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Meniscus Surgery
Researchers writing in the medical journal Arthroscopy say "the
protective benefits of meniscus allografts remain debatable."
Hommen JP, Applegate GR, Del
Pizzo W. Meniscus allograft transplantation: ten-year results of
cryopreserved allografts. Arthroscopy. 2007 Apr;23(4):388-93
PURPOSE: We report the results of cryopreserved meniscus
allograft transplantations with 10 or more years of follow-up.
METHODS: Fourteen medial and 8 lateral meniscus
allografts were evaluated with a mean follow-up of 141 months
(range, 115 to 167 months). The clinical outcome and failure
rate was evaluated by use of a Lysholm score and modified pain
score in 22 patients. The results of radiographic and magnetic
resonance imaging (MRI) analysis were reported in 15 and 7
patients, respectively.
RESULTS: Overall, 25% of medial allografts and 50% of
lateral allografts failed. The combined failure rate was 35%.
There was a 90% improvement in Lysholm scores, as well as pain
scores. There were no discernible Lysholm or pain score
differences for both lateral and medial allografts. Furthermore,
there was no discernible difference in both Lysholm and pain
scores between bone plug and soft-tissue methods of graft
fixation. Ten of fifteen allografts showed radiographic joint
space narrowing, and twelve had progression of degenerative
joint disease. On MRI, all grafts had moderate meniscus
shrinkage and five had grade III signal intensities. Eighty-five
percent of patients underwent subsequent procedures, 5 of whom
required total allograft resection and 2 of whom required
partial allograft resection. One allograft required repair.
CONCLUSIONS: Although transplantation of cryopreserved
allografts improved knee pain and function, the average knee
function was fair at long-term follow-up. Fifty-five percent of
allografts failed when failure criteria for second-look surgery,
knee improvement surveys, and MRI were added to Lysholm and pain
score failures. The protective benefits of meniscus allografts
remain debatable, and inferences cannot be made from this study.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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