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Document Title: Noyes-JBJS-Jul04.shtml
Article Title: Meniscal Transplantation in Symptomatic Patients Less Than Fifty Years Old
Authors: Frank R. Noyes, MD, Sue D. Barber-Westin, BS, and Marc Rankin, MD.
Publication: The Journal of Bone and Joint Surgery
ISSN: 03635465
Date: July 2004.
(Figures included. Reference-denoting numbers appear in the same point size as document text.)
Volume: 86-A
Issue: 7
Pages: 1392-1404
Key Words: Knee, sports medicine, surgery, meniscus, cartilage, grafts, arthritis, arthrosis.
This well-designed and superbly thorough study is essential reading for anyone who has undergone menisectomy, or who has early-stage knee arthrosis due to meniscal loss or damage. Dr. Noyes is renowned for his pioneering work in the field of meniscal repair; indeed, he was one of the first surgeons to both recognize and delve into the importance of preserving every ounce of meniscal tissue in the human knee. (This article includes a commentary by Scott Rodeo and a supplementary table.) Noyes et al. note that even though the results from the meniscal transplantation are encouraging, long-term (for example, greater than 10 years) follow-up is required.
ABSTRACT
Background: The purpose of this study was to prospectively evaluate the results of meniscal transplantation in a consecutive series of younger patients treated for pain in the tibiofemoral compartment following a previous meniscectomy.
Methods: Forty cryopreserved menisci were implanted into thirty-eight patients. Sixteen knees also had an osteochondral autograft transfer, and nine had a knee ligament reconstruction. The clinical outcome and failure rate of all transplants were evaluated at a mean of forty months postoperatively. Meniscal allograft characteristics were determined with use of a rating system that combined subjective, clinical, and magnetic resonance imaging factors.
Results: Thirty-four (89%) of the thirty-eight patients rated the knee condition as improved. Before surgery, thirty patients (79%) had pain with daily activities, but only four (11%) had such pain at the time of the latest follow-up. While noteworthy pain was present in the tibiofemoral compartment in all forty knees before surgery, twenty-seven knees (68%) had no pain and thirteen (33%) had only mild compartment pain at the time of the latest follow-up. Twenty-nine patients (76%) returned to light low-impact sports without problems. Concomitant osteochondral autograft transfer and knee-ligament reconstruction procedures improved knee function and did not increase the rate of complications. Meniscal allograft characteristics were normal in seventeen knees (43%), altered in twelve (30%), and failed in eleven (28%).
Conclusions: The short-term results of meniscal transplantation are encouraging in terms of reducing knee pain and increasing function; however, long-term transplant function and any chondroprotective effects remain unknown and require further investigation.
Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). Refer to this Journal's "Instructions to Authors" for a complete description of levels of evidence.
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