Subtotal or total meniscectomy in the medial or lateral compartment
of the knee results in a high risk of future osteoarthritis. Meniscal
allograft transplantation has been performed for over thirty years
with the scientifically plausible hypothesis that it functions in
a similar way to a native meniscus. It is thought that a meniscal
allograft transplant has a chondroprotective effect, reducing symptoms
and the long-term risk of osteoarthritis. However, this hypothesis has
never been tested in a high-quality study on human participants.
This study aims to address this shortfall by performing a pilot
randomised controlled trial within the context of a comprehensive
cohort study design. Patients will be randomised to receive either meniscal transplant
or a non-operative, personalised knee therapy program. MRIs will
be performed every four months for one year. The primary endpoint
is the mean change in cartilage volume in the weight-bearing area
of the knee at one year post intervention. Secondary outcome measures
include the mean change in cartilage thickness, T2 maps, patient-reported
outcome measures, health economics assessment and complications.Objectives
Methods
The goal of this study was to evaluate the outcomes from arthroscopic “all inside” meniscal repairs using the FasT-Fix suture system, performed at the Gold Coast and Allamanda Private Hospitals during 2006–2007 40 consecutive meniscal repairs in 36 patients were performed both in isolation and in conjunction with ACL reconstruction. All repairs were performed by the senior author (PG), using an arthroscopic all inside technique with the Fastfix suture anchor system. Patients were assessed at a minimum 6 months follow up, including assessment with the IKDC subjective form. 36 patients underwent a total of 40 meniscal repairs. The average age of the patients was 23.4 years (range 14–42). There were 65% male (26 patients) and 35% female (14 pts). 67.5% (27 menisci) were medial and 32.5% (13 menisci) were lateral repairs. 4 patients underwent bilateral repairs (1 involving 2 different operative dates). 55% (22/40 pts) were right knees and 45% (18/40 pts) were left knees. The average number of FasT-Fix meniscal anchors used was 3.8 (range 1–10). 62.5% (25 pts) underwent concurrent anterior cruciate ligament (ACL) reconstruction. 37.5% (15 pts) were isolated meniscal injuries. 55% (22 pts) had associated chondral surface abnormalities. No Significant complications occurred, including no nerve injuries, infections, or post-operative stiffness. 3 patients underwent subsequent re-operation to resect failed repairs, leaving 37 menisci successfully repaired (92.5%). 5 patients 12.5% described some persistent pain post operation. The average IKDC subjective score for those patients with intact repairs was 91 (62–100). Meniscal repair using an arthroscopic all inside technique provides a safe, reliable and reproducible method of repairing torn menisci, without the need for a further ‘safety incision’ to retrieve and tie sutures. The outcomes from this study indicate that patients demonstrate similar functional results, and low failure rates, similar to other published meniscal repair methods, including the gold standard of inside-out repair.
