Meniscal allograft replacement: a 1-year to 6-year experience.

摘要

PURPOSE: Progressive degenerative arthritis leading to premature pain and functional loss in the postmeniscectomy state is a well- recognized and debilitating condition. Meniscal allograft replacement may be a suitable, early treatment alternative for this population at risk. The purpose of this study was to examine the potential benefits of meniscal allograft replacement on relieving pain and restoring function. TYPE OF STUDY: Retrospective clinical review. METHODS: From 1993 to 1999, 29 menisci were implanted in 28 patients. Of these, 25 patients (26 menisci) were available for review. All patients had a minimum of 12 months of follow-up, with an average of 33 months. Study participants included 17 men and 8 women with primary symptoms of pain or instability at study onset. Eighteen patients had grades I through III Outerbridge chondromalacia changes and 7 demonstrated grade IV changes in the affected compartment. Data were collected using the International Knee Documentation Committee (IKDC), Lysholm II, and Tegner scoring systems as well as a visual analogue scale (VAS) for pain measurement. RESULTS: Our findings revealed that following meniscal allograft replacement, pain was significantly reduced and function was improved (P <.001). In addition, IKDC scores for activity were reported as normal or nearly normal in 17 subjects and abnormal in 8 participants. Outerbridge grade had a significant impact on final outcome; only 3 of 7 with grade IV changes achieved normal or nearly normal scores versus 14 of 18 in those with lesser Outerbridge changes. Isolated implants fared the same as those combined with an ACL reconstruction. Overall satisfaction reported by the subjects averaged 83%. Ten second-look procedures revealed 5 normal menisci, 3 with shrinkage, and 2 with recurrent tears. CONCLUSIONS: Earlier results from this population of patients indicated substantial pain relief and improved function. The durability of these early results has not met the test of time for those with exposed subchondral bone. However, statistically significant early and midterm improvements in pain, symptoms, and functional status continue to be noteworthy in the properly selected patient.