Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction.
The menisci provide a vital role in load transmission across the knee joint as well as contribute to knee stability, particularly in the ACL-deficient knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes, which has been well documented both clinically and radiographically. This study examined clinical and patient-reported outcomes following meniscal allograft transplantation with and without combined ACL reconstruction in a select group of 31 patients with complaints of pain and/or instability (34 meniscal allografts); 11 underwent isolated meniscal transplantation and 20 meniscal transplantation combined with ACL reconstruction. Bony fixation was performed with bone plugs for medial transplants and using a bone bridge for lateral transplants. All patients completed several knee-specific and general measures of health-related quality of life and underwent a comprehensive physical examination. Flexion weightbearing PA radiographs at latest follow-up were compared to those obtained preoperatively. Mean follow-up was 2.9 years (range 2-5.5 years). The Activities of Daily Living and Sports Activities Scale scores were 86+/-11 and 78+/-16, respectively, and the average Lysholm score was 84+/-14. There were no significant differences in these scores based upon which meniscus (medial or lateral) was transplanted, concurrent ACL reconstruction, or the degree of chondrosis at arthroscopy. SF-36 scores indicated that patients were functioning at a level similar to the age- and sex-matched population. Twenty-two patients stated they were greatly improved, 8 were somewhat improved, 1 was without change. All but one patient reported that knee function and level of activity were normal or nearly normal. The average loss of motion compared to the noninvolved side was 3 degrees for extension and 9 degrees for flexion. All but one patient had a negative or 1+ Lachman's test. The remaining patient had a 2+ Lachman's test. Assessment with the KT-1000 arthrometer revealed a side-to-side difference of 2 mm (range -2 mm to 7 mm). Average hop and vertical jump indices were both 85% of the contralateral extremity. No statistically significant joint space narrowing was observed by radiography over time. Meniscal allograft transplantation with and without combined ACL reconstruction in carefully selected patients with complaints of compartmental joint line pain and/or instability appears able to provide relief of symptoms and restore relatively high levels of function, particularly during activities of daily living.
Holy Cross Hospital Medical Group, 6000 N. Federal Highway, Ft. Lauderdale, FL 33308, USA.
Erol A
EA
Yoldas
Jon K
JK
Sekiya
James J
JJ
Irrgang
Freddie H
FH
Fu
Christopher D
CD
Harner
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000637:transplantation*; D010007:Osteochondritis / Q000145:classification / Q000601:surgery; D010146:Pain / Q000601:surgery; D017060:Patient Satisfaction; D018579:Patient Selection; D011788:Quality of Life; D020127:Recovery of Function; D000070600:Tibial Meniscus Injuries; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016474:Weight-Bearing