This article is more than 5 years old. Information may no longer be current.
Medial meniscal transplants — 14-year survivorship 83% with HTO
Belgian investigators reported a 70% overall survival rate after viable meniscal allograft transplantation at a mean of 7.2 years follow-up.
Click Here to Manage Email Alerts
Success in performing meniscal
allograft transplantation, as with many other orthopaedic procedures, depends
on whether the surgery is done in the right patient and for the right
indications.
The technique is best indicated for young patients with moderate to severe knee pain following a previous total meniscectomy, according to Peter C.M. Verdonk, MD, of Gent, Belgium. When indications are met, the overall results are optimal.
At the 11th ESSKA Congress, Verdonk presented results of a study he and his colleagues at Ghent University Hospital conducted from 1989 to 2002. They analyzed the long-term survivorship of 100 viable medial and lateral meniscal allografts harvested from donors within 24 hours of their death and cultured in vitro for two weeks.
Investigators performed meniscal transplantations in 96 patients via an arthrotomy, including 61 in the lateral compartment and 39 in the medial compartment. They used soft tissue fixation to attach the grafts to the functional meniscal rim.
The mean follow-up was 7.16 years (range 2 to 14.5 years). The mean patient age was 35 years.
Thirty-three percent of the procedures performed in the medial compartment were done in conjunction with a high tibial osteotomy (HTO) to correct an initial varus malalignment of the lower limb. In some cases, surgeons concomitantly performed another procedure, such as a cruciate ligament reconstruction.
Survivorship analysis
The endpoints for survivorship were moderate occasional or persistent pain (30 points) and/or poor function (80 points) according to the modified Hospital for Special Surgery score.
Failure rates were 28.2% for medial allografts and 16.4% for lateral allografts. “The higher failure rate for the medial group can be mainly explained by the fact that these medial transplantations were performed earlier in the series, so the follow-up time is longer,” Verdonk said.
The mean cumulative survival time for the medial and lateral transplantations was 11.6 years.
“Only the HTO group — the medial meniscus transplantation associated with a HTO — had a failure rate of approximately 15%,” he said. Medial transplantations with concomitant HTOs had a higher mean survival time as well.
Difference with HTO
|
COURTESY OF PETER C. M. VERDONK |
Based on Kaplan-Meier survivorship curves, 86% of medial allografts and 90% of lateral allografts survived five years. At 10 years postop, the survivorship was 74% and 69% for the medial and lateral grafts, respectively, which decreased to 52% and 69%, respectively, at the final 14-year follow-up.
“For the medial transplantation group associated with a HTO, we see a marked difference with a much higher and longer survival rate,” Verdonk said. Survivorship was 100% at five years in this group and 83% at 10 years and 14 years postop.
Rehabilitation involved three weeks of nonweight bearing, or six weeks of nonweight bearing in patients with a HTO, combined with mobilizing the knee to 60º flexion. For the next three weeks, flexion to 90º was permitted with partial weightbearing, which was followed by walking with the aid of a crutch, Verdonk told Orthopaedics Today.
Using grafts that underwent viable preservation did not appear to provide any mechanical advantage, “nor was there any clear difference between soft tissue or bone block fixation” based on comparable studies in the literature, he said.
For more information:
- Verdonk PCM, Demurie A, Almqvist KF, Verdonk R. Survival analysis of 103 viable meniscal allografts. #70. Presented at the 11th ESSKA Congress and 4th World Congress on Sports Trauma. May 5-8, 2004. Athens.