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Meniscal Allografts

par Verdonk, René;Schurhoff, Matthias;Kyriakidis, Theofylaktos ;Dhollander, Aad;Verdonk, Peter
Référence Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation, Springer Science+Business Media, page (2263-2283)
Publication Publié, 2025-01

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Résumé :

Meniscal allograft transplantation has emerged as a useful treatment for carefully selected patients after total or subtotal meniscectomy. Most studies, from short- to long-term (>20 years) clinical follow-ups report patient satisfaction and major pain and function improvement. Radiologically, joint space narrowing significantly progresses only at long-term follow-up. On MRI, extrusion present before surgery is slightly increased postsurgery but stabilizes over time. Histologically, incomplete repopulation of the graft is noticed. Second-look arthroscopy usually shows good healing of the capsule. Extrusion can be limited by capsulodesis. Radiological and MRI criteria suggest that cartilage degeneration is halted in a number of patients, indicating a chondroprotective effect. However, there still is a lack of consensus on how meniscal transplantation success should be evaluated, which makes it difficult to compare study outcomes. Another complicating factor is that more than half of all meniscal transplantations are associated with other soft tissue surgery or corrective knee osteotomies. Radiographic joint space narrowing measurements and MRI signal changes may provide the best assessment tools, but concommitant use of patient reported outcome measurements such as the International Knee Documentation Committee (IKDC) and the Hospital for Special Surgery (HSS) scoring system are essential. Management of irreparable meniscal tears or defects also remains a challenge to eliminate joint line pain, swelling, clicking, catching, locking, and “giving away.” Polyurethane scaffolds provide an innovative, reproducable treatment with short-, mid-, and long-term benefits. Whether synthetic or biologic, scaffold use can widen the meniscus preservation treatment decision-making algorithm and provide symptomatic mid-substance meniscus tissue loss solutions that may prevent or at least delay the need for future arthroplasty. Both procedures are discussed in detail based on existing evidence.