Meniscal Transplant

Indications

 

Subtotal Meniscectomy

 

Young patient

- previous total or near total meniscectomy

- developing joint line pain

- early chondral changes

- normal anatomic alignment

- stable or reconstructable knee

 

Contra-indications

 

> Grade 2 Chondral changes

 

Farr et al Am J Sports Med 2007

- combined mensical transplantation with ACI

- improved patient outcomes

 

Aim

 

To prevent progressive cartilage damage

 

Issues

 

1.  Graft selection

- usually fresh frozen

 

2.  Graft sizing

 

Size needs to vary < 5% compared with original

 

Options

- X-rays accurate in 79% cases

- CT scan

- MRI accurate to within 5 mm

 

3.  Surgical technique

 

Secure fixation important

 

Technique

 

Bone in slot techique

- maintain meniscal attachment

- prepare bone graft to fit in 8 mm slot

 

Mensical Graft PreparationMeniscal Graft 2

 

Small medial or lateral parapatella to make trough

- prepare meniscus

- leave margin of meniscus to allow suture to

- mark site with needle

- just on inner margin of articular surface

- mark with shaver

- insert guide pin, drill over, then insert box cutter

- carefully clean out with shaver

 

Mx Transplant Medial ParapatellarMensicus Preparation 1Meniscus Preparation 2

 

Mark Trough 1Mark Trough 2Guide wire for troughPrepared Trough

 

Pass graft

- place suture at junction of body and posterior horn

- make posteromedial approach

- insert graft bone into slot

- secure with screw

- flip meniscus

- secure posterior horn with all inside sutures, body with inside out, anterior horn with outside in

 

Graft PassageGraft Passage 2Inside Out SuturesOutside In Repair

 

Mensical TransplantMensical Transplant Xray

 

Results

 

McCormick et al Am J Sports Med 2014

- 172 patiens, mean age 30 +/- 10 years

- 95% survival at 5 years

- 22% arthroscopic debridement

- 4.7% need revision transplant or TKR