MENISCAL ALLOGRAFT TRANSPLANTATION FOR UNICOMPARTMENTAL ARTHRITIS OF THE KNEE.

Abstract

One hundred and forty eight meniscus allografts transplanted in one hundred and forty patients between 1988 and 2000 were reviewed. The indication for surgery included disabling knee pain, refractory to conservative treatment, objective symptoms of compartmental crepitus, pain on valgus/varus stress and osteoarthritis documented on arthroscopy following prior total meniscectomy. Knee mal-alignment and instability were also documented. Patients with varus alignment and medial OA, as well as valgus alignment with lateral OA, underwent re-alignment to unload the compartment for allograft transplantation. Patients with anterior cruciate deficiency, underwent ACL reconstruction at the time of allograft transplantation.

The purpose of this paper is to show the benefit of meniscus transplantation in osteoarthritis of the knee.

At a mean follow-up of six years (range two to fourteen), one hundred and twenty-five out of one hundred and forty-eight knees received good to excellent results.

Meniscus allograft transplantation can restore function in patients with arthritis secondary to prior total meniscectomy. The transplantation of a biological load-bearing structure has given reliable long term results, when used in well selected cases.

Forty six patients received an isolated meniscus allograft with forty-one receiving good to excellent results. Eleven received a medial or lateral meniscus allograft with an ACL reconstruction and nine obtained good to excellent results. Seventy five knees received a meniscal allograft in combination with an osteotomy to correct for pre-operative deformity, with sixty-four attaining good to excellent results. The remaining twenty-two knees underwent valgus high tibial osteotomy, meniscus allograft and ACL repair, with nineteen achieving good to excellent results.

Outcome was assessed subjectively and functionally using a modified Lysholm socre and objectively by clinical examination. The Tegner activity scale was used to compare pre and post- operative function. Second look arthroscopy was performed on the first ten transplanted meniscus to assess healing and graft integrity.