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Paper 98: Clinical Outcomes Following Isolated Lateral Meniscal Allograft Transplantation
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ABSTRACTS
measurements before and after surgery. A statistical difference of the femoro-tibial height existed between measurements in extension and schuss position. (minimum 0.30 ⫹/⫺ 0.95 p ⫽ 0.09, maximum 0.55 ⫹/⫺ 0.86 p ⬍ 0.001) Discussion: This original method used for the mesurement of the joint space has a very good reliability. The medial meniscectomy has no effect on the height of the femoro-tibial joint space, immediately after the surgery. So, a radiological narrowing of the femoro-tibial joint space after a meniscectomy is exclusively a sign of osteoarthrosis. Paper 96: A Twenty-year Longitudinal Study on Resection of Discoid Meniscus TAKATOSHI MINEZAKI, KANAGAWA, JAPAN, PRESENTER HISAYA UCHIDA, KANAGAWA, JAPAN JOJI MOCHIDA, ISEHARA-CITY, JAPAN TAISUKE TOMATSU, TOKYO, JAPAN · Tokai University, Kanagawa, Japan Objective: Discoid meniscus is often surgically treated during childhood. The risk of secondary osteoarthritic changes seemed to be high in the long term follow-up. Here the results of a long-term follow-up study on menisectomy are discussed. Patients and Methods: A long-term follow-up study was conducted on 32 patients with 39 knees that were arthrographically diagnosed as having discoid meniscus prior to July 1983. These patients were followed for at least 20 years (follow-up rate: 66.7%). Discoid lateral meniscus was seen in 14 knees of 12 men and 25 knees of 20 women. The age of the patients at the time of surgery ranged from 7 to 41 years (ave. 21.9 years). The duration of postoperative follow-up ranged from 20 to 38 years (ave. 23.3 years). Total menisectomy was performed on 34 knees, and partial menisectomy was performed on 5 knees. Clinical findings were assessed using Lysholm scores, and radiological grades were determined using the Kellgren-Lawrence system. Results: The average Lysholm score for the treated and untreated knees was 91.0 and 97.4 points, respectively; the average score for the treated knee was significantly lower. There was no significant difference in gender, age at the time of surgery, surgical method or morphology classified by Watanabe. The age at the time of surgery was 15 years or younger for the six grade 0 knees, but was 35 years or older for six of the eight grade III or IV knees. Furthermore, among eight knees that underwent preoperative X-ray, the age at the time of surgery in four knees with grade 0 before surgery and at the time of the study was 15 years or younger, but was 35 years or older
in all knees with grade 0 or I before surgery and grade III or IV at the time of the study. Conclusions: Compared to the untreated knees, the Lysholm score for the treated knees was significantly poorer. The number of patients with impaired activities of daily living was low. However, radiological findings showed advanced osteoarthritic changes in some patients, and this tendency was particularly strong for those who underwent surgery at the age of 35 years or older. Paper 97: Outcomes After Meniscal Repair Using the Meniscal Arrow in Knees Undergoing Concurrent Anterior Cruciate Ligament Reconstruction: Analysis of Durability of Repair DAVID R DIDUCH, CHARLOTTESVILLE, VA, USA PRESENTER GREGORY P LEE, MD, CHARLOTTESVILLE, VA, USA JENNIFER HART, CHARLOTTESVILLE, VA, USA · University of Virginia, Charlottesville, VA, USA Purpose: An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness. The purpose of this study was to evaluate whether the Meniscal Arrow is comparable to conventional inside-out suture repair in accomplishing longterm healing of meniscal tears. Methods: This study is an extended follow-up of an original series of thirty-two patients with outcomes analysis. All patients underwent meniscal repair with exclusive use of the Arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction (ACLR). Follow-up assessment included physical examination, arthrometry, the IKDC instrument and the Knee Disorders Subjective History visual analog scale (VAS). Intermediate follow-up at an average of 2.3 years yielded a success rate of 90.6%. The average follow-up in the present study has been extended to 6.6 years. Results: The extended follow-up analysis revealed a substantial attrition in the success rate of this series of patients undergoing meniscal repair with the Arrow. A 90.6% success rate at an average follow-up of 2.3 years deteriorated to 71.4% at 6.6 years. Conclusion: This study provides the longest follow-up in the literature of any of the all-inside meniscal repair implants. The Meniscal Arrow demonstrated long-term meniscal healing rates inferior to those found in the literature for inside-out suture repair techniques. Paper 98: Clinical Outcomes Following Isolated Lateral Meniscal Allograft Transplantation JON K. SEKIYA,
ABSTRACTS CHESAPEAKE, VA, USA PRESENTER YRAM J. GROFF, PITTSBURGH, PA, USA JAMES J IRRGANG, PITTSBURGH, PA, USA FREDDIE H. FU, PITTSBURGH, PA, USA CHRISTOPHER D HARNER, PITTSBURGH, PA, USA · Center for Sports Medicine, Univ. of Pittsburgh, Pittsburgh, PA, USA Background: The purpose of our study was to determine the clinical outcomes following isolated lateral meniscal allograft transplantation. Our hypothesis was that following this procedure, patients would have satisfactory overall knee function and symptom relief, and that the meniscal allograft would provide protection for the transplanted lateral compartment’s chondral surfaces, as seen by delayed radiographic joint space narrowing. Methods: Twenty-five patients were retrospectively reviewed following isolated lateral meniscal allograft transplantation. The average duration of follow up was 3.3 years (range 2 to 6 years) and the average age of the subjects was 30 years (range 19 to 45). Seventeen patients had bony fixation and 8 patients had suture fixation of the anterior and posterior horns of the meniscal allograft. All 25 patients completed subjective questionnaires and seventeen patients also underwent a comprehensive physical and radiographic examination. Results: Ninety-six percent of patients felt that their overall function and activity level were improved following surgery. The SF-36 physical and mental component summary scores for these subjects were higher than age- and gender-matched scores from the US population. Joint space narrowing of the transplanted lateral compartments was not significantly different when compared with the joint space narrowing of the lateral compartment of the contralateral knee. In addition, preoperative and postoperative radiographic joint space measurements of the involved lateral compartment were significantly associated with subjective assessment, symptoms, sports activity score, Lysholm score, and final IKDC rating at latest follow-up. Finally, patients fixed using the bony technique had significantly better range of motion according to IKDC criteria at latest follow-up compared to the suture fixation group. Conclusions: Our results suggest that isolated meniscal allograft transplantation can be a beneficial procedure in properly selected symptomatic patients with a lateral meniscus deficient knee. The data also suggests that earlier meniscal transplantation, before the onset of significant joint space narrowing, may result in improved outcomes. Finally, bony fixation may have a significant advantage over suture fixation, particularly with regard to knee range of motion.
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Paper 99: In Vivo Analysis of Meniscal and Tibiofemoral Kinematics in Cruciate Ligament-deficient Knees using Kinematic Magnetic Resonance Imaging C. BENJAMIN MA, SAN FRANCISCO, CA, USA PRESENTER KEH-YANG LEE, SAN FRANCISCO, CA, USA MARC SAFRAN, SAN FRANCISCO, CA, USA CHRISTINA R ALLEN, SAN FRANCISCO, CA, USA SHARMILA MAJUMDAR, SAN FRANCISCO, CA, USA · University of California, San Francisco, San Francisco, CA, USA Introduction: Deficiency of cruciate ligaments can lead to altered tibiofemoral and meniscal kinematics. However, objective evaluations following ligament injuries and reconstructions have focused only on anterior-posterior tibiofemoral translations. In this study, we analysed the in vivo meniscal and tibiofemoral kinematics in the cruciate ligament-deficient knees using kinematic magnetic resonance imaging. Methods: Five ACL-deficient patients and six normal volunteers were studied using simulated weight-bearing magnetic resonance imaging. Sagittal images were obtained on the injured and the contralateral intact knee. Each knee was imaged in full extension and flexion (45 degrees) with 12.7 kg of axial load applied through a custom-made footplate. Three-dimensional image registration and reconstruction was used to quantitate tibiofemoral and meniscal kinematics. Menisci positions and centroids of the contact areas on the tibial plateau were also calculated. Statistical analysis was performed using ANOVA with p⬍ 0.05 for statistical significance. Results: For tibiofemoral kinematics of normal volunteers, anterior tibial translation was not significantly different between knees at both extension (-0.7 ⫾ 1.0mm) and flexion (0.1 ⫾ 1.1 mm). For the ACL deficient knees, anterior tibial translation was significantly different between the ACL deficient and contralateral intact knee at both extension (1.9 ⫾ 2 mm) and flexion (1.2 ⫾ 1.3 mm). For the intact knees, there was an anterior tibial translation of 3.5 4.9mm from extension to flexion, where as the ACL deficient knee was lower at 2.6 ⫾ 3 mm. For meniscal positions, the centroids of the contact areas of the ACL deficient knee have decrease posterior translation between extension and flexion. The posterior excursion of the posterior horn medial meniscus is also less in flexion for the ACL deficient knee when compared with the contralateral intact knee. Summary: This study demonstrated that tibiofemoral and meniscus kinematics can both be significantly altered with cruciate ligament injuries. Moreover, this noninvasive method allows us to objectively evaluate in vivo meniscal kinematics and contact area. Our results on meniscal positions demonstrated that there was decrease
ABSTRACTS
measurements before and after surgery. A statistical difference of the femoro-tibial height existed between measurements in extension and schuss position. (minimum 0.30 ⫹/⫺ 0.95 p ⫽ 0.09, maximum 0.55 ⫹/⫺ 0.86 p ⬍ 0.001) Discussion: This original method used for the mesurement of the joint space has a very good reliability. The medial meniscectomy has no effect on the height of the femoro-tibial joint space, immediately after the surgery. So, a radiological narrowing of the femoro-tibial joint space after a meniscectomy is exclusively a sign of osteoarthrosis. Paper 96: A Twenty-year Longitudinal Study on Resection of Discoid Meniscus TAKATOSHI MINEZAKI, KANAGAWA, JAPAN, PRESENTER HISAYA UCHIDA, KANAGAWA, JAPAN JOJI MOCHIDA, ISEHARA-CITY, JAPAN TAISUKE TOMATSU, TOKYO, JAPAN · Tokai University, Kanagawa, Japan Objective: Discoid meniscus is often surgically treated during childhood. The risk of secondary osteoarthritic changes seemed to be high in the long term follow-up. Here the results of a long-term follow-up study on menisectomy are discussed. Patients and Methods: A long-term follow-up study was conducted on 32 patients with 39 knees that were arthrographically diagnosed as having discoid meniscus prior to July 1983. These patients were followed for at least 20 years (follow-up rate: 66.7%). Discoid lateral meniscus was seen in 14 knees of 12 men and 25 knees of 20 women. The age of the patients at the time of surgery ranged from 7 to 41 years (ave. 21.9 years). The duration of postoperative follow-up ranged from 20 to 38 years (ave. 23.3 years). Total menisectomy was performed on 34 knees, and partial menisectomy was performed on 5 knees. Clinical findings were assessed using Lysholm scores, and radiological grades were determined using the Kellgren-Lawrence system. Results: The average Lysholm score for the treated and untreated knees was 91.0 and 97.4 points, respectively; the average score for the treated knee was significantly lower. There was no significant difference in gender, age at the time of surgery, surgical method or morphology classified by Watanabe. The age at the time of surgery was 15 years or younger for the six grade 0 knees, but was 35 years or older for six of the eight grade III or IV knees. Furthermore, among eight knees that underwent preoperative X-ray, the age at the time of surgery in four knees with grade 0 before surgery and at the time of the study was 15 years or younger, but was 35 years or older
in all knees with grade 0 or I before surgery and grade III or IV at the time of the study. Conclusions: Compared to the untreated knees, the Lysholm score for the treated knees was significantly poorer. The number of patients with impaired activities of daily living was low. However, radiological findings showed advanced osteoarthritic changes in some patients, and this tendency was particularly strong for those who underwent surgery at the age of 35 years or older. Paper 97: Outcomes After Meniscal Repair Using the Meniscal Arrow in Knees Undergoing Concurrent Anterior Cruciate Ligament Reconstruction: Analysis of Durability of Repair DAVID R DIDUCH, CHARLOTTESVILLE, VA, USA PRESENTER GREGORY P LEE, MD, CHARLOTTESVILLE, VA, USA JENNIFER HART, CHARLOTTESVILLE, VA, USA · University of Virginia, Charlottesville, VA, USA Purpose: An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness. The purpose of this study was to evaluate whether the Meniscal Arrow is comparable to conventional inside-out suture repair in accomplishing longterm healing of meniscal tears. Methods: This study is an extended follow-up of an original series of thirty-two patients with outcomes analysis. All patients underwent meniscal repair with exclusive use of the Arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction (ACLR). Follow-up assessment included physical examination, arthrometry, the IKDC instrument and the Knee Disorders Subjective History visual analog scale (VAS). Intermediate follow-up at an average of 2.3 years yielded a success rate of 90.6%. The average follow-up in the present study has been extended to 6.6 years. Results: The extended follow-up analysis revealed a substantial attrition in the success rate of this series of patients undergoing meniscal repair with the Arrow. A 90.6% success rate at an average follow-up of 2.3 years deteriorated to 71.4% at 6.6 years. Conclusion: This study provides the longest follow-up in the literature of any of the all-inside meniscal repair implants. The Meniscal Arrow demonstrated long-term meniscal healing rates inferior to those found in the literature for inside-out suture repair techniques. Paper 98: Clinical Outcomes Following Isolated Lateral Meniscal Allograft Transplantation JON K. SEKIYA,
ABSTRACTS CHESAPEAKE, VA, USA PRESENTER YRAM J. GROFF, PITTSBURGH, PA, USA JAMES J IRRGANG, PITTSBURGH, PA, USA FREDDIE H. FU, PITTSBURGH, PA, USA CHRISTOPHER D HARNER, PITTSBURGH, PA, USA · Center for Sports Medicine, Univ. of Pittsburgh, Pittsburgh, PA, USA Background: The purpose of our study was to determine the clinical outcomes following isolated lateral meniscal allograft transplantation. Our hypothesis was that following this procedure, patients would have satisfactory overall knee function and symptom relief, and that the meniscal allograft would provide protection for the transplanted lateral compartment’s chondral surfaces, as seen by delayed radiographic joint space narrowing. Methods: Twenty-five patients were retrospectively reviewed following isolated lateral meniscal allograft transplantation. The average duration of follow up was 3.3 years (range 2 to 6 years) and the average age of the subjects was 30 years (range 19 to 45). Seventeen patients had bony fixation and 8 patients had suture fixation of the anterior and posterior horns of the meniscal allograft. All 25 patients completed subjective questionnaires and seventeen patients also underwent a comprehensive physical and radiographic examination. Results: Ninety-six percent of patients felt that their overall function and activity level were improved following surgery. The SF-36 physical and mental component summary scores for these subjects were higher than age- and gender-matched scores from the US population. Joint space narrowing of the transplanted lateral compartments was not significantly different when compared with the joint space narrowing of the lateral compartment of the contralateral knee. In addition, preoperative and postoperative radiographic joint space measurements of the involved lateral compartment were significantly associated with subjective assessment, symptoms, sports activity score, Lysholm score, and final IKDC rating at latest follow-up. Finally, patients fixed using the bony technique had significantly better range of motion according to IKDC criteria at latest follow-up compared to the suture fixation group. Conclusions: Our results suggest that isolated meniscal allograft transplantation can be a beneficial procedure in properly selected symptomatic patients with a lateral meniscus deficient knee. The data also suggests that earlier meniscal transplantation, before the onset of significant joint space narrowing, may result in improved outcomes. Finally, bony fixation may have a significant advantage over suture fixation, particularly with regard to knee range of motion.
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Paper 99: In Vivo Analysis of Meniscal and Tibiofemoral Kinematics in Cruciate Ligament-deficient Knees using Kinematic Magnetic Resonance Imaging C. BENJAMIN MA, SAN FRANCISCO, CA, USA PRESENTER KEH-YANG LEE, SAN FRANCISCO, CA, USA MARC SAFRAN, SAN FRANCISCO, CA, USA CHRISTINA R ALLEN, SAN FRANCISCO, CA, USA SHARMILA MAJUMDAR, SAN FRANCISCO, CA, USA · University of California, San Francisco, San Francisco, CA, USA Introduction: Deficiency of cruciate ligaments can lead to altered tibiofemoral and meniscal kinematics. However, objective evaluations following ligament injuries and reconstructions have focused only on anterior-posterior tibiofemoral translations. In this study, we analysed the in vivo meniscal and tibiofemoral kinematics in the cruciate ligament-deficient knees using kinematic magnetic resonance imaging. Methods: Five ACL-deficient patients and six normal volunteers were studied using simulated weight-bearing magnetic resonance imaging. Sagittal images were obtained on the injured and the contralateral intact knee. Each knee was imaged in full extension and flexion (45 degrees) with 12.7 kg of axial load applied through a custom-made footplate. Three-dimensional image registration and reconstruction was used to quantitate tibiofemoral and meniscal kinematics. Menisci positions and centroids of the contact areas on the tibial plateau were also calculated. Statistical analysis was performed using ANOVA with p⬍ 0.05 for statistical significance. Results: For tibiofemoral kinematics of normal volunteers, anterior tibial translation was not significantly different between knees at both extension (-0.7 ⫾ 1.0mm) and flexion (0.1 ⫾ 1.1 mm). For the ACL deficient knees, anterior tibial translation was significantly different between the ACL deficient and contralateral intact knee at both extension (1.9 ⫾ 2 mm) and flexion (1.2 ⫾ 1.3 mm). For the intact knees, there was an anterior tibial translation of 3.5 4.9mm from extension to flexion, where as the ACL deficient knee was lower at 2.6 ⫾ 3 mm. For meniscal positions, the centroids of the contact areas of the ACL deficient knee have decrease posterior translation between extension and flexion. The posterior excursion of the posterior horn medial meniscus is also less in flexion for the ACL deficient knee when compared with the contralateral intact knee. Summary: This study demonstrated that tibiofemoral and meniscus kinematics can both be significantly altered with cruciate ligament injuries. Moreover, this noninvasive method allows us to objectively evaluate in vivo meniscal kinematics and contact area. Our results on meniscal positions demonstrated that there was decrease