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Frank R Noyes - One of the best experts on this subject based on the ideXlab platform.

  • Repair of complex and avascular Meniscal tears and Meniscal Transplantation.
    Instructional course lectures, 2020
    Co-Authors: Frank R Noyes, Sue D Barber-westin, Ryan C Chen
    Abstract:

    A functional meniscus is critical to the long-term health of the knee joint. The repair of Meniscal tears that extend into the central avascular region requires understanding the appropriate indications, contraindications, surgical techniques, and postoperative rehabilitation protocols. An inside-out repair technique using multiple vertical divergent sutures with an accessory posteromedial or posterolateral incision is recommended for optimal stability. In young, active patients, the risk of repair failure and the need for revision are outweighed by the benefit of Meniscal preservation. Although many Meniscal tears are repairable, not all are salvageable, especially if considerable tissue damage has occurred. The goals of Transplantation of human menisci are to restore partial load-bearing Meniscal function, decrease patient symptoms, and provide chondroprotective effects. Clinical studies have shown that Meniscal Transplantation decreases tibiofemoral joint pain in the short term. The procedure remains in an evolving state with an unpredictable long-term outcome; however, most Meniscal transplants gradually deteriorate, tear, or shrink in size over time, thereby losing the ability to provide function. The current goal is to provide short-term benefits to the patient until a superior Meniscal transplant is clinically available.

  • Meniscal Transplantation in symptomatic patients under fifty years of age survivorship analysis
    Journal of Bone and Joint Surgery American Volume, 2015
    Co-Authors: Frank R Noyes, Sue D Barberwestin
    Abstract:

    Background: The purpose of this study was to prospectively evaluate the long-term results and survivorship of Meniscal Transplantation in a consecutive series of patients. Methods: Forty cryopreserved menisci were implanted into thirty-eight patients. Survival end points were transplant removal, revision, or tibiofemoral compartment pain with daily activities. A worst-case scenario was also calculated for patients who did not have symptoms related to the transplant; in this scenario, additional end points were grade-3 signal intensity, extrusion (>50% of Meniscal width), or tear on magnetic resonance imaging; signs of Meniscal tear on examination; or radiographic loss of joint space. The Cincinnati Knee and International Knee Documentation Committee rating systems were used. Results: All patients were followed for a mean postoperative time of eleven years. The estimated probabilities of transplant survival were 88% at five years, 63% at ten years, and 40% at fifteen years. Worst-case survival rate estimates were 73% at five years, 68% at seven years, 48% at ten years, and 15% at fifteen years. The mean time to failure was 8.2 years for medial transplants and 7.6 years for lateral transplants. The functional analysis detected significant improvements for pain, swelling, the patient’s perception of the knee condition, walking, stair-climbing, and squatting (p < 0.05). Conclusions: The survivorship analysis showed that, at ten years, 63% had not required subsequent surgery and were asymptomatic with daily activities. However, this percentage decreased to 40% at fifteen years. Although the data indicated that the majority of cryopreserved Meniscal transplants may fail in the long term, the resolution of symptoms and improvement in function for several years justifies the procedure in young patients who are symptomatic after meniscectomy. Patients should be advised that the procedure is not curative in the long term and additional surgery will most likely be required. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • repair of complex and avascular Meniscal tears and Meniscal Transplantation
    Journal of Bone and Joint Surgery American Volume, 2010
    Co-Authors: Frank R Noyes, Sue D Barberwestin
    Abstract:

    The importance of the menisci in the human knee is well understood. The menisci occupy 60% of the contact area between the tibial and femoral cartilage surfaces and transmit >50% of joint compression forces. Following meniscectomy, the tibiofemoral contact area decreases by approximately 50%, while the contact forces increase two to threefold1-6. Removal of as little as 15% to 34% of a meniscus increases contact pressures by >350%7. Total lateral meniscectomy results in a 45% to 50% decrease in the total contact area and a 235% to 335% increase in the peak local contact pressure8. Meniscectomy frequently leads to irreparable joint damage, including degeneration of the articular cartilage, flattening of the articular surfaces, and subchondral bone sclerosis. Poor long-term clinical results following partial and total meniscectomy have been reported by many authors9-12. Trauma is one of the most common etiologies of Meniscal tears. For example, 40% to 60% of patients who sustain a rupture of the anterior cruciate ligament also sustain a Meniscal tear13,14. Many of these tears extend into the middle-third avascular region and are amenable to inside-out suture repair. Meniscal tears are classified according to their location and type and the integrity of the tissue15. The meniscus is divided into anterior, middle, and posterior thirds as well as inner, middle, and outer thirds. Tears located at the peripheral attachment sites (meniscofemoral and meniscotibial) are referred to as outer-third, or red-red, tears. Tears located in the middle third are classified as either red-white or white-white. Red-white tears occur at the junction of the outer and middle thirds, approximately 4 mm from the Meniscal attachment, with a vascular supply only in the outer third of the tear. White-white tears are located in …

  • Meniscal repair and Transplantation indications techniques rehabilitation and clinical outcome
    Journal of Orthopaedic & Sports Physical Therapy, 2006
    Co-Authors: Timothy P Heckmann, Sue D Barberwestin, Frank R Noyes
    Abstract:

    Abstract The purpose of this paper is to provide current knowledge regarding the indications, operative techniques, rehabilitation programs, and clinical outcomes of meniscus repair and Transplantation procedures. Meniscus tears that occur in the periphery may be repaired using a variety of operative procedures with high success rates. Complex multiplanar tears that extend into the central one-third avascular zone can also be successfully repaired using a meticulous vertically divergent suture technique. The outcome of these repairs justifies preservation of Meniscal tissue, especially in younger athletic individuals. Meniscal Transplantation is a valid treatment option for patients who have undergone meniscectomy and have related tibiofemoral joint pain, or in whom articular cartilage deterioration in the meniscectomized compartment is present. Rehabilitation after these operations includes knee motion and quadriceps-strengthening exercises initiated the first day postoperatively. The initial goal is to ...

  • Meniscal Transplantation in symptomatic patients less than fifty years old
    Journal of Bone and Joint Surgery American Volume, 2005
    Co-Authors: Frank R Noyes, Sue D Barberwestin, Marc Rankin
    Abstract:

    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.

Sue D Barberwestin - One of the best experts on this subject based on the ideXlab platform.

  • Meniscal Transplantation in symptomatic patients under fifty years of age survivorship analysis
    Journal of Bone and Joint Surgery American Volume, 2015
    Co-Authors: Frank R Noyes, Sue D Barberwestin
    Abstract:

    Background: The purpose of this study was to prospectively evaluate the long-term results and survivorship of Meniscal Transplantation in a consecutive series of patients. Methods: Forty cryopreserved menisci were implanted into thirty-eight patients. Survival end points were transplant removal, revision, or tibiofemoral compartment pain with daily activities. A worst-case scenario was also calculated for patients who did not have symptoms related to the transplant; in this scenario, additional end points were grade-3 signal intensity, extrusion (>50% of Meniscal width), or tear on magnetic resonance imaging; signs of Meniscal tear on examination; or radiographic loss of joint space. The Cincinnati Knee and International Knee Documentation Committee rating systems were used. Results: All patients were followed for a mean postoperative time of eleven years. The estimated probabilities of transplant survival were 88% at five years, 63% at ten years, and 40% at fifteen years. Worst-case survival rate estimates were 73% at five years, 68% at seven years, 48% at ten years, and 15% at fifteen years. The mean time to failure was 8.2 years for medial transplants and 7.6 years for lateral transplants. The functional analysis detected significant improvements for pain, swelling, the patient’s perception of the knee condition, walking, stair-climbing, and squatting (p < 0.05). Conclusions: The survivorship analysis showed that, at ten years, 63% had not required subsequent surgery and were asymptomatic with daily activities. However, this percentage decreased to 40% at fifteen years. Although the data indicated that the majority of cryopreserved Meniscal transplants may fail in the long term, the resolution of symptoms and improvement in function for several years justifies the procedure in young patients who are symptomatic after meniscectomy. Patients should be advised that the procedure is not curative in the long term and additional surgery will most likely be required. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • repair of complex and avascular Meniscal tears and Meniscal Transplantation
    Journal of Bone and Joint Surgery American Volume, 2010
    Co-Authors: Frank R Noyes, Sue D Barberwestin
    Abstract:

    The importance of the menisci in the human knee is well understood. The menisci occupy 60% of the contact area between the tibial and femoral cartilage surfaces and transmit >50% of joint compression forces. Following meniscectomy, the tibiofemoral contact area decreases by approximately 50%, while the contact forces increase two to threefold1-6. Removal of as little as 15% to 34% of a meniscus increases contact pressures by >350%7. Total lateral meniscectomy results in a 45% to 50% decrease in the total contact area and a 235% to 335% increase in the peak local contact pressure8. Meniscectomy frequently leads to irreparable joint damage, including degeneration of the articular cartilage, flattening of the articular surfaces, and subchondral bone sclerosis. Poor long-term clinical results following partial and total meniscectomy have been reported by many authors9-12. Trauma is one of the most common etiologies of Meniscal tears. For example, 40% to 60% of patients who sustain a rupture of the anterior cruciate ligament also sustain a Meniscal tear13,14. Many of these tears extend into the middle-third avascular region and are amenable to inside-out suture repair. Meniscal tears are classified according to their location and type and the integrity of the tissue15. The meniscus is divided into anterior, middle, and posterior thirds as well as inner, middle, and outer thirds. Tears located at the peripheral attachment sites (meniscofemoral and meniscotibial) are referred to as outer-third, or red-red, tears. Tears located in the middle third are classified as either red-white or white-white. Red-white tears occur at the junction of the outer and middle thirds, approximately 4 mm from the Meniscal attachment, with a vascular supply only in the outer third of the tear. White-white tears are located in …

  • Meniscal repair and Transplantation indications techniques rehabilitation and clinical outcome
    Journal of Orthopaedic & Sports Physical Therapy, 2006
    Co-Authors: Timothy P Heckmann, Sue D Barberwestin, Frank R Noyes
    Abstract:

    Abstract The purpose of this paper is to provide current knowledge regarding the indications, operative techniques, rehabilitation programs, and clinical outcomes of meniscus repair and Transplantation procedures. Meniscus tears that occur in the periphery may be repaired using a variety of operative procedures with high success rates. Complex multiplanar tears that extend into the central one-third avascular zone can also be successfully repaired using a meticulous vertically divergent suture technique. The outcome of these repairs justifies preservation of Meniscal tissue, especially in younger athletic individuals. Meniscal Transplantation is a valid treatment option for patients who have undergone meniscectomy and have related tibiofemoral joint pain, or in whom articular cartilage deterioration in the meniscectomized compartment is present. Rehabilitation after these operations includes knee motion and quadriceps-strengthening exercises initiated the first day postoperatively. The initial goal is to ...

  • Meniscal Transplantation in symptomatic patients less than fifty years old
    Journal of Bone and Joint Surgery American Volume, 2005
    Co-Authors: Frank R Noyes, Sue D Barberwestin, Marc Rankin
    Abstract:

    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.

  • Meniscal Transplantation in symptomatic patients less than fifty years old surgical technique
    Journal of Bone and Joint Surgery American Volume, 2005
    Co-Authors: Frank R Noyes, Sue D Barberwestin, Marc Rankin
    Abstract:

    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.

Carl Joachim Wirth - One of the best experts on this subject based on the ideXlab platform.

  • Twenty-year results of combined Meniscal allograft Transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament
    Knee Surgery Sports Traumatology Arthroscopy, 2007
    Co-Authors: Gabriela Lewinski, Klaus A. Milachowski, Karl Weismeier, Dieter Kohn, Carl Joachim Wirth
    Abstract:

    The purpose of this study was to determine the objective and subjective long-term outcomes of the first free Meniscal allograft Transplantations in five patients with complete absence or non-repairable lesion of the medial meniscus after 20 years. Between 1984 and 1986 five patients underwent concomitant medial Meniscal Transplantation with a deep frozen Meniscal allograft, ACL reconstruction and femoral advancement or temporary detachment of the MCL. The clinical outcome of the patients was evaluated 20 years postoperatively using clinical assessment, Lysholm-score, KOOS, IKDC-score, radiographs and magnetic resonance imaging. The Lysholm-score ranged between 21 and 97 points of 100 maximal available points. Corresponding to this the total KOOS ranged between 28.4 and 91.1%. The results of the IKDC-score were evaluated as nearly normal (B) ( n  = 2), abnormal (C) ( n  = 2) and severely abnormal (D) ( n  = 1). The radiological evaluation according to the Kellgren-Lawrence classification showed an increase of the degenerative changes between one and four grades. The radiological results revealed clear degenerative changes with long-term follow-up after Meniscal allograft Transplantation even though some patients did relatively well regarding the subjective and clinical results in the 20-year follow-up examination in comparison with the literature. Despite these relative clear results the question if medial Meniscal Transplantation can protect against development of arthritis cannot definitely be answered because in this first case series some aspects of meniscus Transplantation that have not been considered which turned out to be of importance during the last 20 years. Furthermore, it has to be taken into account that all patients revealed a cartilage damage at the time of surgery and an ACL reconstruction was performed in addition. Nevertheless from biomechanical point of view it might be taken into consideration to combine the medial meniscus Transplantation at least with a high tibial osteotomy. Level of evidence was (IV, case series).

  • THE BIOMECHANICAL EFFECT OF INTRAOPERATIVE PRE-TENSIONING OF Meniscal TRANSPLANTS ON THE TIBIOFEMORAL CONTACT AREA. AN EXPERIMENTAL STUDY IN SHEEP
    2006
    Co-Authors: G. Lewinski, Christof Hurschler, C. Allmann, Carl Joachim Wirth
    Abstract:

    Objective: To determine the effect of intraoperative pre-tensioning of Meniscal transplants on the tibial plateau in an animal experiment: Material and Methods: Thirty-six sheep were used for this animal study. The animals were divided into 6 groups: -group A was the sham group; – in group B medial meniscectomy was performed; in group C-F medial meniscus Transplantation with an autograft was carried out. In group C-F different defined pre-tensioning was applied to Meniscal transplants via bone tunnel sutures (0N, 20N, 40N and 60N respectively). After 6 months the animals were sacrificed. The lower limb specimen were placed in a material testing machine under standard conditions in 30, 60 and 90 degrees of flexion and loaded through the femoral axis to 500N. For determining contact area a thin film pressure transducer (Tekscan) was positioned underneath the medial meniscus. Statistical analysis was performed using Mann-Whitney test. Results: The mean contact pressure of the sham group and the groups with the transplanted meniscus was significantly lower in relation to meniscectomized knees. Significant increases in contact area and reductions in in peak contact pressure could be identified. At greater flexion angles only the Meniscal Transplantation group with the 40N pretension showed a significant increase of contact area and/or very strong trend in relation to meniscectomized knees. Concerning peak contact pressure, all Meniscal transplantated groups with exception th 0N pre-tension group showed significant reduction in comparison to the meniscectomized group. Conclusion: Regarding the results we can conclude that the biological ingrowth has an influence on the biomechanical effect of Meniscal Transplantation. For this animal model and with the compressive load of 500N especially 40N pre-tension of Meniscal transplants seems to be efficient to provide load transmission function of the meniscus.

  • the current state of Meniscal allograft Transplantation and replacement
    Knee, 2003
    Co-Authors: Gabriela Peters, Carl Joachim Wirth
    Abstract:

    Abstract This review details current efforts to transplant or to replace a meniscus. Different substitutes for Meniscal Transplantation or replacement have been used with varying experimental and clinical success. Meniscal Transplantation emerges as a useful option for selected patients with a stable knee and appropriate alignment. Some long-term studies of Meniscal Transplantation prove that cartilage protection is possible. Clear convincing evidence that Meniscal Transplantation or replacement restores the normal function of the knee joint has not been shown. In keeping with the multiple functions and anatomy of the meniscus experience of Meniscal Transplantation has shown that many aspects have to be considered to achieve successful results. This offers many possibilities for further scientific investigations.

  • long term results of Meniscal allograft Transplantation
    American Journal of Sports Medicine, 2002
    Co-Authors: Carl Joachim Wirth, Gabriela Peters, Klaus A. Milachowski, Karl Weismeier, Dieter Kohn
    Abstract:

    Between May 1984 and December 1986, 23 patients with a history of medial meniscectomy and anterior knee instability were entered into a long-term prospective study of the results of medial Meniscal Transplantation combined with reconstruction of the anterior cruciate ligament. In 17 cases a lyophilized Meniscal allograft was used and in 6 cases a deep-frozen Meniscal allograft was used. The patients’ clinical outcomes were evaluated 3 and 14 years postoperatively by clinical assessment, Lysholm score, radiographs, magnetic resonance imaging, arthrography, and, in some cases, arthroscopy. Two anterior cruciate ligament reconstruction control groups were used for comparison, one group having previously undergone meniscectomy and one with intact menisci. The follow-up rate was 100% after 14 years. The Lysholm score was 84 ± 12 points at 3 years postoperatively and 75 ± 23 points at 14 years. Patients with deep-frozen Meniscal transplants generally had better results than patients with lyophilized Meniscal tr...

Brian J. Cole - One of the best experts on this subject based on the ideXlab platform.

  • Biological Knee Reconstruction for Combined Malalignment, Meniscal Deficiency, and Articular Cartilage Disease
    Arthroscopy, 2014
    Co-Authors: Joshua D Harris, Hillary Wilson, Kyle Pilz, Kristen Hussey, Anil K Gupta, Andreas H. Gomoll, Brian J. Cole
    Abstract:

    Purpose The aim of this study was to analyze patient-reported outcomes in those undergoing the triad of simultaneous osteotomy, Meniscal Transplantation, and articular cartilage repair. Methods Patients undergoing simultaneous Meniscal Transplantation, distal femoral or proximal tibial osteotomy, and articular cartilage surgery by a single surgeon (B.J.C.) were analyzed. Meniscal Transplantation was performed using bone-in-slot techniques. Distal femoral and high tibial osteotomies were performed for valgus and varus malalignment, respectively. Microfracture, autologous chondrocyte implantation, and osteochondral autograft or allograft were performed for articular cartilage disease. Validated patient-reported and surgeon-measured outcomes were collected. Preoperative and postoperative outcomes and medial versus lateral disease were compared using Student t tests. Results Eighteen participants (mean age, 34 ± 7.8 years; symptomatic patients, 7.4 ± 5.6 years; 2.4 ± 1.0 surgical procedures before study enrollment; mean follow-up, 6.5 ± 3.2 years) were analyzed. Two thirds of participants had medial compartment pathologic conditions and one third had lateral compartment pathologic processes. At final follow-up, there were statistically significant clinically meaningful improvements in International Knee Documentation Committee (IKDC) subjective classification, Lysholm score, and 4 Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores. Postoperative 12-item short form (SF-12) physical and mental component scores were not significantly different from preoperative scores. The Kellgren-Lawrence classification grade was 1.5 ± 1.1 at 2.5 ± 3.0 years after surgery. There was a significantly higher preoperative SF-12 physical composite score (PCS) in participants with lateral compartment pathologic conditions ( v medial compartment conditions) ( P  = .011). Although there were 13 reoperations in 10 patients (55.5% reoperation rate), only one patient was converted to knee arthroplasty (5.6%) and one to revision cartilage surgery and Meniscal Transplantation (5.6% revision rate). The most common complication was arthrofibrosis (16.7%). Conclusions Statistically significant and clinically meaningful improvements in validated patient-reported clinical outcome scores at long-term follow-up were observed in 18 participants undergoing combined Meniscal Transplantation, osteotomy, and articular cartilage surgery. Although there was a low rate of cartilage or Meniscal revision (or both) and total knee arthroplasty, there was a high rate of reoperation. There was no significant difference in outcomes between participants with medial versus lateral pathologic conditions. Level of Evidence Level IV, therapeutic case series.

  • the effects of medial Meniscal Transplantation techniques on intra articular contact pressures
    Journal of Knee Surgery, 2010
    Co-Authors: Nikhil N Verma, Jack Farr, Brian J. Cole, E Kolb, M B Berkson, Ralph Garretson, Benjamin J Fregly
    Abstract:

    : This study aimed to compare medial compartment contact pressures in knees treated with medial Meniscal Transplantation using either a bone plug or bone trough technique. Peak pressure, mean pressure, and contact area of the medial compartment were determined in 8 cadaveric specimens at 0 degrees and 30 degrees of flexion under a 1000-N load. Contact mechanics were measured for the intact knee, after meniscectomy, and after medial Meniscal transplant with either a bone plug technique or a bone trough technique. Total medial meniscectomy resulted in decreased contact area, increased medial contact pressure, and increased medial peak contact pressure. When comparing Meniscal transplant techniques at both 0 degrees and 30 degrees, no significant difference (P < 0.05) was noted regarding contact mechanics after Transplantation. The bone trough technique shows similar contact mechanics to the double bone plug technique and maintains the natural hoop stress of the meniscus during medial Meniscal Transplantation.

  • Triad of cartilage restoration for unicompartmental arthritis treatment in young patients: meniscus allograft Transplantation, cartilage repair and osteotomy.
    Journal of Knee Surgery, 2009
    Co-Authors: Andreas H. Gomoll, Richard W. Kang, Andrea L. Chen, Brian J. Cole
    Abstract:

    : Arthritis treatment in young patients remains a challenge. Joint replacement surgery offers excellent pain relief but is controversial with this age group because of long-term wear and loosening. Recently, biological reconstructive techniques have become available to improve traditional treatment methods such as osteotomies. We present our experience with a technique for combined Meniscal Transplantation, chondral repair, and osteotomy in 7 patients presenting with a constellation of Meniscal deficiency, focal arthritis, and malalignment. Patients underwent concurrent or staged Meniscal Transplantation, cartilage repair, and osteotomy. Evaluation included the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Short Form-12 and Lysholm scales. At average follow-up of 24 months, patients experienced significant improvements in the IKDC, Lysholm, and KOOS functional scores. Six of 7 patients were able to return to unrestricted activities; 1 patient experienced mild pain with high-impact activities. Combined treatment with Meniscal Transplantation, cartilage repair, and osteotomy demonstrated promising clinical results of unicompartmental arthritis treatment in young patients.

  • Bone plug technique for Meniscal Transplantation
    Operative Techniques in Sports Medicine, 2003
    Co-Authors: Brian J. Cole
    Abstract:

    The goal of Meniscal Transplantation is to restore meniscus structure and function in symptomatic individuals post-meniscectomy. Biomechanical studies have shown that anatomic bony fixation of the horns is required to restore normal knee contact mechanics. The purpose of this chapter is to describe the operative technique and results using bone plugs for medial Meniscal allograft Transplantation.

  • Bone bridge in slot technique for Meniscal Transplantation
    Operative Techniques in Sports Medicine, 2003
    Co-Authors: Brian J. Cole, Jack Farr
    Abstract:

    The menisci play a crucial role in knee function through optimizing contact mechanics (increasing contact area and distributing contact stresses), providing anteroposterior stability, articular cartilage nutrition and proprioception. It is well known that the post-meniscectomized knee can lead to degenerative changes that result in significant pain and disability. Meniscal Transplantation attempts to restore the normal structure and function to the knee joint. Several studies suggest that anatomic bony fixation of the anterior and posterior horns are necessary to approximate normal knee contact mechanics. The purpose of this chapter is to describe the indications, preoperative planning, operative technique, postoperative rehabilitation, and results of the bone bridge in slot technique for Meniscal allograft Transplantation.

René Verdonk - One of the best experts on this subject based on the ideXlab platform.

  • La Transplantation méniscale
    2020
    Co-Authors: René Verdonk, Karl Almqvist, T Lootens, Peter Verdonk, Yves Depaepe
    Abstract:

    Summary Meniscal Transplantation Meniscal Transplantation is designed to relieve mechanical pain in the meniscectomized knee. It could also prevent cartilage degeneration and lessen the risk of osteoarthritis by restoring the normal biomechanics of the knee joint. The results of Meniscal Transplantation have been studied in several patient series and have been found satisfactory. Meniscal Transplantation can be performed as an open or arthroscopic procedure. Both techniques have received ample consideration in the literature. Stable fixation of the Meniscal transplant seems crucial. The results of Meniscal Transplantation, as reported in the literature, show that the transplant does relieve pain and could protect the loadbearing cartilage. Apparently, the results do not differ between frozen and viable allografts. However, the use of viable allografts suggests that donor fibrochondrocytes survive for about two years after Transplantation, as documented by DNA fingerprinting. The clinical follow-i suggests a potential chondroprotective effect of these Meniscal allografts on both the femoral condyle and the tibial plateau. However, three factors negatively affect the clinical success of Meniscal Transplantation. These are inadequate fixation of the anterior and posterior horns, improper sizing of the allograft and malpositioning of the Meniscal horns.

  • Meniscal Transplantation: still experimental surgery? A review.
    Acta Orthopaedica Belgica, 2014
    Co-Authors: Kris Moens, Aad Dhollander, Moens P, Verdonk K, René Verdonk, Karl Almqvist, Jan Victor
    Abstract:

    Introduction : the objective of this review is to give a state of affairs of Meniscal Transplantation, with the accent on preservation and surgical techniques. Materials and methods : All articles were selected by performing a search on the literature by using relevant keywords. The most relevant articles were selected with close attention to the publication date. Results : When a Meniscal tear is diagnosed, suture can be an option in the vascular zone, whereas the more frequently affected avascular zone heals poorly. A meniscectomy however is not without consequences, wherefore Meniscal Transplantation can be seen as a therapeutic option for pain reduction and improvement of function when the meniscus is lost. The Meniscal scaffold, allograft and autograft can be currently withheld as possible grafts, where the Meniscal scaffolds hold great promise as an alternative to the allograft. Various fixation techniques are therefore developed, where viable, deep frozen as well as cryopreservated allografts seem to give the most promising short term results. The Transplantation can be performed using an open as well as an arthroscopic technique, using soft tissue fixation, bone plugs or blocks. De primacy of one technique can’t be proven. In general Meniscal Transplantation can be considered as an acceptable procedure. Discussion : Since the outcomes of different studies are difficult to compare, an attempt should be made to limit new studies to the comparison of one aspect. We can conclude that larger, more comparative randomised controlled long-term studies are necessary to resolve which techniques can give the best long-term results.

  • Meniscus allograft Transplantation: a current concepts review
    Knee Surgery Sports Traumatology Arthroscopy, 2007
    Co-Authors: James H. Lubowitz, Peter C. M. Verdonk, John B. Reid, René Verdonk
    Abstract:

    Meniscus alloTransplantation represents the biological solution for the symptomatic, meniscus-deficient patient who has not developed advanced osteoarthritis. A growing body of evidence suggests that pain relief and functional improvement may reliably be achieved at short- and medium-term follow-up, and even, in some cases, at long-term (>10 years) follow-up. Future research must address the issue of optimal timing of the procedure and whether Meniscal Transplantation results in demonstrable long-term benefits, especially with regard to protection of articular cartilage.

  • Meniscal substitutes--animal experience.
    Scandinavian Journal of Medicine & Science in Sports, 2007
    Co-Authors: D. Kohn, René Verdonk, H. Aagaard, R. Sell, M. Dienst
    Abstract:

    : Animal studies have shown that meniscus allografts and tendon autografts generally heal to the capsule, are revascularized and repopulated with host cells. In animals, neither Meniscal allografts nor tendon or fat autografts gain the properties of a normal meniscus. Meniscus allografts and tendon autografts are promising as both seem to offer some protection to the cartilage of the tibial plateau. There is no evidence that Meniscal Transplantation can prevent cartilage degenerative changes, and the long-term effect of Meniscal Transplantation on articular cartilage remains unknown. Whether cellular repopulation of the Meniscal allograft is sufficient to restore its biomechanical properties is unknown. Collagen scaffolds and tissue engineered grafts are still under investigation, showing promising results especially for the former. Viable Meniscal allografts should be implanted within 1 to 2 weeks after harvesting, as the production of proteoglycans decreases after 2 weeks.

  • Viable Meniscal Transplantation.
    Acta Orthopaedica Belgica, 1998
    Co-Authors: René Verdonk, P. Van Daele, B Claus, K Van Den Abbeele, P Desmet, G. Verbruggen, Eric Veys, C Hurel, H Claessens
    Abstract:

    On a avance l'idee que la restauration d'une congruence normale entre femur et tibia au moyen de menisques normaux pourrait etre une solution a de nombreux problemes mecaniques au niveau du genou. De bons resultats fonctionnels ont ete obtenus, par Transplantation Meniscale, dans des cas de degenerescence Meniscale unicompartimentaire. Cependant, ce type de chondroprotection ne peut etre evalue qu'avec un recul de 10 a 20 ans. On a obtenu avec des allogreffes fraiches une incorporation satisfaisante de transplant meniscaux mais la disponibilite reste un probleme avec cette methode de remplacement Meniscal. On a demontre la possibilite d'une incorporation et d'une colonisation par des fibroblastes avec des allogreffes Meniscales lyophilisees et cryoconservees. L'arthroscopie de controle a montre une retraction secondaire au niveau de quelques transplants. L'implantation d'une allogreffe Meniscale viable a ete realisee dans une serie de 25 patients. La methode a d'abord ete validee. Les menisques peuvent etre conserves a l'etat viable dans un milieu semi-synthetique, sans perte apparente de l'activite cellulaire fibro-chondroblastique. Pendant cette periode d'incubation, le receveur approprie peut etre choisi et prepare. On dispose d'un temps suffisant pour effectuer des tests de laboratoire, pour ecarter le risque de contamination bacterienne et de transmission virale. Ceci permet d'eliminer les risques qui peuvent etre associes a un transplant vivant. Il faut garder en memoire le fait que le genou est une articulation portante. C'est le patient lui-meme qui controle sa mise en charge et le controle de ce facteur par le medecin n'est pas toujours possible. L'importance de la mise en charge reste donc un aspect qui ne peut pas toujours etre determine scientifiquement et dont il faut tenir compte dans les resultats. Au vu des resultats prometteurs obtenus avec les allogreffes tendineuses et avec les allogreffes Meniscales chez le mouton, la Transplantation Meniscale chez l'homme est devenue une possibilite therapeutique seduisante, d'autant plus que les resultats des menisques synthetiques ont ete plutot decevants. La Transplantation Meniscale implique la necessite de disposer d'une methode de conservation adequate.