Mannan Ashim, Walmsley Katie, Schranz Peter, Mandalia Vipul
Exeter Knee Reconstruction Unit, Royal Devon & Exeter Hospital, UK.
Exeter Knee Reconstruction Unit, Royal Devon & Exeter Hospital, UK.
Knee. 2020 Oct;27(5):1370-1377. doi: 10.1016/j.knee.2020.05.007. Epub 2020 Aug 3.
The meniscal deficient knee often exists within the setting of associated pathology including instability, malalignment and chondral injury. The aim of this study was to establish the role of meniscal allograft transplantation (MAT) as part of a staged approach to treatment of the previously menisectomised knee and report: (a) primary data endpoints (pre and post-operative Knee Injury and Osteoarthritis outcome scores (KOOS), Tegner scores, satisfaction scores and graft survival), and (b) secondary endpoints:(complication/reoperation rates, and meniscal extrusion measurements as determined by MRI).
This prospective study included all patients that underwent arthroscopic fresh frozen allograft MAT at our institution (2010-2017) using a soft tissue fixation technique.
Twenty-seven MAT procedures were performed in 26 patients (16 lateral, 11 medial). Ten patients underwent ACL reconstruction, three ACI and two osteotomy in the pre-MAT phase. Seven patients underwent ACI within the post-operative phase. Post-operative mean KOOS scores improved significantly in all subscales (p < .002) as did Tegner scores (p < .05). Graft survival was 100%, satisfaction rate 92%, and mean meniscal extrusion 3.04 mm. Post operatively, three patients required meniscal repair and a single patient, partial menisectomy of graft. Two patients underwent arthroscopic arthrolysis following MAT.
This series highlights the multifactorial profile of the meniscal deficient knee and the role of MAT as a safe and reliable technique in the staged and comprehensive biologic treatment available to minimise symptoms and maximise outcomes.
半月板缺失的膝关节常伴有包括不稳定、力线不正和软骨损伤等相关病理情况。本研究的目的是确定半月板同种异体移植（MAT）作为分期治疗先前半月板切除膝关节方法的一部分所起的作用，并报告：（a）主要数据终点（术前和术后膝关节损伤和骨关节炎疗效评分（KOOS）、泰格纳评分、满意度评分和移植物存活率），以及（b）次要终点：（并发症/再次手术率，以及通过MRI测定的半月板挤出量）。
本前瞻性研究纳入了在我们机构（2010 - 2017年）接受关节镜下新鲜冷冻同种异体半月板移植并采用软组织固定技术的所有患者。
26例患者（16例外侧，11例内侧）接受了27次半月板同种异体移植手术。10例患者在半月板同种异体移植术前阶段进行了前交叉韧带重建，3例进行了自体软骨细胞移植，2例进行了截骨术。7例患者在术后阶段进行了自体软骨细胞移植。术后所有亚量表的平均KOOS评分均显著改善（p < 0.002），泰格纳评分也显著改善（p < 0.05）。移植物存活率为100%，满意度为92%，平均半月板挤出量为3.04毫米。术后，3例患者需要半月板修复，1例患者对移植物进行了部分半月板切除术。2例患者在半月板同种异体移植术后接受了关节镜下粘连松解术。
本系列研究突出了半月板缺失膝关节的多因素特征，以及半月板同种异体移植作为一种安全可靠的技术在分期和综合生物治疗中的作用，可将症状降至最低并使治疗效果最大化。
4级。
