Document Title: Noyes-JBJS-Sep05.shtml
Article Title: Surgical Techniques: 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: Journal of Bone and Joint Surgery (American Edition)
Date: September 2005
Volume 87, pages 149-165
Keywords: Meniscal allografting, transplantation, osteoarthritis avoidance.

(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 original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 1392-1404, July 2004 (and can be found here in the Knee Library as Noyes-JBJS-Jul04.shtml.). This September 2005 article describes and expounds on the actual surgical technique (the bone-bridge method) in great depth, and delves into the fine points essential to correct execution of the surgical technique (and therefore indispensable to optimal outcome for the patient). Meanwhile, the companion July 2004 article discusses the surgical technique in less detail, yet focuses on the underlying research and associated study results. Both articles constitute excellent reading for anyone who has lost a meniscus and is considering undergoing meniscal allografting. Both provide superbly penetrating insight, razor-sharp writing, and richly detailed illustrations.

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.

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