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A prospective outcomes study of meniscal allograft transplantation
Robert F LaPrade1, Nicholas J Wills, Stanislav I Spiridonov
1Biomechanics Department, Steadman Philippon Research Institute, The Steadman Clinic, 181 W. Meadow Drive, Suite 400, Vail, CO 81657, USA. drlaprade@sprivail.org
Background:
Symptomatic early-onset chondromalacia often develops after a meniscectomy in the affected knee compartment. The role of meniscal transplantation in reducing pain and improving function in patients with prior ipsilateral meniscectomy is still being defined.
Hypothesis:
Patients with symptomatic early-onset chondromalacia of the knee after ipsilateral meniscectomy will have improved clinical outcomes after meniscal transplantation.
Study Design:
Case series; Level of evidence, 4.
Methods:
All patients who underwent meniscal allograft transplantation between July 2003 and December 2006 were prospectively followed. The indications for surgery were unicompartmental knee pain and postactivity effusions after total or near-total meniscectomy in patients with closed physes. High-field magnetic resonance imaging (1.5-T or 3-T magnets) was used to assess the articular cartilage of the affected compartment. The meniscal transplantations were performed with an arthroscopically assisted technique. Modified Cincinnati knee and International Knee Documentation Committee (IKDC) subjective and IKDC objective outcome scores were obtained on all patients preoperatively and postoperatively to evaluate patients' outcomes.
Results:
Forty patients with an average age of 25 years and a body mass index of 25.4 were included. After an average final follow-up of 2.5 years, IKDC subjective scores increased significantly from 54.5 to 72.0 (P < .001). Modified Cincinnati knee scores increased from 55.2 to 75.3 (P < .001). The preoperative IKDC objective scores measuring effusion improved significantly from 6 A (normal), 29 B (nearly normal), and 5 C (abnormal), when compared with the postoperative scores of 33 A (normal) and 1 B (nearly normal) (P < .01). Five patients sustained tears of their meniscal transplants and underwent partial meniscectomies of the transplant graft.
Conclusion:
The results confirm that meniscal transplantation significantly reduces pain, decreases activity-related effusions, and improves function in patients with prior meniscectomy; however, the long-term chondroprotective effects remain unknown.