A new arthroscopic technique for lateral meniscal allograft. This article describes the detail involved in the arthroscopic surgical technique of the meniscal allograft transplant mat for both medial and lateral compartments of the knee joint. Unfortunately, despite advances in arthroscopy, not. It is a cartilage piece that separates two disks and is a shock absorber that helps in giving strength, coordination as well as help in distributing the body weight evenly on the knee joint. Walk with crutches and a brace locked in extension. Various meniscal transplant techniques have been described, all of which are considered surgically demanding. In this context, medial meniscal allograft transplantation arises as the preferred procedure. Indications, techniques, rehabilitation, and clinical outcome. Thus, depending upon surgeon preference, the meniscus allografts are prepared so that techniques utilizing a bone bridge or bone plugs can be performed. Surgical techniques meniscus transplantation study group.
Meniscal transplant is not a perfect procedure and is not as good as having your own meniscus. Surgical complications the risk of complications from meniscal transplant surgery is very slight. A meniscal transplant uses a sizematched cadaver meniscus to replace the damaged meniscus in an effort to alleviate pain, improve function and preserve the joint. Remnants of the lateral meniscal tissue are debrided to a bleeding rim of approximately 1 mm. This system is designed to simplify and standardize the preparation process. Surgical technique for meniscal allograft transplantation. Meniscal transplant, a specialty knee surgery now available at uhs, has been a gamechanger for athletes. These surgical techniques and instruments could standardize. The actual cost meniscus transplant surgery will depend on the type of surgery performed on the knee joint as well as the severity of the medical condition of the knee. Oct 02, 2015 for some patients, meniscus allograft transplantation mat is a viable surgical solution that aims to reduce pain and improve function. In it, a miniature camera is inserted through a small incision.
Arthroscopic techniques and instruments for meniscal allograft. Meniscal allograft transplant mat is a promising biological solution for the symptomatic young patient with a meniscusdeficient knee that has not developed advanced osteoarthritis. Waiting time depends on the availability of a graf. Meniscal allograft transplantation using a novel allarthroscopic. The radiologist must know the surgical technique of meniscal transplantation and be familiar with the normal findings of posttransplant imaging in mri for the accurate evaluation of these patients and recognize the signs of probable complications. Stiffness, reoperation, and incomplete healing are the most common complications. Surgical knee will be in a hinged rehab brace locked in full extension for 4 weeks postop. First described in 1972 by zuker and colleagues, the utilization of mat has increased substantially, with continuous improvements in patient selection and surgical technique. Surgical technique video 1 shows the comprehensive technique of arthroscopic medial meniscal allograft transplant in a left knee with soft tissue in socket.
Laprade discussed meniscus repair in ajsm webinar moderator, dr. Cigna medical coverage policies musculoskeletal knee. Meniscal allograft transplantation has become a beneficial and established surgical procedure when performed with meticulous attention to detail. Such a procedure is still in the domain of the superspecialist and will not be offered at most orthopaedic units although the procedure is becoming more mainstream. Meniscal transplant surgery is a type of surgery that replaces a persons missing or damaged meniscus with a meniscus from a cadaver donor. As surgical techniques are refined and outcomes continue to improve, it.
Orthopedic surgeons attempt to preserve the meniscus when surgically treating a torn meniscus. The indications and techniques for meniscal transplant. It is very important to correlate the morphological alterations with the patients clinic. If the meniscus is damaged and it cant be surgically repaired, a meniscus transplant may be an option. The decision to perform meniscal transplant surgery is a process of exclusion, with the vast majority of patients who undergo meniscal resection not requiring consideration of meniscal transplant. Laprade discussed meniscus repair in ajsm webinar dr. This surgical technique is feasible and results in good positioning of the meniscal graft. This technical note describes an improved arthroscopic technique of meniscal transplantation that simplifies the surgical procedure and secures the allograft to the tibia at three sites. Meniscal transplant surgery seattle, wa knee replacement. Motion restrictions is probably not what a middleaged patient is expecting as a result of their meniscus surgery.
The meniscus transplant center meniscus replacement for. This advanced meniscal transplant instructional course will focus on the more challenging meniscal pathologies and repair options available. The meniscus transplant center is one of the few places in the world dedicated to this procedure. The meniscus transplant center meniscus replacement for arthritis. Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis. Consider a heel lift in opposite shoe to normalize gait. Patients with significant loss of their meniscal cartilage due to trauma or multiple arthroscopic trimmings of the meniscus may experience symptoms due to the loss of this tissue. Participants will hear lectures on current concepts, evidence and the latest techniques from a faculty of experts from across europe. Your knee has 2 wedgeshaped pieces of cartilage, 1 on each side of your knee. Overoptimistic patient expectations of recovery and. It is a big operation and probably takes about around 6 months to make a full recovery, therefore rehabilitation is a key component of success.
Meniscus transplant surgery is a type of surgery that replaces your missing or damaged meniscus with a meniscus from a cadaver donor. Meniscal transplantation has become an attractive option in selected patients with incapacitating knee pain. Regular assessment of gait to avoid compensatory patterns. Meniscal allograft transplantation is surgery in which a meniscus a cshaped cartilage in the knee is placed into your knee. Meniscal transplant surgery johns hopkins medicine. The 70 arthroscope is used to examine posteromedial meniscal regions. Meniscal transplantation is a surgical procedure to replace the damaged meniscus of the knee with healthy cartilage. This surgery is not commonly performed in australia, with only a few surgeons trained and experienced in the procedure. Treating a symptomatic medial meniscectomized knee is challenging because of limited surgical options. Meniscal transplant surgery is an arthroscopic procedure. A meniscal transplant is an outpatient procedure performed using tiny instruments through a small incision known as arthroscopic or keyhole surgery using a regional aneasthetic. Meniscal transplant sports medicine knee specialist minnesota. The meniscal replacement, or meniscal transplant, takes an intact meniscus from a donor and implants it into the space where the old meniscus once was.
The technique of a lateral meniscus transplant involves making a bony trough and sliding the trough with the meniscal attachments into place in the joint. Meniscal transplant surgery is a type of surgery that replaces your missing or damaged meniscus with a meniscus from a cadaver donor. Arthroscopic medial meniscal transplant using multiple fixation. Patient positioning and diagnostic arthroscopy our technique begins with placing the patient supine under general anesthesia with a lateral post for the operative leg. Surgery versus physical therapy for a meniscal tear and osteoarthritis. Meniscal transplantation in symptomatic patients less than fifty years old. More stitches are placed into the meniscal transplant to sew it into place. Tapered teardrop technique osteochondral proximal tibial and lateral meniscal allograft transplant meniscal root repair. Meniscal transplant surgery what is meniscus transplant surgery. A meniscus transplant is a surgical procedure to replace the entire meniscus and its rim with a donor meniscus harvested from a human donor and purchased from a tissue bank.
The meniscus is a cshaped cartilage ring that acts like a cushion between the shinbone and the thighbone. Quality physical therapy and rehabilitation is an important part of regaining strength and function after a meniscal transplant. Meniscal transplants orthopaedic surgery specialists ltd. Arthrex meniscal transplant systems are designed to provide a method for implantation of the meniscal allograft with rigid fixation at the horn attachments. Our technique begins with placing the patient supine under general anesthesia with a lateral post for the operative leg. Meniscus repair is a type of orthopedic surgery that is performed to repair the damages caused on meniscus cartilage in the knee. The new meniscal tissue is anchored into the shinbone to stabilize the transplant. Robertson performs a meniscus allograft transplant using the conmed meniscus allograft transplant instrumentation.
This book discusses all aspects of meniscal transplantation, covering the use of. However, meniscus transplant does not work for everybody. Frequently asked questions faq meniscal transplant. The patient is placed supine on the operating table, and standard anterolateral and anteromedial portals are created adjacent to the patellar tendon. Surgical video of medial meniscus replacement technique, narrated by dr. The surgical procedure of meniscus transplantation involves first removing the torn fragments of original meniscus cartilage, securely placing and attaching the meniscus transplant, enough to permit axial and rotational loads, and finally checking the placement to make sure the rest of the tissues in the knee are working properly with the new tissue.
Specifically, the dovetail meniscal allograft set is a meniscal allograft technique that fashions a meniscus allograft having a trapezoidal shape for a bonetobone interlock with a. Cartilage restoration often, when the meniscus or ligaments are damaged, the articular cartilage, which covers the ends of the bones, is damaged as well. The purpose of this article was to detail the arthroscopic medial meniscal allograft transplantation technique with the use of 2 bone plugs. Meniscal allograft transplantation with soft tissue in. Preoperative assessment, surgical considerations, and clinical outcomes article in the journal of knee surgery 276 june 2014 with 32 reads. Typically, a 2 to 4inch incision is made in the knee with a few other small poke holes. Preferably performed for lateral meniscal incompetence, the dovetail technique anatomically recreates the normal lateral meniscal relationships within the knee. Meniscal allograft transplantation with soft tissue in bone. Meniscal transplant surgery brigham and womens hospital. The meniscus is a complex structure that provides both cushioning and stability to the knee.
This book discusses all aspects of meniscal transplantation, covering the use of both allografts and meniscal substitutes, including collagen and polyurethane implants. In the past, if a meniscus was damaged beyond repair, it was simply removed. In other words, even if a patient got a proper diagnosis and excellent surgical technique, problems with motion restrictions in the knee developed early. Surgical instruments were specifically designed to assist in the allarthroscopic approach for mat. A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. Medial meniscus transplant surgical technique youtube. Some surgeons transplant the meniscus without any bone attached to it, while others advocate that a bony bridge or bone plugs on the meniscal horns are used to ensure a good strong fixation of the graft. Some surgeons leave the allograft anchored to its bony attachments and fix these bone bridges or plugs into size matched slots, troughs or holes. The specific tear pattern, number of components of the tear, and remaining rim width are. Our surgical technique is categorized into 7 steps to replicate this procedure as shown in the video 1.
Meniscus transplant surgery is very common for meniscus repair problem. All involve arthroscopy and some require open surgery, as well. The authors describe their bridgeinslot technique for lateral meniscal allograft transplantation and their 2bone plug technique for medial meniscal allograft transplantation. Knee arthroscopy is one of the most commonly performed surgical procedures. A meniscus transplant or meniscal transplant is a transplant of the meniscus of the knee, which separates the thigh bone from the lower leg bone. The trough is necessary instead of 2 bone plugs because the attachment sites of the lateral meniscus are between 12 to 14mm apart. Transplantation act is a cellbased cartilage repair surgical technique which utilizes an individuals own cells in an effort to repair damage to articular cartilage with the goal of improving joint function and reducing pain. The meniscus to be transplanted is taken from a cadaver, and, as such, is known as an allograft. The risk of complications from meniscal transplant surgery is very slight. The worn or damaged meniscus is removed and is replaced with a new one from a donor. Robert laprade, md, phds article comparable outcomes after buckethandle meniscal repair and vertical meniscal repair can be achieved at a minimum 2 years followup. Video 1 shows the comprehensive technique of arthroscopic medial meniscal allograft transplant in a left knee with soft tissue in socket fixation. Meniscal transplant is still an evolving technique, and achieving good results depends on appropriate patient selection table 1, graft preservation, prudent operative techniques, and adequate.
Over recent years, appreciation for the critical role of the meniscus in joint biomechanics has led to an emphasis on meniscal preservation. The surgical procedure of meniscus transplantation involves first removing the torn fragments of original meniscus cartilage, securely placing. This surgical technique describes a bone bridge technique used in conjunction with the stryker slot instruments orderfor meniscal transplantation. As surgical techniques are refined and outcomes continue to improve, it is vital to consider the utility of such procedures and offer a straightforward approach. In order to succeed, a replacement must duplicate the mechanical function of the original meniscal cartilage. This book discusses all aspects of meniscal transplantation, covering the use of both. Surgical technique of lateral meniscal allograft transplantation with use of a bone trough. The surgery usually takes place under general anesthesia. We can see from the scarring in the photo that this surgical procedure requires that the knee be opened up considerably more. Meniscal transplantation is technically difficult, as it must be.
Frequently asked questions compiled by patients that have undergone meniscal transplant surgery, it is hoped these frequently asked questions will answer some of your concerns prior to surgery. The procedure involves the collection and culture of articular cartilage cells i. The new meniscus is taken from a person who has died cadaver and donated. The surgeon will make one small incision in the knee joint, with two or three other nicks to help situate the transplant properly.
Meniscal allograft transplant mat is a promising biological solution for the symptomatic young patient with a meniscus deficient knee that has not developed advanced osteoarthritis. Subsequent peripheral graft fixation to the capsular rim with 20 fiberwire achieves the goal of creating a solid meniscal allograft construct. Meniscus transplant is a highly skilled procedure involving accurate diagnosis, acquisition of the perfect donor tissue, complex surgery, and specialized rehabilitation. If there is persistent pain or bone friction seen in the knee joint and if the meniscus cannot be repaired, then the surgeons go for a meniscal transplant and it is mostly.