VandenBerg Curtis, Mandelbaum Bert, Stelma Sarah, Troyer Stockton, Collon Kevin, Shea Kevin
Children's Hospital Los Angeles, Los Angeles, California, USA.
Co-Chair Medical Affairs, Co-Director Sports Medicine, Co-Director Regenerative Orthobiologics, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA.
Video J Sports Med. 2022 Mar 29;2(2):26350254211058737. doi: 10.1177/26350254211058737. eCollection 2022 Mar-Apr.
Lateral meniscus deficiency in young patients typically results from irreparable lateral meniscus tears, often associated with discoid meniscus. Such cases present a challenging clinical scenario given the known natural history of meniscus deficiency leading to degenerative lateral knee compartment changes. Managing this problem in a skeletally immature patient presents additional clinical and surgical considerations.
Lateral meniscus allograft transplantation (LMAT) is indicated in patients with prior total or subtotal lateral meniscectomy resulting from irreparable lateral meniscus tears, with the goal of providing chondroprotection to the lateral compartment of the knee. Patients are assessed preoperatively for ligamentous stability of the knee, mechanical alignment, and associated chondral injuries to determine whether secondary procedures may be indicated.
We present an all-arthroscopic technique for LMAT using small bone plugs in the anterior and posterior meniscus roots secured through 2 separate anatomic root drill tunnels tied over a bone bridge. The meniscus allograft is further secured using an outside-in suture repair technique. Special attention is given to meniscus allograft preparation, anatomic meniscus root identification, and drilling using a minimally disruptive transphyseal technique. Graft passage, suture management, and meniscus fixation and repair are also highlighted.
Anticipated outcomes from LMAT in skeletally mature patients are excellent, particularly if preexisting chondral degenerative changes are not present. Prior studies with greater than 7-year follow-up in adolescent patients undergoing meniscus allograft transplantation have shown reoperation rates of less than 6% with no growth disturbances noted, with most patients able to return to their prior level of sport. Computed tomography modeling data using this technique shows a proximal tibial physeal surface area disruption of less than 2.5%; therefore, the risk of growth disturbance is very low.
DISCUSSION/CONCLUSION: The surgical technique demonstrated here offers a safe and effective approach for the management of lateral meniscus deficiency after subtotal lateral meniscectomy for irreparable meniscus tears in skeletally immature patients. The chondroprotective effect of the lateral meniscus can be restored with an anatomically placed lateral meniscus allograft with minimal disruption to the proximal tibial physis.
年轻患者的外侧半月板缺损通常由无法修复的外侧半月板撕裂所致，常与盘状半月板相关。鉴于半月板缺损的已知自然病程会导致外侧膝关节腔退变，此类病例呈现出具有挑战性的临床情况。在骨骼未成熟的患者中处理这一问题需要额外的临床和手术考量。
外侧半月板同种异体移植（LMAT）适用于因无法修复的外侧半月板撕裂而先前接受过外侧半月板全切或次全切的患者，目的是为膝关节外侧腔提供软骨保护。术前评估患者膝关节的韧带稳定性、机械对线以及相关软骨损伤情况，以确定是否可能需要二期手术。
我们介绍一种全关节镜下的LMAT技术，使用小骨栓固定在前、后半月板根部，通过2个独立的解剖根部钻孔隧道固定在骨桥上。同种异体半月板通过由外向内的缝合修复技术进一步固定。特别关注同种异体半月板的制备、解剖学半月板根部的识别以及使用微创经骺技术进行钻孔。还强调了移植物的通过、缝线管理以及半月板的固定和修复。
骨骼成熟患者进行LMAT的预期效果良好，尤其是在不存在先前软骨退变改变的情况下。先前对接受半月板同种异体移植的青少年患者进行的随访超过7年的研究表明，再次手术率低于6%，未发现生长障碍，大多数患者能够恢复到先前的运动水平。使用该技术的计算机断层扫描建模数据显示，胫骨近端骨骺表面积破坏小于2.5%；因此，生长障碍的风险非常低。
讨论/结论：此处展示的手术技术为骨骼未成熟患者因无法修复的半月板撕裂行外侧半月板次全切术后的外侧半月板缺损管理提供了一种安全有效的方法。通过解剖学放置的外侧同种异体半月板可恢复外侧半月板的软骨保护作用，同时对胫骨近端骨骺的破坏最小。
