Zsidai Bálint, Lucidi Gian Andrea, Winkler Philipp W, Gnandt Ryan J, Engler Ian D, Musahl Volker
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Video J Sports Med. 2022 Oct 11;2(5):26350254221107036. doi: 10.1177/26350254221107036. eCollection 2022 Sep-Oct.
Meniscus allograft transplantation (MAT) may be indicated for young patients with joint line pain following subtotal or total meniscectomy. Several different approaches for performing MAT have been described in the literature and are influenced by appropriate patient selection, graft-sizing, and soft-tissue fixation techniques. Clinical studies demonstrate favorable results regarding pain relief and knee function in young patients undergoing MAT, making it a viable option for the treatment of postmeniscectomy syndrome.
Meniscus allograft transplantation is indicated for symptomatic patients following subtotal or total meniscectomy. Selection criteria include patient age below 40 to 45 years, body mass index below 35, chondral changes of grade 2 or less, anatomic or correctable joint alignment, and normal or correctable knee stability.
A standard arthroscopy is performed to confirm the indication for MAT, followed by debridement of the meniscus remnant up to the meniscus-capsular junction. The meniscus horns are prepared using a single No. 5 suture, while 4 to 5 No. 2 sutures are passed through the posterior body. The anterior and posterior root tunnels are drilled, and the meniscus is inserted through a posterior vertical arthrotomy using suture passers transmitted via the bone tunnels. The allograft is manipulated into proper position with a probe and the application of axial traction on the posterior root suture. At this point, sutures attached to the posterior horn are passed to the posterior capsule and 6 to 8 inside-out sutures are used to stabilize and fixate the midbody and anterior portion of the allograft.
Several clinical studies report good outcomes following MAT with a mean survival rate of approximately 70% at 10-year follow-up and 60% at 15 years. Additionally, some evidence is currently available regarding the long-term chondroprotective effect of MAT.
DESCRIPTION/CONCLUSION: All-soft tissue meniscus allograft transplantation is a feasible approach for substitution of the damaged native meniscus and maintenance of tibiofemoral contact mechanics. Consequently, MAT is an important procedure in the toolkit of knee surgeons providing treatment for young, symptomatic postmeniscectomy patients.
对于半月板次全或全切除术后出现关节线疼痛的年轻患者，可能需要进行同种异体半月板移植（MAT）。文献中描述了几种不同的MAT手术方法，这些方法受到合适的患者选择、移植物尺寸确定和软组织固定技术的影响。临床研究表明，接受MAT的年轻患者在疼痛缓解和膝关节功能方面取得了良好效果，这使其成为治疗半月板切除术后综合征的可行选择。
同种异体半月板移植适用于半月板次全或全切除术后出现症状的患者。选择标准包括患者年龄在40至45岁以下、体重指数低于35、软骨损伤2级或以下、解剖结构或可纠正的关节对线、以及正常或可纠正的膝关节稳定性。
进行标准关节镜检查以确认MAT的适应症，随后将半月板残余部分清创至半月板-关节囊交界处。使用一根5号缝线准备半月板角，同时4至5根2号缝线穿过半月板后体部。钻出前后根隧道，通过经骨隧道传递的缝线推送器，经后垂直关节切开术插入半月板。使用探针将同种异体移植物调整到合适位置，并对后根缝线施加轴向牵引。此时，将连接后角的缝线穿过至后关节囊，并使用6至8根由内向外的缝线稳定和固定同种异体移植物的中间部分和前部。
多项临床研究报告了MAT术后的良好结果，10年随访时平均生存率约为70%，15年时为60%。此外，目前有一些关于MAT长期软骨保护作用的证据。
描述/结论：全软组织同种异体半月板移植是替代受损天然半月板并维持胫股接触力学的可行方法。因此，MAT是膝关节外科医生为年轻的、有症状的半月板切除术后患者提供治疗的重要手术方法。
