procedures are performed for meniscal injuries. It is essential that this commonly performed surgery be supported by robust evidence. PURPOSE: To compare the effectiveness of arthroscopic surgery for meniscal injuries in all populations. STUDY DESIGN: Systematic review. METHODS: An online search was conducted for randomized controlled trials (RCTs) and systematic reviews (SRs) that compared treatment options for meniscal injury...
July 18, 2016: American Journal of Sports Medicine
Camila Cohen Kaleka, Alfredo Santos Netto, Júlio César Almeida E Silva, Mariana Key Toma, Ricardo de Paula Leite Cury, Nilson Roberto Severino, Claudio Santili
BACKGROUND: Although the size of the meniscal allograft is crucial during meniscal transplantation, the accuracy of meniscal measurement methods is still under debate. A number of methods based on radiographic and magnetic resonance imaging (MRI) data as well as on anthropometric data have been proposed, but their reproducibility and reliability are still unclear. PURPOSE: To compare meniscal length and width as measured by different techniques (anthropometric and plain radiographic) to establish which of these 2 methods is more reliable and cost-effective for determining the meniscal size in comparison to MRI...
July 15, 2016: American Journal of Sports Medicine
Suzanne Maher, Hongsheng Wang, Matthew F Koff, Nicole Belkin, Hollis G Potter, Scott Rodeo
Injury to the meniscus of the knee has been implicated as a significant risk factor for the subsequent development of osteoarthritis, but the mechanisms of joint degeneration are unclear. Our objective was to develop a clinically applicable methodology to evaluate the relationship of joint contact mechanics at the time of surgery to biological changes of articular cartilage as a function of time following surgery. A series of pre-, intra- and post-operative protocols were developed which utilized electronic sensors for the direct measurement of contact mechanics, and advanced imaging to assess cartilage health...
July 13, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Yiying Qi, Guangnan Chen, Gang Feng
Transplantation of mesenchymal stem cells (MSCs) is a potential therapy for meniscus regeneration. However, when using single cell suspension injection, there is frequently a significant loss of cells, with only a small percentage of cells remaining at the target site. This issue may be solved with the use of MSC sheets. In the present study, we investigated whether the use of MSC sheets were able to regenerate the meniscus effectively in a rat meniscectomized model. The anterior half of the medial meniscus in 10 rats was excised and an MSC sheet was transplanted in the MSC sheet treatment group, while untreated rats served as the control...
July 2016: Experimental and Therapeutic Medicine
Chase S Dean, Javier Olivetto, Jorge Chahla, Raphael Serra Cruz, Robert F LaPrade
The medial meniscus is crucial for knee homeostasis. Treating patients who have undergone a subtotal or total meniscectomy, or equivalent irreparable tear pattern, can be extremely challenging, especially in young, active patients. The importance of meniscal preservation has been reported by several authors. Meniscal repair is now widely accepted as the first surgical option for treating medial meniscal tears. Moreover, current guidelines recommend preserving as much meniscal tissue as possible. Treating a symptomatic medial meniscectomized knee is challenging because of limited surgical options...
April 2016: Arthroscopy Techniques
Ana Rey-Rico, Angelique Klich, Magali Cucchiarini, Henning Madry
Alginates are important hydrogels for meniscus tissue engineering as they support the meniscal fibrochondrocyte phenotype and proteoglycan production, the extracellular matrix (ECM) component chiefly responsible for its viscoelastic properties. Here, we systematically evaluated four biomedical- and two nonbiomedical-grade alginates for their capacity to provide the best three-dimensional (3-D) microenvironment and to support proteoglycan synthesis of encapsulated human meniscal fibrochondrocytes in vitro. Biomedical-grade, high mannuronic acid alginate spheres (BioLVM, BioMVM) were the most uniform in size, indicating an effect of the purity of alginate on the shape of the spheres...
2016: Scientific Reports
Austin J Ramme, Eric J Strauss, Laith Jazrawi, Heather T Gold
OBJECTIVE: A discoid meniscus is more prone to tears than a normal meniscus. Patients with a torn discoid lateral meniscus are at increased risk for early onset osteoarthritis requiring total knee arthroplasty (TKA). Optimal management for this condition is controversial given the up-front cost difference between the two treatment options: the more expensive meniscal allograft transplantation compared with standard partial meniscectomy. We hypothesize that meniscal allograft transplantation following excision of a torn discoid lateral meniscus is more cost-effective compared with partial meniscectomy alone because allografts will extend the time to TKA...
September 2016: Physician and Sportsmedicine
Catherine Van Der Straeten, Paul Byttebier, Annelies Eeckhoudt, Jan Victor
BACKGROUND: Meniscal tears are common knee injuries. Meniscal allograft transplantation (MAT) has been advocated to alleviate symptoms and delay osteoarthritis (OA) after meniscectomy. We investigated (1) the long-term outcome of MAT as a treatment of symptomatic meniscectomy, (2) most important factors affecting survivorship and (3) OA progression. METHODS: From 1989 till 2013, 329 MAT were performed in 313 patients. Clinical and radiographic results and MAT survival were evaluated retrospectively...
2016: PloS One
Frank R Noyes, Sue D Barber-Westin
BACKGROUND: Clinical outcomes and survivorship of meniscus transplants remain unclear, especially when magnetic resonance imaging (MRI) and weightbearing radiographic findings are included as endpoints. Many studies calculate survivorship based only on subsequent operative procedures. PURPOSE: We prospectively determined long-term survivorship and functional outcomes of 72 consecutive meniscus transplants. The effects of articular cartilage damage, concurrent osteochondral autograft transfer (20 knees), patient age, and tibiofemoral compartment were evaluated...
September 2016: American Journal of Sports Medicine
Nam-Hong Choi, Bong-Seok Yang, Sang-Young Lee, Chae-Chul Lee, Chang-Yk Lee, Brian N Victoroff
PURPOSE: The purpose of this study was to compare the insertion sites of the posterior horn between discoid and non-discoid lateral meniscus using magnetic resonance imaging (MRI). METHODS: Two hundred and twenty-seven patients who had MRI scans before surgery and underwent arthroscopy were enroled in this study. A coronal view showing the narrowest width of the midbody of the lateral meniscus was chosen to measure the widths of the entire tibial plateau and the midbody of the lateral meniscus...
May 13, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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