- Email: [email protected]
Paper # 270: Graft Extrusion in Open vs Arthroscopic Meniscus Transplantation: A 1 Year Comparative Study of 39 Patients
e252
ABSTRACTS
Menisci transplantation was associated with a valgus osteotomy (HTO) in 3 cases and with supracondylar femoral varus osteotomy in 1 case, using the Puddu plate. In one patient an intra-articular reconstruction of the anterior cruciate ligament (ACL) was performed using hamstrings tendons fixed with TTS system on the femur and with an absorbable interference screw on the tibia. In 4 cases there were focal chondral lesions treated with autologous chondrocyte transplantation (MACI). In 1 patient the Puddu plate was removed, in 3 cases a meniscectomy of the controlateral meniscus was performed and 1 case had a thermal ACL shrinkage. In all patients the arthroscopically assisted surgical technique was performed associated with a mini arthrotomy to insert the graft. Peripheral capsular fixation of the meniscus has been performed with the use of soft tissue attachments (in-out, out-in and all inside techniques), while the anterior and posterior horn of the graft were sutured to the capsule inside the joint and fixed on the anterior wall of the tibia with an overcortical knot placed at the end of the tibial tunnels. Postoperative protocol: 3 weeks of non-weight bearing with ROM limitation to 0-90° then two weeks of progressive bearing. Closed kinetic chain exercises are preferred for the first 6 weeks. Often protocols are determined by concomitant surgery. Jogging was allowed after 5-6 months and return to full activity was planned at 9-12 months. Careful evaluation of the patients pre-operatively and at follow-up has been carried out by IKDC, Lysholm and Tegner score. 24 months after surgery an MRI was used to look for potential meniscus extrusion. Results: Following meniscal allograft transplantation, good-excellent results are achieved in nearly 85% of cases. The IKDC showed 15 patients in group A, 4 in group B and 1 in group C. At the Lysholm score 15 had excellent results. All patients highlighted a measurable decrease of pain and returned to pre-operative sport level. One patient had a re-rupture of the transplanted medial meniscus treated with an all-inside suture after 14 months. Two cases showed a re-tear of the lateral meniscus, treated with partial resection after 11 months in 1 case and with an all-inside re-suture after 4 months in the other one. This last patient two months later showed an extension deficit due to a bucket-handle tear of the same meniscus, treated with partial meniscectomy. No significant relationship was found between clinical results and meniscal extrusion. Conclusions: Our short term results show a dramatic
improvement of function and quality of life. Persistent symptoms are most frequently related to improper patient selection. The arthroscopically assisted surgical procedure without bone-plug, although much more technically demanding compared with open techniques, shows a decreased morbidity, no disruption of collateral ligaments and allows an early rehabilitation. This technique should be performed only after considerable practice.
Paper # 270: Graft Extrusion in Open vs Arthroscopic Meniscus Transplantation: A 1 Year Comparative Study of 39 Patients PETER VERDONK, MD, PHD, BELGIUM TINEKE DE CONINCK, BELGIUM WOUTER HUYSSE, MD, BELGIUM RENÉ E. VERDONK, MD, PHD, BELGIUM · Ghent University Hospital and Terneuzen Zorgsaam Ghent, BELGIUM Summary: Graft position is influenced by the surgical technique; the radial displacement of arthroscopically implanted MATs is, both lateral and medial, significantly less than meniscal transplants implanted by open surgery Abstract: Purpose: To evaluate the radial displacement of meniscal allograft transplants (MATs) in patients operated with an open technique vs. an arthroscopic technique at 1 year postoperatively. Radial displacement or extrusion of the graft is frequently observed after meniscus transplantation. The hypothesis is that arthroscopically inserted MATs extrude less than open MATs and therefore have a more intra-articular position than open surgery transplants. Materials and Methods: 39 patients were included in the study: the first group of open surgery transplants consisted of 16 patients (10 lateral, 6 medial). The second group of arthroscopic transplants consisted of 21 patients (14 lateral, 7 medial). MR-images were taken one year post-surgery. The displacement, evaluated on 1,5T MR coronal images, was defined as the distance between the tibial plateau and the outer edge of the meniscus. Results: The radial displacement of lateral open surgery transplants (mean⫽ 4,04 mm; SD⫽ 1,46) is significantly larger (p ⬍ 0,05) than the displacement of arthroscopically implanted MATs (mean⫽ 3,38 mm; SD⫽ 0,85). The external displacement of medial open surgery transplants (mean⫽ 4,71 mm; SD⫽ 0,97) is significantly
ABSTRACTS larger (p ⬍ 0,05) than the displacement of arthroscopically implanted MATs (mean⫽ 2,36 mm; SD⫽ 0,89). Conclusion: Graft position is influenced by the surgical technique; the radial displacement of arthroscopically implanted MATs is, both lateral and medial, significantly less than meniscal transplants implanted by open surgery. The clinical relevance remains to be determined.
Paper # 271: The Short Term Clinical and MRI Results after Meniscus Transplantation: Ninety Nine Cases SUL-GEE KIM, MD, KOREA YONG-KON KOH, SOUTH KOREA SEUNG-BAE JO, SOUTH KOREA HONG-KYO MOON, MD, SOUTH KOREA · Yonsei Sarang Hospital Seoul, SOUTH KOREA Summary: The presented data shows that the transplanted lateral meniscus extrudes in the lateral direction significantly more than the medial meniscus. However, the clinical outcome after meniscus transplantation was not adversely affected by the allograft extrusion. Abstract: Introduction: The purpose of this study was to compare the allograft extrusion using MRI in short term period after the medial and lateral meniscal allograft transplantation and correlate the extrusion with clinical outcome. Methods: Ninety nine cases (67 men and 32 women) were available for MRI evaluations. The age at surgery ranged from 21 to 52 years of age (average: 35 years). Seventy three lateral and 26 medial meniscus allografts were evaluated with a mean follow-up of 22 months (range, 12 to 53 months). The absolute value and relative percentage of the width of extruded menisci was measured in the coronal image that showed maximal extrusion. Clinical outcome was evaluated with Lysholm score. Results: The mean extrusion was 4.5mm in lateral meniscus versus 2.7mm in medial meniscus (p⫽0.000) and the relative percentage of extrusion was 50.0% versus 30.8% (p⫽0.000). Lysholm score significantly increased from 49.0 preoperatively to 87.3 postoperatively in lateral meniscus and from 50.9 to 89.7 in medial meniscus. The difference of final score between the groups was not significant (p⫽0.381). The overall Lysholm score was not correlated with the degree of extrusion (p⫽0.202) Conclusions: The presented data shows that the transplanted lateral meniscus extrudes in the lateral direction significantly more than the medial meniscus. However,
e253
the clinical outcome after meniscus transplantation was not adversely affected by the allograft extrusion. Key Words: Menisus, transplantation, extrusion Paper # 272: Magnetic Resonance Imaging Findings of Popliteomeniscal Fascicle Among Knee Joints With and Without Recurrent Subluxation of Lateral Meniscus JUN SUGANUMA, MD, JAPAN RYUUTA MOCHIZUKI, MD, JAPAN YUTAKA INOUE, MD, JAPAN EIKOU YAMABE, MD, JAPAN YOSHIYUKI UEDA, MD, JAPAN TAIRA KANAUCHI, MD, JAPAN · Hiratsuka City Hospital Hiratsuka, Kanagawa, JAPAN Summary: Insufficiency of sPMF had existed in both knee joints before a patient had locking symptoms, indicating that sPMF insufficiency can be a necessary condition of locking symptoms, and high incidence of iPMF insufficiency was found only in joints with RSLM, suggesting that iPMF insufficiency is an effect of locking symptoms in knee joints with RSLM. Abstract: Purpose: The aim of this study was to investigate posterosuperior and anteroinferior popliteomeniscal fascicles (sPMF and iPMF) using magnetic resonance imaging (MRI) in control knee joints and joints with recurrent subluxation of the lateral meniscus (RSLM) to examine the incidence of PMF insufficiency of the groups. Methods: Knee joints were diagnosed with RSLM when there was a history of mechanical locking episodes, and when subluxation of the lateral meniscus was recognized on arthroscopy. In this study, 240 knee joints were evaluated. The joints were classified into control group (217 joints), RSLM group (16 joints), and contralateral RSLM group (7 joints). Classification of sPMF (iPMF) on MRI was as follows. Type I: A tense low-intensity band is running from the superior (inferior) border of the lateral meniscus to the popliteus tendon. Type II: An unclear band is running from the superior (inferior) border of the lateral meniscus. Type III: No band is seen. Types II and III of PMF were supposed to be PMF insufficiency. The distribution of knee joints according to the 3 groups and the PMF types were examined. Results: The percentage of sPMF and iPMF insufficiency was 40% and 25% in control, 100% and 29% in contralateral RSLM, and both 100% in RSLM groups. Significant difference in the distribution of knee joints by classification of sPMF was recognized between control and contralateral RSLM groups. That of iPMF was also
ABSTRACTS
Menisci transplantation was associated with a valgus osteotomy (HTO) in 3 cases and with supracondylar femoral varus osteotomy in 1 case, using the Puddu plate. In one patient an intra-articular reconstruction of the anterior cruciate ligament (ACL) was performed using hamstrings tendons fixed with TTS system on the femur and with an absorbable interference screw on the tibia. In 4 cases there were focal chondral lesions treated with autologous chondrocyte transplantation (MACI). In 1 patient the Puddu plate was removed, in 3 cases a meniscectomy of the controlateral meniscus was performed and 1 case had a thermal ACL shrinkage. In all patients the arthroscopically assisted surgical technique was performed associated with a mini arthrotomy to insert the graft. Peripheral capsular fixation of the meniscus has been performed with the use of soft tissue attachments (in-out, out-in and all inside techniques), while the anterior and posterior horn of the graft were sutured to the capsule inside the joint and fixed on the anterior wall of the tibia with an overcortical knot placed at the end of the tibial tunnels. Postoperative protocol: 3 weeks of non-weight bearing with ROM limitation to 0-90° then two weeks of progressive bearing. Closed kinetic chain exercises are preferred for the first 6 weeks. Often protocols are determined by concomitant surgery. Jogging was allowed after 5-6 months and return to full activity was planned at 9-12 months. Careful evaluation of the patients pre-operatively and at follow-up has been carried out by IKDC, Lysholm and Tegner score. 24 months after surgery an MRI was used to look for potential meniscus extrusion. Results: Following meniscal allograft transplantation, good-excellent results are achieved in nearly 85% of cases. The IKDC showed 15 patients in group A, 4 in group B and 1 in group C. At the Lysholm score 15 had excellent results. All patients highlighted a measurable decrease of pain and returned to pre-operative sport level. One patient had a re-rupture of the transplanted medial meniscus treated with an all-inside suture after 14 months. Two cases showed a re-tear of the lateral meniscus, treated with partial resection after 11 months in 1 case and with an all-inside re-suture after 4 months in the other one. This last patient two months later showed an extension deficit due to a bucket-handle tear of the same meniscus, treated with partial meniscectomy. No significant relationship was found between clinical results and meniscal extrusion. Conclusions: Our short term results show a dramatic
improvement of function and quality of life. Persistent symptoms are most frequently related to improper patient selection. The arthroscopically assisted surgical procedure without bone-plug, although much more technically demanding compared with open techniques, shows a decreased morbidity, no disruption of collateral ligaments and allows an early rehabilitation. This technique should be performed only after considerable practice.
Paper # 270: Graft Extrusion in Open vs Arthroscopic Meniscus Transplantation: A 1 Year Comparative Study of 39 Patients PETER VERDONK, MD, PHD, BELGIUM TINEKE DE CONINCK, BELGIUM WOUTER HUYSSE, MD, BELGIUM RENÉ E. VERDONK, MD, PHD, BELGIUM · Ghent University Hospital and Terneuzen Zorgsaam Ghent, BELGIUM Summary: Graft position is influenced by the surgical technique; the radial displacement of arthroscopically implanted MATs is, both lateral and medial, significantly less than meniscal transplants implanted by open surgery Abstract: Purpose: To evaluate the radial displacement of meniscal allograft transplants (MATs) in patients operated with an open technique vs. an arthroscopic technique at 1 year postoperatively. Radial displacement or extrusion of the graft is frequently observed after meniscus transplantation. The hypothesis is that arthroscopically inserted MATs extrude less than open MATs and therefore have a more intra-articular position than open surgery transplants. Materials and Methods: 39 patients were included in the study: the first group of open surgery transplants consisted of 16 patients (10 lateral, 6 medial). The second group of arthroscopic transplants consisted of 21 patients (14 lateral, 7 medial). MR-images were taken one year post-surgery. The displacement, evaluated on 1,5T MR coronal images, was defined as the distance between the tibial plateau and the outer edge of the meniscus. Results: The radial displacement of lateral open surgery transplants (mean⫽ 4,04 mm; SD⫽ 1,46) is significantly larger (p ⬍ 0,05) than the displacement of arthroscopically implanted MATs (mean⫽ 3,38 mm; SD⫽ 0,85). The external displacement of medial open surgery transplants (mean⫽ 4,71 mm; SD⫽ 0,97) is significantly
ABSTRACTS larger (p ⬍ 0,05) than the displacement of arthroscopically implanted MATs (mean⫽ 2,36 mm; SD⫽ 0,89). Conclusion: Graft position is influenced by the surgical technique; the radial displacement of arthroscopically implanted MATs is, both lateral and medial, significantly less than meniscal transplants implanted by open surgery. The clinical relevance remains to be determined.
Paper # 271: The Short Term Clinical and MRI Results after Meniscus Transplantation: Ninety Nine Cases SUL-GEE KIM, MD, KOREA YONG-KON KOH, SOUTH KOREA SEUNG-BAE JO, SOUTH KOREA HONG-KYO MOON, MD, SOUTH KOREA · Yonsei Sarang Hospital Seoul, SOUTH KOREA Summary: The presented data shows that the transplanted lateral meniscus extrudes in the lateral direction significantly more than the medial meniscus. However, the clinical outcome after meniscus transplantation was not adversely affected by the allograft extrusion. Abstract: Introduction: The purpose of this study was to compare the allograft extrusion using MRI in short term period after the medial and lateral meniscal allograft transplantation and correlate the extrusion with clinical outcome. Methods: Ninety nine cases (67 men and 32 women) were available for MRI evaluations. The age at surgery ranged from 21 to 52 years of age (average: 35 years). Seventy three lateral and 26 medial meniscus allografts were evaluated with a mean follow-up of 22 months (range, 12 to 53 months). The absolute value and relative percentage of the width of extruded menisci was measured in the coronal image that showed maximal extrusion. Clinical outcome was evaluated with Lysholm score. Results: The mean extrusion was 4.5mm in lateral meniscus versus 2.7mm in medial meniscus (p⫽0.000) and the relative percentage of extrusion was 50.0% versus 30.8% (p⫽0.000). Lysholm score significantly increased from 49.0 preoperatively to 87.3 postoperatively in lateral meniscus and from 50.9 to 89.7 in medial meniscus. The difference of final score between the groups was not significant (p⫽0.381). The overall Lysholm score was not correlated with the degree of extrusion (p⫽0.202) Conclusions: The presented data shows that the transplanted lateral meniscus extrudes in the lateral direction significantly more than the medial meniscus. However,
e253
the clinical outcome after meniscus transplantation was not adversely affected by the allograft extrusion. Key Words: Menisus, transplantation, extrusion Paper # 272: Magnetic Resonance Imaging Findings of Popliteomeniscal Fascicle Among Knee Joints With and Without Recurrent Subluxation of Lateral Meniscus JUN SUGANUMA, MD, JAPAN RYUUTA MOCHIZUKI, MD, JAPAN YUTAKA INOUE, MD, JAPAN EIKOU YAMABE, MD, JAPAN YOSHIYUKI UEDA, MD, JAPAN TAIRA KANAUCHI, MD, JAPAN · Hiratsuka City Hospital Hiratsuka, Kanagawa, JAPAN Summary: Insufficiency of sPMF had existed in both knee joints before a patient had locking symptoms, indicating that sPMF insufficiency can be a necessary condition of locking symptoms, and high incidence of iPMF insufficiency was found only in joints with RSLM, suggesting that iPMF insufficiency is an effect of locking symptoms in knee joints with RSLM. Abstract: Purpose: The aim of this study was to investigate posterosuperior and anteroinferior popliteomeniscal fascicles (sPMF and iPMF) using magnetic resonance imaging (MRI) in control knee joints and joints with recurrent subluxation of the lateral meniscus (RSLM) to examine the incidence of PMF insufficiency of the groups. Methods: Knee joints were diagnosed with RSLM when there was a history of mechanical locking episodes, and when subluxation of the lateral meniscus was recognized on arthroscopy. In this study, 240 knee joints were evaluated. The joints were classified into control group (217 joints), RSLM group (16 joints), and contralateral RSLM group (7 joints). Classification of sPMF (iPMF) on MRI was as follows. Type I: A tense low-intensity band is running from the superior (inferior) border of the lateral meniscus to the popliteus tendon. Type II: An unclear band is running from the superior (inferior) border of the lateral meniscus. Type III: No band is seen. Types II and III of PMF were supposed to be PMF insufficiency. The distribution of knee joints according to the 3 groups and the PMF types were examined. Results: The percentage of sPMF and iPMF insufficiency was 40% and 25% in control, 100% and 29% in contralateral RSLM, and both 100% in RSLM groups. Significant difference in the distribution of knee joints by classification of sPMF was recognized between control and contralateral RSLM groups. That of iPMF was also