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Meniscus preservation is key first step of cartilage repair
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PRAGUE — Meniscus preservation in surgery is the critical first step in cartilage repair, according to a presenter at the 16th EFORT Congress, here.
“Meniscus and cartilage are an eternal couple because they live together and hopefully for very long time. They do affect each other,” Henning Madry, MD, said. “We have a very strong association between the status of cartilage and meniscal lesions.”
Henning Madry
Madry said cartilage and meniscal lesions do affect one another, and orthopedic surgeons see this in the rate of osteoarthritis following meniscectomy. He said large cartilage defects may induce meniscal lesions.
Arthroscopic meniscal repair offers osteoarthritis prophylaxis. Preservation of the meniscus is key, and Madry advised orthopedic surgeons to remember meniscal integrity.
As to the question of whether it is good practice to perform simultaneous cartilage and meniscal repair, Madry said studies have shown combined procedures improve clinical outcome as much as either procedure alone. Madry cited a study by Harris showing that, of 110 patients followed for 36 months, there were mixed results with combined procedures for cartilage repair and meniscal surgery, including meniscal allograft transplantation with autologous cartilage implantation, osteochondral allograft transplantation, osteochondral autograft transfer system and microfracture. Overall, 50% of patients had at least one additional surgery, such as high tibial osteotomy, distal femoral osteotomy, or cruciate or collateral ligament reconstruction, after the index procedure. In that study, the researchers reported 12% failures for meniscal allograft transplantation alone.
“There was no real, clear benefit,” he said. “It is always an individual decision to do this, and these data do not speak against it.”
Madry advised surgeons to continue to practice complex cases that cannot be solved by just a single treatment. Combined procedures for cartilage repair will be the focus of future studies, possibly in large cohorts with the use of the large European registries.
“The most important lesson is here is that meniscus preservation in surgery is the very first step of cartilage repair,” he said. – by Kristine Houck, MA, ELS
Reference:
Madry H. Meniscus and cartilage: The infernal couple. Presented at: EFORT Congress; May 27-29, 2015; Prague.
Disclosure:
Madry reports no relevant financial disclosures.