[Transplantation of deep frozen menisci].

PURPOSE OF THE STUDY

Subtotal or total meniscectomy will increase weight-bearing per square unit of the cartilage surface approximately threeand- half-times. A long-term overloading of cartilage is clinically manifested by pain, swelling and a rapid onset of early arthritic lesions discernible on radiograms. One of the options for the treatment of degenerative changes in the joint is meniscal transplant. The authors present their first experience with the transplantation of deep frozen meniscal tissue in the Czech Republic.

MATERIAL

By September 2006, we had treated 26 patients with clinical problems following subtotal or total meniscectomy. The patients, 15 women and 11 men, were between 24 and 46 years of age. Eighteen patients underwent transplantation of the medial meniscus and eight received a lateral meniscal transplant. Concomitant repair of the anterior cruciate ligament (ACL) was indicated in 11 patients, of whom 10 were treated with semitendinosus tendon graft and one with patellar ligament allograft. One patient with a lateral meniscal transplant and ACL reconstruction also had suture of the medial meniscus for a previously sustained injury. In 16 patients, chondromalacia was at the level of Outerbridge grade II and, only in five patients, the finding was Outerbridge grade I. Five patients with grade III chondromalacia were treated using the microfracture technique. Valgus or varus osteotomy was not indicated at all.

METHODS

The goal of meniscal transplant surgery is: 1) to relieve pain after meniscectomy; 2) to prevent degenerative changes of cartilage; 3) to eliminate or reduce the risk of development of osteoarthritic lesions; 4) to restore normal mechanics of the knee joint. Patient selection is important and it is necessary to take into consideration: 1) level of cartilage degenerative changes; 2) knee alignment; 3) knee joint stability; 4) graft size. In patients with instability of the knee and indications for meniscal graft, it is necessary to stabilize the joint by ligament reconstruciton prior to transplantation; in the case of malalignment corrective osteotomy is required.

RESULTS

All patients healed without complications. At the end of the third follow-up month, the range of motion was S-0-0-130 in 22 patients and S-0-0-120 in three patients. Only one patient had the range of motion restricted to S-0-0-110. Evaluation showed improvement from pre-operative values to those at 6 months and two years post-operatively as follows: IKDS score, 57-64 to 73-80 to 76-84; Lysholm score, 50-76 to 80-90 to 85-95; and Tegner score, 2-4 to 4-7 to 5-8. No complications associated with meniscal transplant incorporation were recorded. Also in five patients with Outbridge grade III degenerative changes, meniscal transplantation was successfully carried out. In four patients, of which two had a cartilage defect treated, second-look arthroscopy showed that the lesions healed with healthy fibrocartilaginous tissue.

CONCLUSIONS

All patients reported resolution of subjective complaints, as seen from the results of the IKDC, Lysholm and Tegner scoring systems. It was obvious that when biomechanics of the knee joint were restored, conditions facilitating healing of chondral defects were provided. Based on this experience, the authors conclude that meniscal transplantation improves the quality of life in biologically young patients with clinical problems after meniscectomy.