Management of Meniscal Injury: Repair, Meniscectomy, and Transplantation / 대한정형외과학회잡지

Although total meniscectomy had been performed as a treatment of meniscal tear, many published articles reported progression of the degeneration process and development of the osteoarthritis after meniscectomy. Meniscal repair has been performed increasingly, with the increased knowledge of the biomechanical properties of the meniscus. However, resection of the meniscus is still needed for irreparable tear and should be performed as minimally as possible to maintain the important functions of the meniscus. When substantial meniscal tissue is resected, meniscal allograft transplantation is considered to be a therapeutic option for young active patients to prevent the progress of degenerative change of the cartilage. In this review, indications and outcomes after meniscectomy, meniscal repair, and meniscal transplantation for the treatment of the meniscal injury are discussed.

Meniscal Allograft Transplantation: Clinical Results and Recovery of Sports Activity / 대한스포츠의학회지

The purpose of this study was to evaluate the clinical results and recovery of sports activity in patients who received meniscal allograft transplantation. From December 1999 to May 2009, we selected 36 cases out of 38 cases who received meniscal transplantation using fresh frozen allograft. The mean age was 33.8 years (range: 17-50 years) and the mean follow up was 68.8 months (range: 12-142 months). Clinical results were evaluated with knee assessment scoring system (KASS), Lysholm knee score and International knee Documentation Committee. The information of quadriceps and hamstrings strength recovery was obtained using Tegner activity scale, Tegner activity score and Biodex system II (Biodex, USA), and it was used to evaluate the recovery of sports activity. The average KASS score was increased from 61.7 preoperatively to 83.8 postoperatively. The average Lysholm score was increased from 77.7 preoperatively to 87.7 postoperatively. Also, Tegner activity scale, Tegner activity score and the recovery of quadriceps and hamstrings increased at 1year after surgery. In knee joint position sense, the proprioception increased compared to preoperational count. We propose the meniscal allograft transplantation is one of a proper treatment after subtotal or total meniscectomy, which can significantly relieve pain and improve function of the knee joint.

The Clinical Results Using the Second Look Arthroscopic Findings and MRI after Allogenic Meniscal Transplantation

PURPOSE: The purpose of this study was to evaluate the clinical results and the changes of allogenic meniscal transplantation by using the second look arthroscopic findings and the MRI changes after surgery. MATERIALS AND METHODS: From July 1997 to February 2007, among the patients that underwent allogenic meniscal transplantation, we chose 25 patients who underwent secondary arthroscopic evaluation. 16 of these 25 patients were men and 8 were women. Secondary arthroscopic evaluation was done without MRI in 3 cases. The mean age was 36.1 yr and the average follow up period was 28 months. Biopsy by the secondary arthroscopic evaluation was done in 2 cases. We evaluated the clinical results by the Lysholm knee scoring scale, the Knee Society Score (KSS) system and the Hospital for Special Surgery (HSS) knee score. RESULTS: Second-look arthroscopy after allogenic meniscal transplantation revealed that 23 cases seemed normal at the probing procedure. 5 cases showed a decreased posterior horn size. The MRI findings and secondary arthroscopic findings matched in all cases. The clinical Lysholm score improved from preoperative 65.4 points to postoperative 80.6 points, the Knee Society Score (KSS) improved from preoperative 64.6 points to postoperative 82.6 points, the functional score improved from preoperative 70.2 points to postoperative 85.6 points and the Hospital for Special Surgery (HSS) knee score improved from preoperative 66.4 points to postoperative 82.5 points (p=0.000). The function after surgery improved on all the tests and this was proved by paired t-tests. CONCLUSION: Allogenic meniscal transplantation showed good results on the second look arthroscopy and the follow-up MRI and according to the clinical functional outcome. We think that confirmation through arthroscopy after follow-up MRI for the patients with clinical knee problems seems to be necessary.

Clinical Evaluation using MRI and Arthroscopy after Meniscal Transplantation / 대한정형외과학회잡지

Purpose: To evaluate the status of transplanted menisci using MRI and arthroscopy. Materials and Methods: Between March 1998 and October 2004, twenty three patients underwent a meniscal transplant at our institution. Twenty-one out of 23 patients were available for follow-up and were evaluated an average of 44 months (range, 19 to 87 months). Four allografts were medial and 17 were lateral. There were 17 men and 4 women with ages ranging from 16 to 47 years (mean, 29.6 years). The clinical outcomes were evaluated using the Lysholm score, the International Knee Documentation Committee (IKDC) subjective score and the modified Hospital for Special Surgery (HSS) score. MRI and arthroscopic examinations were performed in 18 and 11 patients respectively. Results: The average Lysholm score improved from 60.6 to 85.7, and that of the IKDC subjective score and modified HSS score (knee score/functional score) was 79.5 and 88/93 respectively. Six of the eleven knees that underwent the arthroscopic examinations were confirmed to be normal. The MRI evaluation revealed all the allografts to have healed completely but there was degeneration/shrinkage of the allografts, and injuries to the surrounding articular cartilage. Extrusion or subluxation of the menisci was observed in all cases. Conclusion: Meniscal transplantation may be an effective procedure for young and active patients suffering from pain after a meniscectomy with minimal degenerative changes. However, a partial tear, extrusion or subluxation of the allograft menisci and a progression of degenerative arthritis have been reported. Therefore, more accurate and reliable surgical techniques as well as a long-term follow-up are recommended.

Clinical problems of arthroscopic meniscal allograft(two-cases report and literature review) / 中国矫形外科杂志

[Objective]To discuss the clinical problems of meniscal transplantation based on 2 cases clinical practical results including the harvest and preserved methods of meniscal allograft,operative procedure,rehabilitation plan and side-effect,combining with literature review,so as to provide reference for further clinical practice and research.[Method]The meniscal allograft were perfumed with arthroscopic technique on 2 patients,younger than 50 years,suffering from severe meniscus tear or defect at the time of other procedures.The initial clinical results about relieving of symptoms,recovery of functions were evaluated after short time rehabilitations.[Result]There was no operative side-injury and signs of knee instability.The incisions healed well without exudation.The knee joint swelling disappeared in 6 weeks.Rejection reaction was not observed in all of laboratory tests.The VAS were 8,6 preoperatively and 3,2 postoperatively.The processes of rehabilitation were normal.[Conclusion]Considering the difficult in maintaining severe tear meniscus and the characteristics of immune evasion of meniscus,meniscal allograft may be expectable option in the future.Very many researches have provided theoretical base.The results of long-time following-up should be further observed and wany clinical problems need to be further solved.

Chronological Changes of the Human Allograft Meniscal Transplants: MRI, Arthroscopic and Histologic Study

Vascular ingrowth is essential for the survial of the graft tissue. The purposes of this study were to evaluate any changes in signal intensity of cqropreserved meniscal allograft with time in the magnetic resonance images(MRI) and to demonstrate the viability of the grafts. Eight patients underwent meniscal transplantation with cryopreserved allcgrafts using the bone block technique. MRIs of the knee were taken at 3 days, 3 weeks, 6 weeks, 3 month, 6 months. And I year after the implantation. A second-look arthroscopy and a small meniscal biopsy(sized 2mm x 2mm1 at the peripheral and central part of the meniscus were conducted at 3 months and 1 year. Three days after the operation, the signal intensity of the implanted meniscus revealed a homogenrous low signaJ intensity that could not be differentiated from that of' a contralateral normal meniscus. At 3 weeks, a high signal intensity appeared at the periphery of the meniscus. This signal, which did not communicate into the joint space, fuither intensified at 6 weeks. The high signal intensity of the meniscus, though still higher than that of the normal meniscus, decrexsed slightly at 3 months and continued to decrease progressively even a year after the implantation. The second-look arthroscopy revealed that the grafts were viable and that there was no tearing or shrinking of the meniscus. Cellular proliferation was also found at the central edge oi' the meniscus at 3 months. This cellular pattern differentiated from that of a nonmal meniscus in that the d stribution of cells was not in an even, but in a clonal pattem. The cellularity after a year, however, was sirnilar to that of normal meniscus except some area with deficiency of cells. It can be concluded that increased signal intensity of' the implanted meniscus with time indicates hypervascularity caused by vascular ingrowth, similar to the high signal intensity ot>tained from normal meniscus in young children. Increasecl signal intensity in the chronological postoperative MRls demonstrates the viability of the implanted cryopreserved meniscal allograft.