Meniscal Transplantation in a 25-Year-Old: How to Make It Work! My - PowerPoint PPT Presentation

Meniscal Transplantation in a 25-Year-Old: How to Make It Work! My Outcomes, It’s the Right Answer Thomas Carter MD Phoenix, AZ

Disclosure I have disclosures and this information can be found in the : AAOS Disclosure Program online at www.aaos.org

Biomechanically, medial MAT improves stress distribution Normal meniscus Meniscectomy Meniscal Allograft Courtesy Drs Verma and Farr

Indications • symptoms localized to involved compartment (joint effusion may affect this) • not indicated if asymptomatic • make certain chondromalacia due to meniscus excision • address other pathology (ACL, alignment, cartilage)

Chondromalacia • insurance companies say grade 2 or less • clinical benefit even with grade 3 • consensus is if grade 4 not indicated • isolated defect is not a contraindication

By Whom? Need to have experience with: -meniscus repairs -meniscal root repairs -ACL reconstructions -osteotomies

Surgical Techniques 1. No bone 2. Bone -plugs -bridge Dovetail dovetail slot

Bone vs. No Bone • b asic science studies show better to anchor horns with bone • many authors report soft tissue fixation has the same clinical outcomes as using bone • don’t forget about graft itself

Meniscal Root Tears hoop stresses only reestablished if horns attached adequately

Suture only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation Abat et al. Am J Sports Med 2012;40:1591-6 • 88 meniscal allograft 33 sutures only 55 bone plugs • minimum follow-up 3 years (range 36-48 mths)

Abat et al . • extrusion > 3 mm -suture 72.2% -bone 30.9% • repair retears -suture 21.4% -bone 7.3%

Anterior horn- only sutures

Suturing • typically 8-10 are all that are needed • stabilize posterior segment first • place suture at junction of posterior 1/3 and anterior 2/3 (reduction suture) • then suture at junction of posterior 2/3 and anterior 1/3

Rehab • 0-4 weeks ROM 0-90 ° partial weight bearing • 4 weeks full weight bearing and bicycling • 3 – 4 months “running” • 5/6 months until typically functionally recovered

Meniscus and Osteotomy • not uniform agreement as to when to perform • agreed that it should not be as great of a correction as for DJD

Clinical Outcomes Meta-analysis • evidence that it provides pain relief and improved function • 10 year graft survival rates of 70-80% • radiographic results are encouraging as to slowing progression, but not scientifically confirmed • it does not stop arthritis

Meniscal allograft transplantation: 10 year follow-up Carter and Rabago Arthroscopy 2012;28:suppl 1:e17-18 • 40 of initial 47 recipients (85%) (cryopreserved grafts) • 32 (80%) symptoms improved • 33 (82%) graft survivorship (7 partial excisions -4 after 7yrs)

IMREF Group 2015 Consensus Statement on Practice of Meniscal Allograft Transplantation Getgood A, et al. AJSM 2017:1195-1205 Good article for those of you having desire to learn more about meniscal allografts from those of us with significant experience

THANK YOU