Garcia Jose Rafael, Allende Felicitas, Chahla Jorge
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Video J Sports Med. 2024 Nov 12;4(6):26350254241279324. doi: 10.1177/26350254241279324. eCollection 2024 Nov-Dec.
Anterior cruciate ligament (ACL) injuries frequently present with lateral meniscal injuries, and when irreparable, this may lead to meniscectomy, increasing the risk for osteoarthritis. Lateral meniscal allograft transplant (LMAT) can restore knee function and proper contact pressures. When combined with osteochondral allograft (OCA) for chondral defects, results are highly positive.
LMAT is indicated in relatively young patients (<50 years of age) with a symptomatic, meniscus-deficient knee that has failed conservative treatment. The knee must be stable, without articular cartilage damage that cannot be repaired, and patients should be able to adhere to postoperative rehabilitation and future care. Indications for OCA include young, active patients with posttraumatic osteochondral defects, osteonecrosis, osteochondritis dissecans, large focal defects, previous cartilage repair failure, or patellofemoral joint cartilage lesions.
After a diagnostic arthroscopy is performed and concomitant injuries are ruled out, the lateral meniscal tissue is debrided to a 1- to 2-mm rim for the recipient site preparation. Tibial sockets for root fixation are created using tibial guides and passing sutures are placed. A capsulodesis is performed to reduce meniscal extrusion by securing the lateral capsule through a transtibial tunnel to the anteromedial tibial cortex with high-strength sutures. A meniscal allograft, prepared with bone plugs, is introduced through an enlarged anterolateral portal. After it is accurately positioned, it is stabilized using Fast-Fix Flex devices and circumferential sutures. The bone plug sutures are then fixed through the tibial tunnels to the anteromedial tibial cortex with a button. The large cartilage defect is addressed with an OCA transplant, involving defect measurement, careful reaming, and press-fit insertion of a donor plug, ensuring congruent articulation.
Patients can expect improved clinical outcomes and high patient satisfaction with LMAT and concomitant OCA. The use of bone plugs minimizes soft tissue dissection while achieving solid osseous fixation.
DISCUSSION/CONCLUSIONS: LMAT with OCA leads to restored contact pressures to near-physiological levels, a high patient satisfaction of over 85%, and mean allograft survival of 16 years.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
前交叉韧带（ACL）损伤常伴有外侧半月板损伤，若无法修复，可能导致半月板切除术，增加骨关节炎风险。外侧半月板同种异体移植（LMAT）可恢复膝关节功能及正常接触压力。与骨软骨同种异体移植（OCA）联合用于软骨缺损时，效果非常理想。
LMAT适用于相对年轻（<50岁）、有症状且半月板缺失的膝关节，经保守治疗无效。膝关节必须稳定，无无法修复的关节软骨损伤，患者应能坚持术后康复及后续护理。OCA的适应症包括年轻、活跃的创伤后骨软骨缺损、骨坏死、剥脱性骨软骨炎、大面积局灶性缺损、既往软骨修复失败或髌股关节软骨损伤患者。
在进行诊断性关节镜检查并排除合并损伤后，将外侧半月板组织清创至1至2毫米边缘，以准备受体部位。使用胫骨导向器制作用于根部固定的胫骨窝，并放置通过缝线。通过经胫骨隧道用高强度缝线将外侧关节囊固定至胫骨前内侧皮质，进行关节囊缝合以减少半月板挤压。将带有骨栓的半月板同种异体移植物通过扩大的前外侧入口引入。准确放置后，使用Fast-Fix Flex装置和环形缝线进行固定。然后用纽扣将骨栓缝线通过胫骨隧道固定至胫骨前内侧皮质。通过OCA移植处理大的软骨缺损，包括缺损测量、仔细扩孔以及将供体栓压配插入，确保关节吻合。
患者可预期通过LMAT及联合OCA获得改善的临床结果和较高的患者满意度。使用骨栓可减少软组织分离，同时实现牢固的骨固定。
讨论/结论：LMAT联合OCA可使接触压力恢复至接近生理水平，患者满意度超过85%，同种异体移植物平均存活16年。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，则作者在提交本出版物时已包含患者的豁免声明或其他书面批准形式。
