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Meniscus potpourri
Arthroscopy: The Journal or Arthroscopic & Related Surgery Online
O c t o b e r 1999, S u p p l e m e n t 1 • V o l u m e 15 • N u m b e r 7
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Meniscus Potpourri Abstracts These are the abstracts of the papers presented at the Second Biennial Meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Washington, DC, May 29June 3, 1999.
149. Size V a r i a n c e in Meniscal A n a t o m y and Its Clinical Relevance.
Sanjay Pa tari, M.D. Andrew S. Levy, M.D. Russ Parsons, Ph.D. Ron Campolattaro, M.D. Meniscus Potpourri Introduction: Meniscal repair has become common in the operative treatment of meniscal injuries. A variety of suture repair techniques have been described. Bioabsorbable implants have been developed to improve meniscal repair and reduce morbidity. Current recommended selection of implant size is based solely on the anatomical location of the meniscal tear. The basis for these recommendations has not been reported. The failure to accommodate individual variations in anatomy may result in the use of suboptimally sized implants. An implant that is too short may not provide ideal fixation and an implant that is too long may impinge upon nearby neurovascular structures or result in discomfort. The purpose of this study is to address the issue of meniscal variance relevant to implant size and http••••WW2•us•e•sevierhea•th•c•m•inst•ser•e?se••••7babs&action=searchDB&group=Meniscus+P•tpourri
(1 of 6) [12/13t2007 12:43:06 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
placement. Methods: 17 cadaver knees from 17 different subjects of varying morphology and sex were obtained. For each specimen the tibial plateau, medial and lateral menisci, and adjacent joint capsule were isolated. The peripheral rim length of the medial and lateral menisci was recorded. The lateral and medial menisci were divided into sixteen equal segments. The widths of the menisci and the adjacent joint capsule at each of these segments were recorded individually by three independent observers. Statistical analysis using a repeated measure model was employed to analyze the data. Results: Mean meniscal width for the anterior third was 9 mm (range 7-10). In the middle third, mean meniscal width was 11 mm (range 10-14). The posterior third mean meniscal width was 14 mm (range 11-15) for the medial and 12 mm (range 11-12) in the lateral meniscus. Capsule thickness averaged 2.6mm (range 2-4.1). No correlation was noted between meniscal thickness and circumference. (P<0.05) Discussion: The design of the implants in the literature suggests that its size should measure approximately one-half of the total meniscal width at the site of placement. The current sizing recommendations for implants suggest a tack size of 10 mm for the anterior third, 13 mm for the middle third, and 13 mm or 16 mm for the posterior third of the meniscus. Since the implant need only be approximately one-half of these observed widths, it is clear that current sizing recommendations are overesti mated. Conclusion: Current meniscal repair implant sizes are too long and place the patient at risk for implant impingement upon nearby neurovascular structures and soft tissue irritation. The lack of correlation between width and circumference raises questions that need to be addressed to enhance our understanding of how meniscal variance effects function.
150. Derivation of a Rule For Predicting Unstable Meniscal Tears in Patients with Osteoarthritis of the Knee. G.F. Dervin, M.D. I.G. Stiell, M.D. G. Wells, Ph.D. K. Rody, R.N. Meniscus Potpourri
Objective: Orthopaedic surgeons are repeatedly challenged to manage symptomatic osteoarthritis of the knee in patients who have failed all conservative means of treatment. Arthroscopic surgery is the most commonly performed procedure for this condition though outcomes are not consistently favorable. The resection of unstable meniscal tears appears to be associated with better outcomes following arthroscopy. Diagnosis of these tears is not precise and often relies on expensive technology such as magnetic resonance imaging. There are no available guidelines for the diagnosis of meniscal tears in patients with osteoarthritis of the knee. Purpose: The goal of the present study was to prospectively study a cohort of such patients referred for arthroscopy and to perform a standardized clinical examination of these patients, test the interobserver reliability of clinical variables, and use multivariate techniques to establish a clinical prediction rule to select these patients. Methods: Patients with osteoarthritis of the knee refractory to conservative medical treatment were http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (2 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online
selected for arthroscopic evaluation. A standardized assessment protocol was administered to each patient and repeated by a second observer when feasible to permit calculation of the kappa coefficient ( K) for interobserver agreement. Arthroscopic determination of unstable meniscal tears was recorded by one observer who reviewed a video recording and was blinded to preoperative data based on objective criteria. Univariable methods were used to select those variables which had the strongest association with meniscal tear which were then entered into a logistic regression model. Results: One hundred and fifty two patients (51% women, mean age 61 yrs) were enrolled. There were 92 meniscal tears (77 medial and 15 lateral). Interobserver agreement was poor to fair (~<0.4) for all clinical variables except radiographic measures which were very good. Univariable methods established a difference between those variables as recorded by the clinical fellows (1st observer) and those by the treating surgeon (2nd observer). Fellows and surgeons predicted unstable meniscal tear preoperatively with equivalent accuracy of 60%. Surgeons were chosen as the source of predictor variables for the greater clinical relevance based on generalizability to current practicing surgeons. Those variables with univariable association of p < 0.2 and 1< > 0.15 were entered into the logistic regression for prediction of a medial meniscal tear. The model yielded the following variables with their odds ratios (95% C.I.): history of swelling, 0.42 (0.21, 0.97); ballottable effusion, 0.38 (0.17, 0.91); and positive MacMurray test, 2.21 (0.92, 4.5). The model was 69% accurate for all patients and 76% for those patients with advanced medial compartment osteoarthritis defined by joint space height of 2 mm or less. Discussion: This study underscored the difficulty in using clinical variables to predict unstable medial meniscal tears which were addressed at arthroscopy. Swelling and effusions were negative predictors of tears in this population while a positive MacMurray test was the only provocative maneuver which remained useful. Interobserver reliability must be improved and the rule refined in a new data set before use in the field. The validity of unstable tear as a clinically relevant outcome awaits to be confirmed in this same cohort in the next phase of the study.
151. Arthroscopic Treatment of Lateral Discoid Meniscus.
Zhai Weitao, M.D. Jiang Yao, M.D. Ma Rong, M.D. Zeng Bingfang, M.D. Meniscus Potpourri
Purpose: "To evaluate the efficacy of arthroscopic treatment of lateral discoid meniscus." Method: 214 arthroscopic surgeries of lateral discoid meniscus in 188 meniscectomy patients were performed. Of these, 79 cases were male, 109 cases were female and average age was 26 (6 to 65) years; 82 cases were in right knee, 70 cases were in left knee and 26 cases were bilateral; Complete discoid meniscus were in 58 knees, incomplete were in 141 cases and wrisberg-ligament type were in 15 knees. Partial meniscectomy was performed in 60 knees, subtotal meniscectomy in 122 knees and total meniscectomy in 42 knees. Generally, Wrisberg-ligamental meniscus should be completely resected. Partial or subtotal meniscectomy depended on the thickness and movability of the discoid meniscus and the severity of tear. Result: All of the 188 patients were followed up 3 months postoperatively and 165 patients were http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (3 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
followed up 12-18 months postoperatively. The good and excellent results were similar. But the patients with degenerative cartilage disease get better result in the second follow-up. Residual meniscus was the cause of 2 patients with poor result. There was no significant difference between the result of partial and subtotal meniscectomy. Significant difference was seen between total meniscectomy group and other two groups because of the lateral unstability from complete lateral meniscectomy. Conclusion: Symptomatic lateral discoid meniscus should be resected arthroscopically no matter of the age and the classification. Significancy: We find that the prevalence of discoid meniscus in China is much higher than that reported in other countries, so its treatment should be paid attention to.
152. The Anterior Intermeniscal Ligament: An Anatomic Study. Eric W. Nelson, M.D. Robert F. LaPrade, M.D. Meniscus Potpourri
Purpose: The purpose of this study was to describe the incidence and insertion patterns of the anterior intermeniscal ligament, as well as its relation to other anatomic structures of the anterior knee. Method: Fifty unpaired cadaveric knees were dissected with an average age of 76 years (range 43-96 years). An identifiable distinct intermeniscal ligament was found in 47 (94%) specimens with an average length of 33 mm and an average mid-substance width of 3.3 mm. The average perpendicular distances to the anterior margins of the anterior cruciate ligament, medial tibial spine, and lateral tibial spine were 9.8 mm, 13.0 mm, and 16.0 mm respectively. In 7 specimens (14%) there was no tibial insertion for the anterior horn of the medial meniscus (AHMM) with the only anchor for the AHMM being the anterior intermeniscal ligament. In another five specimens (10%), the anterior intermeniscal ligament served as the major insertion for the AHMM with only a fine fascial connection to the tibial plateau; making the anterior intermeniscal ligament the primary attachment for the AHMM in 24% of specimens. Results: We found the incidence of the anterior intermeniscal ligament of the knee to be much higher, 94%, than previously reported radiographic, MRI, or cadaveric studies (12-69%). In addition, we found a variant of the attachment of the anterior horn of the medial meniscus which differs from previous reports. Conclusion and Significance: It is the authors' hope that this anatomic data may identify procedures which place the ligament at risk such as anterior placement of tibial tunnels for ACL reconstruction. Finally, in the subset of specimens with no or little bony tibial insertion for the anterior horn of the medial meniscus, this lack of a bony anchor may make the medial meniscus relatively more mobile, may make inadvertent injury to the intermeniscal ligament during tibial tunnel preparation or arthroscopic debridement a clinically significant destabilizer of the medial meniscus, and may raise yet another issue for consideration in the field of meniscal transplantation in regards to fixation of meniscal allografts.
153. Meniscal Tibial Slope. Anatomoradiological Study. Comparison with Bony Slope. http://www2.us.elsevierhealth.com/instJserve?se...O7babs&action searchDB&group Meniscus+Potpourri (4 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online
Jean-Yves Jenny, M.D. Etienne Rapp, M.D. Meniscus Potpourri
Introduction: Posterior proximal tibial slope is usually measured by the bony slope on plain X-rays. But the relevant kinematic slope includes tibial cartilage and meniscii, and could be different. The authors performed an anatomoradiological study of the so-called <> in comparison to the bony slope. Methods: 20 gross specimens without degenerative changes were studied. Four metallic clamps were fixed on the most anterior or posterior part of the medial or lateral meniscosynovial border. Lateral plain X-ray was taken for each knee, and the bony and meniscal slopes were compared. Paired Wilcoxon T-test and correlations were calculated with a 5% significant limit. Results: The mean paired difference between bony and meniscal slopes was-6°: the actual meniscal slope was less oblique than the bony slope, and it was almost perpendicular to the proximal tibial axis. There was a significant correlation between bony and medial meniscal slopes. There was no correlation between bony and lateral slopes, nor between medial and lateral slopes. Discussion and Conclusion: These results suggest that the proximal tibial meniscal slope, which is the mechanically active one, is less oblique than the usually measured bony slope. Medial meniscal slope and bony slope are very strongly correlated for one given knee. But medial and lateral meniscal slopes can be very different for one given knee. These results could have an influence on the design of total or unicondylar knee replacements: the polyethylene slope of the tibial surface, which should reconstruct the natural articular design, should reproduce the meniscal, and not the bony slope. The medial and lateral slopes should perhaps be individually reconstructed.
154. Meniscal Transplantation Using Non-Irradiated Fresh Frozen Menisci.
Erol A. Yoldas, M.D. Christopher D. Harner, M.D. Meniscus Potpourri
Objective: "To evaluate meniscal transplantation using non-irradiated fresh frozen allografts." Methods: Between 1993 and 1995, 25 meniscal transplantations (22 knees) were performed (13 males, 9 females, average age 27 [range, 15-42]). Follow-up averaged 26 months (12-45). Patients averaged 2.4 (1-4) surgical procedures prior to transplantation. Twelve medial and 13 lateral menisci were transplanted. Pain and/or instability, intact joint space, and neutral alignment was necessary for patient inclusion. Correlating lateral radiographs with tissue bank measurements allowed sizing of the meniscus. Surgery was arthroscopically assisted. Menisci were fixed with bone plugs medially and a bone bridge laterally. Twelve patients had associated instability (11 ACL, 1 PCL) and were simultaneously reconstructed using allograft tissue. Rehabilitation of immediate motion and progressive weight-bearing was followed. Results: Surgical: 4 patients had Grade I chondrosis, 18 Grade II, and 3 Grade III changes. Rating http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (5 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
Scales: Self-rating for activities of daily living was 87 (75-100) and sports 69/100 (35-100). Eighteen patients greatly improved, 3 somewhat improved, 1 without change. IKDC scores included: Activitym 21 normal/nearly normal, 1 abnormal; Painm15 normal/nearly normal, 7 abnormal; Swelling--17 normal/nearly normal, 5 abnormal. Lysholm score was 87 (40-100). Physical Examination: Nineteen patients had no effusion and 3 mild. Range of motion averaged 0-134 ° (0-140°). Eleven patients with simultaneous ACL reconstruction: 10 had normal/1 +, and 1 had 2+ Lachman. There was no joint line tenderness. 5/11 lateral transplants had persistent asymptomatic joint line swelling. Functional Testing: Compared to uninvolved knee: an average loss of 1.4 ° (-2-8 °) extension, 7.8 ° (0-25 °) flexion; KT-1000 demonstrated a 1.1 mm (-1-5)increase in translation; and vertical jump and hop averaged 84.5% (63103) and 87.1% (47-112) respectively. Radiographs: No progressive joint space narrowing was seen on flexion weight-bearing views. Conclusions and Significance: Meniscal transplantation in a select group of patients with pain and/or instability is considered a viable procedure. To date, no graft has required removal.
http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (6 of 6) [12/13/2007 12:43:06 PM]
O c t o b e r 1999, S u p p l e m e n t 1 • V o l u m e 15 • N u m b e r 7
° Previous article in Issue • Next article in Issue • Drug links from Mosby's DrugConsult • Genetic information from OMIM << Back to topic list
Meniscus Potpourri Abstracts These are the abstracts of the papers presented at the Second Biennial Meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Washington, DC, May 29June 3, 1999.
149. Size V a r i a n c e in Meniscal A n a t o m y and Its Clinical Relevance.
Sanjay Pa tari, M.D. Andrew S. Levy, M.D. Russ Parsons, Ph.D. Ron Campolattaro, M.D. Meniscus Potpourri Introduction: Meniscal repair has become common in the operative treatment of meniscal injuries. A variety of suture repair techniques have been described. Bioabsorbable implants have been developed to improve meniscal repair and reduce morbidity. Current recommended selection of implant size is based solely on the anatomical location of the meniscal tear. The basis for these recommendations has not been reported. The failure to accommodate individual variations in anatomy may result in the use of suboptimally sized implants. An implant that is too short may not provide ideal fixation and an implant that is too long may impinge upon nearby neurovascular structures or result in discomfort. The purpose of this study is to address the issue of meniscal variance relevant to implant size and http••••WW2•us•e•sevierhea•th•c•m•inst•ser•e?se••••7babs&action=searchDB&group=Meniscus+P•tpourri
(1 of 6) [12/13t2007 12:43:06 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
placement. Methods: 17 cadaver knees from 17 different subjects of varying morphology and sex were obtained. For each specimen the tibial plateau, medial and lateral menisci, and adjacent joint capsule were isolated. The peripheral rim length of the medial and lateral menisci was recorded. The lateral and medial menisci were divided into sixteen equal segments. The widths of the menisci and the adjacent joint capsule at each of these segments were recorded individually by three independent observers. Statistical analysis using a repeated measure model was employed to analyze the data. Results: Mean meniscal width for the anterior third was 9 mm (range 7-10). In the middle third, mean meniscal width was 11 mm (range 10-14). The posterior third mean meniscal width was 14 mm (range 11-15) for the medial and 12 mm (range 11-12) in the lateral meniscus. Capsule thickness averaged 2.6mm (range 2-4.1). No correlation was noted between meniscal thickness and circumference. (P<0.05) Discussion: The design of the implants in the literature suggests that its size should measure approximately one-half of the total meniscal width at the site of placement. The current sizing recommendations for implants suggest a tack size of 10 mm for the anterior third, 13 mm for the middle third, and 13 mm or 16 mm for the posterior third of the meniscus. Since the implant need only be approximately one-half of these observed widths, it is clear that current sizing recommendations are overesti mated. Conclusion: Current meniscal repair implant sizes are too long and place the patient at risk for implant impingement upon nearby neurovascular structures and soft tissue irritation. The lack of correlation between width and circumference raises questions that need to be addressed to enhance our understanding of how meniscal variance effects function.
150. Derivation of a Rule For Predicting Unstable Meniscal Tears in Patients with Osteoarthritis of the Knee. G.F. Dervin, M.D. I.G. Stiell, M.D. G. Wells, Ph.D. K. Rody, R.N. Meniscus Potpourri
Objective: Orthopaedic surgeons are repeatedly challenged to manage symptomatic osteoarthritis of the knee in patients who have failed all conservative means of treatment. Arthroscopic surgery is the most commonly performed procedure for this condition though outcomes are not consistently favorable. The resection of unstable meniscal tears appears to be associated with better outcomes following arthroscopy. Diagnosis of these tears is not precise and often relies on expensive technology such as magnetic resonance imaging. There are no available guidelines for the diagnosis of meniscal tears in patients with osteoarthritis of the knee. Purpose: The goal of the present study was to prospectively study a cohort of such patients referred for arthroscopy and to perform a standardized clinical examination of these patients, test the interobserver reliability of clinical variables, and use multivariate techniques to establish a clinical prediction rule to select these patients. Methods: Patients with osteoarthritis of the knee refractory to conservative medical treatment were http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (2 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online
selected for arthroscopic evaluation. A standardized assessment protocol was administered to each patient and repeated by a second observer when feasible to permit calculation of the kappa coefficient ( K) for interobserver agreement. Arthroscopic determination of unstable meniscal tears was recorded by one observer who reviewed a video recording and was blinded to preoperative data based on objective criteria. Univariable methods were used to select those variables which had the strongest association with meniscal tear which were then entered into a logistic regression model. Results: One hundred and fifty two patients (51% women, mean age 61 yrs) were enrolled. There were 92 meniscal tears (77 medial and 15 lateral). Interobserver agreement was poor to fair (~<0.4) for all clinical variables except radiographic measures which were very good. Univariable methods established a difference between those variables as recorded by the clinical fellows (1st observer) and those by the treating surgeon (2nd observer). Fellows and surgeons predicted unstable meniscal tear preoperatively with equivalent accuracy of 60%. Surgeons were chosen as the source of predictor variables for the greater clinical relevance based on generalizability to current practicing surgeons. Those variables with univariable association of p < 0.2 and 1< > 0.15 were entered into the logistic regression for prediction of a medial meniscal tear. The model yielded the following variables with their odds ratios (95% C.I.): history of swelling, 0.42 (0.21, 0.97); ballottable effusion, 0.38 (0.17, 0.91); and positive MacMurray test, 2.21 (0.92, 4.5). The model was 69% accurate for all patients and 76% for those patients with advanced medial compartment osteoarthritis defined by joint space height of 2 mm or less. Discussion: This study underscored the difficulty in using clinical variables to predict unstable medial meniscal tears which were addressed at arthroscopy. Swelling and effusions were negative predictors of tears in this population while a positive MacMurray test was the only provocative maneuver which remained useful. Interobserver reliability must be improved and the rule refined in a new data set before use in the field. The validity of unstable tear as a clinically relevant outcome awaits to be confirmed in this same cohort in the next phase of the study.
151. Arthroscopic Treatment of Lateral Discoid Meniscus.
Zhai Weitao, M.D. Jiang Yao, M.D. Ma Rong, M.D. Zeng Bingfang, M.D. Meniscus Potpourri
Purpose: "To evaluate the efficacy of arthroscopic treatment of lateral discoid meniscus." Method: 214 arthroscopic surgeries of lateral discoid meniscus in 188 meniscectomy patients were performed. Of these, 79 cases were male, 109 cases were female and average age was 26 (6 to 65) years; 82 cases were in right knee, 70 cases were in left knee and 26 cases were bilateral; Complete discoid meniscus were in 58 knees, incomplete were in 141 cases and wrisberg-ligament type were in 15 knees. Partial meniscectomy was performed in 60 knees, subtotal meniscectomy in 122 knees and total meniscectomy in 42 knees. Generally, Wrisberg-ligamental meniscus should be completely resected. Partial or subtotal meniscectomy depended on the thickness and movability of the discoid meniscus and the severity of tear. Result: All of the 188 patients were followed up 3 months postoperatively and 165 patients were http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (3 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
followed up 12-18 months postoperatively. The good and excellent results were similar. But the patients with degenerative cartilage disease get better result in the second follow-up. Residual meniscus was the cause of 2 patients with poor result. There was no significant difference between the result of partial and subtotal meniscectomy. Significant difference was seen between total meniscectomy group and other two groups because of the lateral unstability from complete lateral meniscectomy. Conclusion: Symptomatic lateral discoid meniscus should be resected arthroscopically no matter of the age and the classification. Significancy: We find that the prevalence of discoid meniscus in China is much higher than that reported in other countries, so its treatment should be paid attention to.
152. The Anterior Intermeniscal Ligament: An Anatomic Study. Eric W. Nelson, M.D. Robert F. LaPrade, M.D. Meniscus Potpourri
Purpose: The purpose of this study was to describe the incidence and insertion patterns of the anterior intermeniscal ligament, as well as its relation to other anatomic structures of the anterior knee. Method: Fifty unpaired cadaveric knees were dissected with an average age of 76 years (range 43-96 years). An identifiable distinct intermeniscal ligament was found in 47 (94%) specimens with an average length of 33 mm and an average mid-substance width of 3.3 mm. The average perpendicular distances to the anterior margins of the anterior cruciate ligament, medial tibial spine, and lateral tibial spine were 9.8 mm, 13.0 mm, and 16.0 mm respectively. In 7 specimens (14%) there was no tibial insertion for the anterior horn of the medial meniscus (AHMM) with the only anchor for the AHMM being the anterior intermeniscal ligament. In another five specimens (10%), the anterior intermeniscal ligament served as the major insertion for the AHMM with only a fine fascial connection to the tibial plateau; making the anterior intermeniscal ligament the primary attachment for the AHMM in 24% of specimens. Results: We found the incidence of the anterior intermeniscal ligament of the knee to be much higher, 94%, than previously reported radiographic, MRI, or cadaveric studies (12-69%). In addition, we found a variant of the attachment of the anterior horn of the medial meniscus which differs from previous reports. Conclusion and Significance: It is the authors' hope that this anatomic data may identify procedures which place the ligament at risk such as anterior placement of tibial tunnels for ACL reconstruction. Finally, in the subset of specimens with no or little bony tibial insertion for the anterior horn of the medial meniscus, this lack of a bony anchor may make the medial meniscus relatively more mobile, may make inadvertent injury to the intermeniscal ligament during tibial tunnel preparation or arthroscopic debridement a clinically significant destabilizer of the medial meniscus, and may raise yet another issue for consideration in the field of meniscal transplantation in regards to fixation of meniscal allografts.
153. Meniscal Tibial Slope. Anatomoradiological Study. Comparison with Bony Slope. http://www2.us.elsevierhealth.com/instJserve?se...O7babs&action searchDB&group Meniscus+Potpourri (4 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online
Jean-Yves Jenny, M.D. Etienne Rapp, M.D. Meniscus Potpourri
Introduction: Posterior proximal tibial slope is usually measured by the bony slope on plain X-rays. But the relevant kinematic slope includes tibial cartilage and meniscii, and could be different. The authors performed an anatomoradiological study of the so-called <
154. Meniscal Transplantation Using Non-Irradiated Fresh Frozen Menisci.
Erol A. Yoldas, M.D. Christopher D. Harner, M.D. Meniscus Potpourri
Objective: "To evaluate meniscal transplantation using non-irradiated fresh frozen allografts." Methods: Between 1993 and 1995, 25 meniscal transplantations (22 knees) were performed (13 males, 9 females, average age 27 [range, 15-42]). Follow-up averaged 26 months (12-45). Patients averaged 2.4 (1-4) surgical procedures prior to transplantation. Twelve medial and 13 lateral menisci were transplanted. Pain and/or instability, intact joint space, and neutral alignment was necessary for patient inclusion. Correlating lateral radiographs with tissue bank measurements allowed sizing of the meniscus. Surgery was arthroscopically assisted. Menisci were fixed with bone plugs medially and a bone bridge laterally. Twelve patients had associated instability (11 ACL, 1 PCL) and were simultaneously reconstructed using allograft tissue. Rehabilitation of immediate motion and progressive weight-bearing was followed. Results: Surgical: 4 patients had Grade I chondrosis, 18 Grade II, and 3 Grade III changes. Rating http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (5 of 6) [12/13/2007 12:43:06 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
Scales: Self-rating for activities of daily living was 87 (75-100) and sports 69/100 (35-100). Eighteen patients greatly improved, 3 somewhat improved, 1 without change. IKDC scores included: Activitym 21 normal/nearly normal, 1 abnormal; Painm15 normal/nearly normal, 7 abnormal; Swelling--17 normal/nearly normal, 5 abnormal. Lysholm score was 87 (40-100). Physical Examination: Nineteen patients had no effusion and 3 mild. Range of motion averaged 0-134 ° (0-140°). Eleven patients with simultaneous ACL reconstruction: 10 had normal/1 +, and 1 had 2+ Lachman. There was no joint line tenderness. 5/11 lateral transplants had persistent asymptomatic joint line swelling. Functional Testing: Compared to uninvolved knee: an average loss of 1.4 ° (-2-8 °) extension, 7.8 ° (0-25 °) flexion; KT-1000 demonstrated a 1.1 mm (-1-5)increase in translation; and vertical jump and hop averaged 84.5% (63103) and 87.1% (47-112) respectively. Radiographs: No progressive joint space narrowing was seen on flexion weight-bearing views. Conclusions and Significance: Meniscal transplantation in a select group of patients with pain and/or instability is considered a viable procedure. To date, no graft has required removal.
http://www2.us.elsevierhealth.com/inst/serve?se...O7babs&action searchDB&group Meniscus+Potpourri (6 of 6) [12/13/2007 12:43:06 PM]