MENISCAL MENISCAL ALLOGRAFT ALLOGRAFT

TRANSPLANTATIONTRANSPLANTATION(MAT)(MAT)

"“"“Preliminary results. Clinical Preliminary results. Clinical protocol”protocol”

Drs. J.D. Ayala Mejías,Drs. J.D. Ayala Mejías,1 1 L. Alcocer,L. Alcocer,11 A. Estévez, A. Estévez,22

R. Canosa,R. Canosa,33 C. Gavín, C. Gavín,33 C. Vidal C. Vidal 44

1. Hospital Monográfico de Traumatología, 1. Hospital Monográfico de Traumatología, Cirugía Ortopédica y Rehabilitación. ASEPEYO. Coslada, Madrid.Cirugía Ortopédica y Rehabilitación. ASEPEYO. Coslada, Madrid.

2. Clínica Nuestra Sra. de América. Madrid.2. Clínica Nuestra Sra. de América. Madrid.3. Hospital Fundación Alcorcón. Madrid.3. Hospital Fundación Alcorcón. Madrid.

4. Hospital Universitario 12 de Octubre. Madrid.4. Hospital Universitario 12 de Octubre. Madrid.

“ “GRUPO DE ESTUDIO DE GRUPO DE ESTUDIO DE MADRID” PROTOCOL MADRID” PROTOCOL

Drs. Luis Alcocer, Juan Ayala MejíasDrs. Luis Alcocer, Juan Ayala Mejías (Hospital Monográfico de Traumatología, Cirugía Ortopédica (Hospital Monográfico de Traumatología, Cirugía Ortopédica

y Rehabilitación. ASEPEYO. Madrid)y Rehabilitación. ASEPEYO. Madrid)

Canosa R, Gavín C. Canosa R, Gavín C. (Fundación Hospital Alcorcón)(Fundación Hospital Alcorcón)

Estévez A. Estévez A. (Clínica N. S. de América)(Clínica N. S. de América)

Vidal C. Vidal C. (Hospital Universitario 12 de Octubre)(Hospital Universitario 12 de Octubre)

PREOPERATIVE PROTOCOL

Donor measurements• Meniscus• Tibial plateau

Recipient measurements• True PA and lateral xray• CT: tibial plateau

1.1. Total meniscectomy , body and posterior Total meniscectomy , body and posterior hornhorn

2.2. Age: < 55 y-o.Age: < 55 y-o.3.3. Sports and physical activitiesSports and physical activities4.4. Local untractable painLocal untractable pain5.5. No instability (?)No instability (?)6.6. Normal axial limb aligment (?) Normal axial limb aligment (?) 7.7. Outerbridge I and II grade (III, IV?)Outerbridge I and II grade (III, IV?)

INDICATIONSINDICATIONS

Material and methodMaterial and method

11 cases (4 rejected < 12 m f/u)11 cases (4 rejected < 12 m f/u)OR Nov. 2001 – Jul 2003OR Nov. 2001 – Jul 2003Mean F/U (months) = 13.6; r(8,22)Mean F/U (months) = 13.6; r(8,22)

Labour activ.Labour activ.

Material and methodMaterial and method

Material and methodMaterial and method

Months post-meniscectomyMonths post-meniscectomy35 (2 – 90)35 (2 – 90)

Nº of previous arthroscopiesNº of previous arthroscopies2.3 (1-5)2.3 (1-5)

Tibial plateau measurements (mean)

Donor 35 mm x 49 mmPatient 32 mm x 46 mm

Material and methodMaterial and method

0

1

2

ACL PCL Varus

Material and methodMaterial and method

0

1

2

3

Grade 0 Grade I Grade II

Femoral condyle

0

1

2

3

4

Grade 0 Grade I Grade II

Tibial plateau

Outerbridge chondral lesions

IKDC: subjectiveIKDC: subjectiveassessmentassessment

Pre-opPre-op Post-opPost-op

SymptomsSymptoms 23.7523.75 25.3325.33

Sport activ.Sport activ. 27.7527.75 35.7635.76

TOTALTOTAL 38.2738.27 48.7248.72

IKDC: objectiveIKDC: objectiveassessmentassessment

PRE-OP/PRE-OP/POST-OPPOST-OP

A (Normal)A (Normal)

B (Nearly B (Nearly normal)normal) C (Abnormal)C (Abnormal) D (Severely D (Severely

abnormal)abnormal)

Compartmental Compartmental findingsfindings 2/42/4 1/11/1 3/13/1 1/11/1

Range of motionRange of motion 5/65/6 2/12/1

Functional testFunctional test 3/43/4 3/23/2 1/11/1

TOTALTOTAL 3/53/5 4/24/2

IKDC: objectiveIKDC: objectiveassessmentassessment

PRE-OP/PRE-OP/POST-OPPOST-OP

LysholmLysholm TegnerTegner WOMACWOMAC

TOTALTOTAL 45/65.7545/65.75(Abnormal/Fair)(Abnormal/Fair)

4.5/3.54.5/3.5(Mod. heavy (Mod. heavy

work/recreational work/recreational sports)sports)

85.5/86.385.5/86.3(120)(120)

Follow-up: arthroscopyFollow-up: arthroscopy

2 revision arthroscopy2 revision arthroscopy

• arthrofibrosis (4th month)• infection vs. inmunologic response

(11th month)

Follow-up: Follow-up: arthroscopy/MRIarthroscopy/MRI

Revision MRI (5 cases)Revision MRI (5 cases)

• 5 peripherically healed• 4 body and/or anterior horn extruded• 5 intrasubstance degeneration

Follow-up: MRIFollow-up: MRI

6th month post-op

Follow-up: MRIFollow-up: MRI

6th month post-op

OUR SURGICAL TECHNIQUEOUR SURGICAL TECHNIQUE

• With or without bone plugs (?) With or without bone plugs (?) • Peripheral groove for medial meniscusPeripheral groove for medial meniscus• Contralateral tunnelsContralateral tunnels• Posterior horn suture (Fast FixPosterior horn suture (Fast Fix®® MI, Sharp Shutter MI, Sharp Shutter®® ME) ME)• Meniscus body (Sharp ShutterMeniscus body (Sharp Shutter®®))• Anterior horn suture (outside-in)Anterior horn suture (outside-in)

CONCLUSIONSCONCLUSIONS

• Promissing Promissing byological and mechanical byological and mechanical resultsresults

• Good Good preliminary clinical resultspreliminary clinical results• ““Dissappointing” Dissappointing” mid-term results (5-10 mid-term results (5-10

years)years)

¡MUCHAS GRACIAS!¡MUCHAS GRACIAS!THANK YOU !THANK YOU !