Advertisement

Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction

  • Erol A. Yoldas
  • Jon K. Sekiya
  • James J. Irrgang
  • Freddie H. Fu
  • Christopher D. HarnerEmail author
Knee

Abstract

The menisci provide a vital role in load transmission across the knee joint as well as contribute to knee stability, particularly in the ACL-deficient knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes, which has been well documented both clinically and radiographically. This study examined clinical and patient-reported outcomes following meniscal allograft transplantation with and without combined ACL reconstruction in a select group of 31 patients with complaints of pain and/or instability (34 meniscal allografts); 11 underwent isolated meniscal transplantation and 20 meniscal transplantation combined with ACL reconstruction. Bony fixation was performed with bone plugs for medial transplants and using a bone bridge for lateral transplants. All patients completed several knee-specific and general measures of health-related quality of life and underwent a comprehensive physical examination. Flexion weightbearing PA radiographs at latest follow-up were compared to those obtained preoperatively. Mean follow-up was 2.9 years (range 2–5.5 years). The Activities of Daily Living and Sports Activities Scale scores were 86±11 and 78±16, respectively, and the average Lysholm score was 84±14. There were no significant differences in these scores based upon which meniscus (medial or lateral) was transplanted, concurrent ACL reconstruction, or the degree of chondrosis at arthroscopy. SF-36 scores indicated that patients were functioning at a level similar to the age- and sex-matched population. Twenty-two patients stated they were greatly improved, 8 were somewhat improved, 1 was without change. All but one patient reported that knee function and level of activity were normal or nearly normal. The average loss of motion compared to the noninvolved side was 3° for extension and 9° for flexion. All but one patient had a negative or 1+ Lachman's test. The remaining patient had a 2+ Lachman's test. Assessment with the KT-1000 arthrometer revealed a side-to-side difference of 2 mm (range −2 mm to 7 mm). Average hop and vertical jump indices were both 85% of the contralateral extremity. No statistically significant joint space narrowing was observed by radiography over time. Meniscal allograft transplantation with and without combined ACL reconstruction in carefully selected patients with complaints of compartmental joint line pain and/or instability appears able to provide relief of symptoms and restore relatively high levels of function, particularly during activities of daily living.

Keywords

Meniscal allografts Transplantation Meniscus transplantation Meniscal surgery Meniscus 

Notes

Acknowledgements

This investigation was performed at the Center for Sports Medicine, University of Pittsburgh Medical Center. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

References

  1. 1.
    Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SLY (2000) Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Trauma 18:109–115Google Scholar
  2. 2.
    Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy: factors affecting the knee after the operation. J Bone Joint Surg Br 66:666–671PubMedGoogle Scholar
  3. 3.
    Appel H (1970) Late results after meniscectomy in the knee joint: a clinical and roentgenologic follow-up investigation. Acta Orthop Scand Suppl:133Google Scholar
  4. 4.
    Arnoczky SP, Mcdevitt CA, Schmidt MB (1988) The effect of cryopreservation on canine menisci: a biochemical, morphologic, biomechanical evaluation. J Orthop Res 6:1–12PubMedGoogle Scholar
  5. 5.
    Arnoczky SP, Warren RF, McDevitt CA (1990) Meniscal replacement using a cryopreserved allograft. Clin Orthop 252:121–128PubMedGoogle Scholar
  6. 6.
    Cameron JC, Saha S (1997) Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop 337:164–171PubMedGoogle Scholar
  7. 7.
    Cummins JF, Mansour JN, Howe Z, Allan DG (1997) Meniscal transplantation and degenerative articular change: an experimental study in the rabbit. Arthroscopy 13:485–491PubMedGoogle Scholar
  8. 8.
    DeHaven KE, Arnoczky SP (1994) Meniscus repair: basic science, indications for repair, and open repair. AAOS Instr Course Lect 43:65–76Google Scholar
  9. 9.
    DeHaven KE, Lohrer WA, Lovelock JE (1995) Long-term results of open meniscal repair. Am J Sports Med 23:524–530Google Scholar
  10. 10.
    Eggli S, Wegmuller H, Kosina J, Huckell C, Jakob RP (1995) Long-term results of arthroscopic meniscal repair: an analysis of isolated tears. Am J Sports Med 23:715–720PubMedGoogle Scholar
  11. 11.
    Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30:664–670Google Scholar
  12. 12.
    Ferrari JD, Bach BR Jr, Bush-Joseph CA, Wang T, Bojchuk J (2001) Anterior cruciate ligament reconstruction in men and women: an outcome analysis comparing gender. Arthroscopy 17:588–596PubMedGoogle Scholar
  13. 13.
    Fritz J, Irrgang J, Harner CD (1996) Rehabilitation following allograft meniscal transplantation: a review of the literature and case study. J Orthop Sports Phys Ther 24:98–106PubMedGoogle Scholar
  14. 14.
    Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthritic knee joints. Acta Orthop Scand 51:871–879Google Scholar
  15. 15.
    Garrett JC, Stevensen RW (1991) Meniscal transplantation in the human knee: a preliminary report. Arthroscopy 7:57–62PubMedGoogle Scholar
  16. 16.
    Harner CD, Fu FH (1993) The immune response to allograft ACL reconstruction. Am J Knee Surg 6:45–46Google Scholar
  17. 17.
    Harner CD, Olson E, Irrgang, JJ, Silverstein S, Fu FH, Silbey M (1996) Allograft versus autograft anterior cruciate ligament reconstruction 3 to 5 year outcome. Clin Orthop 324:134–144PubMedGoogle Scholar
  18. 18.
    Hsieh HH, Walker PS (1976) Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Joint Surg Am 58:87–93PubMedGoogle Scholar
  19. 19.
    Indelicato PA, Bittar ES, Prevot TJ, Woods GA, Branch TP, Huegel M (1990) Clinical comparison of freeze-dried and fresh frozen patellar tendon allografts for anterior cruciate ligament reconstruction of the knee. Am J Sports Med 18:335–342PubMedGoogle Scholar
  20. 20.
    Irrgang JJ, Snyder-Mackler L, Wainer R, Fu FH, Harner CD (1998) Development of a patient reported measure of function of the knee. J Bone Joint Surg Am 80:1132–1145PubMedGoogle Scholar
  21. 21.
    Jackson DW, McDevitt CA, Simon TM (1992) Meniscal transplantation using fresh and cryopreserved allografts: an experimental study in goats. Am J Sports Med 20:644–656PubMedGoogle Scholar
  22. 22.
    Jackson DW, Grood ES, Goldstein JD, Rosen MA, Kurzweil PR, Cummings JF, Simon TM (1993) A comparison of patellar tendon autograft and allograft used for ACL reconstruction in the goat model. Am J Sports Med 21:176–185PubMedGoogle Scholar
  23. 23.
    Johnson DL, Bealle D (1999) Meniscal allograft transplantation. Clin Sports Med 18:93–107PubMedGoogle Scholar
  24. 24.
    Johnson DL, FU FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394PubMedGoogle Scholar
  25. 25.
    Johnson RJ, Kettelkamp DB, Clark W, Leaverton P (1974) Factors affecting late results after meniscectomy. J Bone Joint Surg Am 56:719–729PubMedGoogle Scholar
  26. 26.
    Jones RE, Smith EC, Reisch JS (1978) Effects of medial menisectomy in patients older then forty years. J Bone Joint Surg Am 60:783–786PubMedGoogle Scholar
  27. 27.
    Levy IM, Torzilli PA, Warren R (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64:883–888PubMedGoogle Scholar
  28. 28.
    Markolf KL, Mensch JS, Amstutz HC (1976) Stiffness and laxity of the knee—the contributions of the supporting structures. J Bone Joint Surg Am 58:583–594PubMedGoogle Scholar
  29. 29.
    McConville OR, Kipnis JM, Richmond JC, Rockett SE, Michaud MJ (1993) The effect of meniscal status on knee stability and function after anterior cruciate ligament reconstruction. Arthroscopy 9:431–439PubMedGoogle Scholar
  30. 30.
    McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-item short-form health survey (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263PubMedGoogle Scholar
  31. 31.
    McHorney CA, Ware JE Jr, Lu JFR, Sherbourne CD (1994) The MOS 36-item short-form health survey (SF-36). III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32:40–66PubMedGoogle Scholar
  32. 32.
    Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscal transplantation. Int Orthop 13:1–11PubMedGoogle Scholar
  33. 33.
    Noyes FR, Barber-Westin SD (1995) Irradiated meniscal allografts in the human knee: a two- to five-year follow up. Orthop Trans 19:417Google Scholar
  34. 34.
    Noyes FR, Barber SD, Mangine RE (1990) Bone-patellar tendon-bone and fascia lata allografts for reconstruction of the ACL. J Bone Joint Surg Am 72:1125–1136PubMedGoogle Scholar
  35. 35.
    Nyland J, Johnson DL, Caborn DN, Brindle T (2002) Internal health status belief and lower perceived functional deficit are related among anterior cruciate ligament-deficient patients. Arthroscopy 18:515–518CrossRefPubMedGoogle Scholar
  36. 36.
    Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43:752–757Google Scholar
  37. 37.
    Paletta GA, Manning T, Snell E, Parker R, Bergfeld J (1997) The effect of allograft meniscal replacement on intrarticular contact area and pressures in the human knee. Am J Sports Med 25:692–698PubMedGoogle Scholar
  38. 38.
    Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11:684–687PubMedGoogle Scholar
  39. 39.
    Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F (2001) Meniscal allograft transplantation: two to eight year results. Am J Sports Med 29:410–414PubMedGoogle Scholar
  40. 40.
    Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM (1988) The forty-five degree posterioranterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 70:1479–1483PubMedGoogle Scholar
  41. 41.
    Schulte K, Thompson W, Jamison J, Harner CD (1996) The immunological response to allograft anterior cruciate ligament reconstruction: clinical correlation. Arthroscopy 12:357–358Google Scholar
  42. 42.
    Seedhom BB, Wright V (1974) Functions of the menisci—a preliminary study. J Bone Joint Surg Br 56:381–382Google Scholar
  43. 43.
    Shapiro ET, Richmond JC, Rockett SE, McGrath MM, Donaldson WR (1996) The use of a generic, patient based health assessment (SF-36) for evaluation of patients with anterior cruciate ligament injuries. Am J Sports Med 24:196–200PubMedGoogle Scholar
  44. 44.
    Shelbourne KD, Gray T (2000) Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery: five- to fifteen-year evaluations. Am J Sports Med 28:446–452Google Scholar
  45. 45.
    Shoemaker SC, Markolf KL (1986) The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. J Bone Joint Surg Am 68:71–79PubMedGoogle Scholar
  46. 46.
    Stone KR, Rodkey WA, Weber R (1992) Meniscal regeneration with copolymeric collagen scaffolds. In vitro and in vivo studies evaluated clinically, histologically, and biomechanically. Am J Sports Med 20:73–81Google Scholar
  47. 47.
    Tapper EM, Hoover NW (1969) Late results after meniscectomy. J Bone Joint Surg Am 69:517–526Google Scholar
  48. 48.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMedGoogle Scholar
  49. 49.
    VanArkel ER, DeBoer H (1995) Human meniscal transplantation. J Bone Joint Surg Br 77:589–595PubMedGoogle Scholar
  50. 50.
    Veltri DM, Warren RF (1994) Current status of allograft meniscal transplantation. Clin Orthop 303:44–55PubMedGoogle Scholar
  51. 51.
    Verdonk R (1997) Alternative treatments for meniscal injuries. J Bone Joint Surg Br 79:866–873CrossRefPubMedGoogle Scholar
  52. 52.
    Walker PS, Erkman MJ (1975) The role of the meniscus in force transmission across the knee. Clin Orthop 109:184–192PubMedGoogle Scholar
  53. 53.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedGoogle Scholar
  54. 54.
    Wexler G, Bach BR Jr, Bush-Joseph CA, Smink D, Ferrari JD, Bojchuk J (2000) Outcomes of anterior cruciate ligament reconstruction in patients with Worker's Compensation claims. Arthroscopy 16:49–58PubMedGoogle Scholar
  55. 55.
    Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30:174–181PubMedGoogle Scholar
  56. 56.
    Zukor DJ, Brooks PJ, Gross AE (1988) Meniscal allografts-experimental and clinical study. Orthop Rev 17:522Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Erol A. Yoldas
    • 1
  • Jon K. Sekiya
    • 2
  • James J. Irrgang
    • 3
  • Freddie H. Fu
    • 3
  • Christopher D. Harner
    • 3
    Email author
  1. 1.Holy Cross Hospital Medical GroupFt. LauderdaleUSA
  2. 2.Bone and Joint/Sports Medicine Institute, Department of Orthopaedic SurgeryNaval Medical Center PortsmouthPortsmouth USA
  3. 3.Center for Sports MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations