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Document Title: Cole-AJSM-Jun06.shtml
Article Title: Prospective Evaluation of Allograft Meniscus Transplantation: A Minimum 2-Year Follow-up
Authors: Brian J. Cole, MD, Michael G. Dennis, MD, Stephen J. Lee, Shane J. Nho, Rajeev S. Kalsi, Jennifer K. Hayden, RN, MS and Nikhil N. Verma, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: June 2006
Volume 34, pages 919-927
Keywords: Meniscus, meniscal allograft, transplant, cartilage, osteoarthritis, meniscus, meniscectomy.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: The authors found that meniscal allografting works well for relieving knee pain and improving knee function, but that long-term studies are needed. Ideally, a meniscal allograft transplant would bring an improvement that would last for the rest of the patient's life.
Note: This article includes razor-sharp comments by Frank Noyes and Sue Barber-Westin, two researchers who have done pioneering work in the realm of meniscal allografting.
ABSTRACT
Background: Clinical and biomechanical studies have demonstrated the increase in contact pressure and progressive deterioration of the tibiofemoral compartments that occur after partial or complete meniscectomy. Meniscus transplantation has been indicated for the symptomatic postmeniscectomy patient to alleviate symptoms and potentially prevent the progression of articular degeneration.
Purpose: To report the early-term results after allograft meniscus transplantations from a single institution performed by a single surgeon.
Study Design: Case series; Level of evidence, 4.
Methods: Forty-four meniscus transplants in 39 patients were evaluated at minimum 2-year follow-up using the Lysholm, Tegner, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Noyes symptom rating and sports activity, and SF-12 scoring systems; visual analog pain scales; patient satisfaction; and physical examination. Four transplants failed early, leaving 40 transplants in 36 patients for review. Patients were grouped into medial and lateral transplant groups as well as those with isolated and combined procedures. Twenty-one menisci were transplanted in isolation (52.5%), and 19 were combined with other procedures (47.5%) to address concomitant articular cartilage injury.
Results: Patients demonstrated statistically significant improvements in standardized outcomes surveys and visual analog pain and satisfaction scales. In 7 patients, treatment had failed at final follow-up. Overall, 77.5% of patients reported they were completely or mostly satisfied with the procedure, and 90% of patients were classified as normal or nearly normal using the International Knee Documentation Committee knee examination score at final follow-up. There were no significant differences in the medial and lateral subgroups, although the lateral subgroup did demonstrate a trend toward greater improvement. No significant differences were noted in the isolated and combined subgroups.
Conclusion: Meniscus transplantation alone or in combination with other reconstructive procedures results in reliable improvements in knee pain and function at minimum 2-year follow-up. Longer term studies are necessary to determine if transplantation can prevent the articular degeneration associated with meniscectomy.
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