The Journal of Bone and Joint Surgery (American) 86:1392-1404 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
Meniscal Transplantation in Symptomatic Patients Less Than Fifty Years Old
Frank R. Noyes, MD1,
Sue D. Barber-Westin, BS1 and
Marc Rankin, MD1
1 Deaconess Hospital, 311 Straight Street, Cincinnati, OH 45219. E-mail address
for S.D. Barber-Westin:
sbwestin{at}csmref.org
Investigation performed at Cincinnati Sportsmedicine and Orthopaedic
Center, Cincinnati, Ohio
In support of their research or preparation of this manuscript, one or more
of the authors received outside funding from the Cincinnati Sportsmedicine
Research and Education Foundation and a grant from Cryo-Life. None of the
authors received payments or other benefits or a commitment or agreement to
provide such benefits from a commercial entity. No commercial entity paid or
directed, or agreed to pay or direct, any benefits to any research fund,
foundation, educational institution, or other charitable or nonprofit
organization with which the authors are affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department at 781-449-9780, to order the CDM-ROM).
A video supplement to this article is available from the Video Journal
of Orthopaedics. A video clip is available at the JBJS web site,
www.jbjs.org. The Video Journal of Orthopaedics can be contacted
at (805) 962-3410, web site: www.vjortho.com.
A video supplement to this article is available from the Video Jour-
nal of Orthopaedics. A video clip is available at the JBJS web site,
www.jbjs.org. The Video Journal of Orthopaedics can be contacted
at (805) 962-3410, web site: www.vjortho.com.
Background: The purpose of this study was to prospectively evaluate
the results of meniscal transplantation in a consecutive series of younger
patients treated for pain in the tibiofemoral compartment following a previous
meniscectomy.
Methods: Forty cryopreserved menisci were implanted into
thirty-eight patients. Sixteen knees also had an osteochondral autograft
transfer, and nine had a knee ligament reconstruction. The clinical outcome
and failure rate of all transplants were evaluated at a mean of forty months
postoperatively. Meniscal allograft characteristics were determined with use
of a rating system that combined subjective, clinical, and magnetic resonance
imaging factors.
Results: Thirty-four (89%) of the thirty-eight patients rated the
knee condition as improved. Before surgery, thirty patients (79%) had pain
with daily activities, but only four (11%) had such pain at the time of the
latest follow-up. While noteworthy pain was present in the tibiofemoral
compartment in all forty knees before surgery, twenty-seven knees (68%) had no
pain and thirteen (33%) had only mild compartment pain at the time of the
latest follow-up. Twenty-nine patients (76%) returned to light low-impact
sports without problems. Concomitant osteochondral autograft transfer and knee
ligament reconstruction procedures improved knee function and did not increase
the rate of complications. Meniscal allograft characteristics were normal in
seventeen knees (43%), altered in twelve (30%), and failed in eleven
(28%).
Conclusions: The short-term results of meniscal transplantation are
encouraging in terms of reducing knee pain and increasing function; however,
long-term transplant function and any chondroprotective effects remain unknown
and require further investigation.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.
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