von Lewinski Gabriela, Milachowski Klaus A, Weismeier Karl, Kohn Dieter, Wirth Carl Joachim
Orthopaedic Department Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1072-82. doi: 10.1007/s00167-007-0362-4. Epub 2007 Jun 19.
The purpose of this study was to determine the objective and subjective long-term outcomes of the first free meniscal allograft transplantations in five patients with complete absence or non-repairable lesion of the medial meniscus after 20 years. Between 1984 and 1986 five patients underwent concomitant medial meniscal transplantation with a deep frozen meniscal allograft, ACL reconstruction and femoral advancement or temporary detachment of the MCL. The clinical outcome of the patients was evaluated 20 years postoperatively using clinical assessment, Lysholm-score, KOOS, IKDC-score, radiographs and magnetic resonance imaging. The Lysholm-score ranged between 21 and 97 points of 100 maximal available points. Corresponding to this the total KOOS ranged between 28.4 and 91.1%. The results of the IKDC-score were evaluated as nearly normal (B) (n = 2), abnormal (C) (n = 2) and severely abnormal (D) (n = 1). The radiological evaluation according to the Kellgren-Lawrence classification showed an increase of the degenerative changes between one and four grades. The radiological results revealed clear degenerative changes with long-term follow-up after meniscal allograft transplantation even though some patients did relatively well regarding the subjective and clinical results in the 20-year follow-up examination in comparison with the literature. Despite these relative clear results the question if medial meniscal transplantation can protect against development of arthritis cannot definitely be answered because in this first case series some aspects of meniscus transplantation that have not been considered which turned out to be of importance during the last 20 years. Furthermore, it has to be taken into account that all patients revealed a cartilage damage at the time of surgery and an ACL reconstruction was performed in addition. Nevertheless from biomechanical point of view it might be taken into consideration to combine the medial meniscus transplantation at least with a high tibial osteotomy. Level of evidence was (IV, case series).
本研究的目的是确定5例内侧半月板完全缺失或不可修复性损伤患者在20年后首次进行的游离半月板同种异体移植的客观和主观长期结果。1984年至1986年期间，5例患者接受了同种异体冷冻半月板移植、前交叉韧带重建以及内侧副韧带股骨推进或临时松解术。术后20年，通过临床评估、Lysholm评分、膝关节损伤和骨关节炎疗效评分（KOOS）、国际膝关节文献委员会（IKDC）评分、X线片和磁共振成像对患者的临床结果进行评估。Lysholm评分在满分100分中为21至97分。相应地，KOOS总分在28.4%至91.1%之间。IKDC评分结果评估为接近正常（B级）（n = 2）、异常（C级）（n = 2）和严重异常（D级）（n = 1）。根据Kellgren-Lawrence分类进行的放射学评估显示，退变程度增加了1至4级。放射学结果显示，半月板同种异体移植术后长期随访存在明显的退变改变，尽管与文献相比，一些患者在20年随访检查中的主观和临床结果相对较好。尽管有这些相对明确的结果，但内侧半月板移植能否预防关节炎的发展这一问题仍无法明确回答，因为在这个首个病例系列中，半月板移植的一些方面在过去20年中被证明是重要的，但之前未被考虑到。此外，必须考虑到所有患者在手术时均存在软骨损伤，并且还进行了前交叉韧带重建。然而，从生物力学角度来看，可能需要考虑至少将内侧半月板移植与高位胫骨截骨术相结合。证据等级为（IV级，病例系列）。
