Scientific Basis of Meniscus Transplantation

Load Transmission

• Medial Meniscus
  50% medial joint load
  Lateral Meniscus
  70% lateral joint load
• Meniscus
  50% joint load in extension
  90 % joint load in flexion

First Human Meniscal Allograft Transplantation

• Milachowski – May 24, 1984Munich University

Indications

• “Selected” patients undergoing ACL reconstruction who are meniscal-deficient
• ACL instability pattern not correctable with ACLR alone in some patients
• Documented increased graft force in meniscal-deficient knees

Contraindications

These are poor candidates:
• Patients with symptoms not related to meniscal deficiency
• Significant chondral pathology (Noyes/Garrett)
• Uncorrected/uncorrectable malalignment
• Uncorrected/uncorrectable instability
• Knee abusers
• Unrealistic expectations

Avoid “Prophylaxis” Transplantation

Preventive benefit unproven
• Not currently recommended or justified
• Better to monitor patient’s symptoms closely and do annual bone scan
Recent data to “Push” indications
• Chondroprotection benefit with immediate transplantation compared to delayed transplantation post-menisectomy in animal model (Rijk, Arthroscopy 2004)
• Observation of rapid degenerative progression in lateral compartment s/p menisectomy (Alford, Arthroscopy 2005)

Processing Methods

Fresh Frozen
• Less expensive, good results, most commonly used
Cryopreserved
• Relatively expensive, some cell survival

Surgical Techniques

- No Bone
- Bone
• Block
• Plugs
• Keyhole / Dovetail

Meniscal Transplantation

• Lateral meniscus – bone block technique
  
• Medial meniscus
If no previous ACL reconstruction, can use bone block technique
If previous ACL reconstruction, use bone plug technique
If concomitant ACL reconstruction, use either technique

• 12 MAT from 2004 to 2007


• Mean age 26.7


• VAS score for pain improved from 5.5 to 1.4


• Tegner score improved from 3 to 5.9


• Lysholm knee score improved from 62.5 to 88.6


• IKDC Subjective score improved from 50 to 79.5

Conclusion

• MAT is no longer investigational


• Success rates: (Medial 70-75%) (Lateral 80-85%)
Demanding surgery
Improve stability
Decrease pain
Not proven to protect cartilage
Only answer for lateral menisectomy patient with pain and swelling

Please note that the information contained herein is for general medical information only.
If you have any specific medical condition or queries, please consult your medical doctor.

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