Background

The objective was to evaluate the benefit that could be obtained in terms of pain and efficacy with processed segmental allografts on 20 patients in meniscal repair treatment.

Introduction: Lateral meniscectomies lead to degenerative arthritis and therefore meniscus transplantation has been considered. In literature, this procedure appears to have good clinical results. The aim of this study was to evaluate our clinical results at mid-term follow-up and to correlate these results to the morphology and position of the transplanted meniscus.

Material and methods: Twenty-eight patients operated in 4 surgical centers, were retrospectively reviewed following lateral meniscal allograft transplantation. The mean age of the patients was 34 years (range, 18 to 50 years). Before surgery, all these patients suffered of permanent lateral femorotibial pain without radiological knee arthritis. The knees were all stable or stabilized, without axial malalignment of the lower limbs or corrected by a concomitant high tibial osteotomy. Arthroscopic procedure was performed for 9 patients and arthrotomy for 19 patients. Different techniques of fixation of the transplant were used, with or without bone plugs. The associated procedures were 2 ACL reconstruction, 3 high tibial varus osteotomies, and 1 mosaicplasty. The IKDC score were used for the analysis of the functional results. An arthroTDM or an arthro MRI was used to analyse the morphology and position of the transplanted meniscus.

Results: The mean follow-up was 35 months (range, 12 months to 6 years). The mean post-operative subjective IKDC score was 65.5 points (range, 19.5 to 89 points). There were 2 failures associated with a fast arthritic evolution and 2 functional bad results. The others 24 patients (85%) were satisfied or very satisfied, with a real improvement of the pain and the function. Seventeen patients (60%) have started again a sportive activity superior than the one pre-operating. At the last follow-up, all transplanted meniscus have healed, but the morphology and position of the transplanted meniscus was not always normal with absence of the middle segment in 3 cases; its extrusion in 9 cases, a posterior segment shortened or partially hurt in 5 cases and its absence in 3 cases. Better results were associated with good meniscus positioning and morphology.

Discussion: Our works confirm that lateral meniscal allograft is a therapeutic option with favourable results in terms of pain reduction and functional improvement in the medium term for symptomatic patients after lateral meniscectomy. Our results are comparable with those of the literature. The allograft is technically reliable, reproducible notably for the methods of fixation. A long term follow-up is necessary to evaluate the benefit of these grafts on the protection of the cartilage.

Purpose of the study: Spontaneous repair of lost deep chondral tissue is minimal in the knee joint. A clinical trial of chondrocyte autografts as described by Brittberg and Peterson was undertaken by the Nantes University Hospital and the French Society of Arthroscopy in 1999.

Material and methods: Twenty-eight patients, mean age 28 years, underwent surgery in eight centers. Etiologies were: osteochondritis (n=14), isolated posttraumatic chondorpathy (n=7), chondropathy and full-thickness ACL tear (n=7). All lesions involved the condyles and were deep (ICRS grades 3 and 4). Mean surface area involved after debridement was 490 mm2 (range 150–1000 mm2). Patients were followed three years after the autologous grafting to assess functional outcome. An MRI was obtained at 2–3 years. Thirteen control arthroscopy procedures were performed including eight with biopsy specimens for histology and immunohisto-chemistry studies.

Results: Twenty-six patients were reviewed at more than two years. There were no general complications, three patients presented a partial avulsion of the graft treated by arthroscopy and one underwent arthrolysis at six months. Function improved in all patients except three and pain improved in all. The ICRS score improved from 43 points (range 19–70) to 77 points (range 39–84). Sixteen control MRIs were available and showed that the graft was hypertrophic in eleven cases, on level in four, and insufficient in one. Marginal integration was good in 11 cases and partial in five. Subchondral integration was complete in ten cases and mediocre in six. The arthroscopic score was nearly normal (score 8–11) in eight cases and abnormal in five (score 4–7). The histological class according to Knutsen (hyaline richness) was: one in group 1 (> 60%), three in group 2 (> 40%), four in group 3 (< 40%) and one in group 4 (bony or fibrous tissue). Function score (r=0.78 and MRI score (r=0.76) were correlated with arthroscopic sores. There was no correlation with the histological results.

Discussion: Clinical outcome was improved in more than 80% of cases, similar to results reported for histological series. The arthroscopic and histological results were equivalent to those reported by Knutsen but inferior to those reported by Bentley or Peterson.