@RamonCugat

Orthopaedic Surg & Sports Med InstituteISAKOS Approved Teaching Center

Trasplante Meniscal

MEDICINE DOCTORSRamon CUGATXavier CUSCÓPedro ÁLVAREZRoberto SEIJASGilbert STEINBACHERDavid BARASTEGUIEduardo MAURIEduardo ALENTORN-GELIBetina NISHISHINYAJuan Manuel BOFFAMarta RIUSEsther SALASebastian GROSSIManel LLUSÁJordi TOMÁSJordi TEIXIDÓAntonio ARCALÍSMontse GARCIA-BALLETBOAna WANG-SAEGUSAWenceslao ESPINOSAPatricia LAIZSue-Sonia TIZOLJordi NAVARROAna GIMENOSilvia VIZCAÍNOEila RIVERAMiguel RENGIFOIgnacio MUÑOZIsabel MUÑOZ

VETERINARY DOCTORS.- IVOT:

Alex TARRAGÓDiego LÓPEZ

Javier TOTUSAUS.- Universidad CEU-UCH de Valencia:

José Mª CARRILLOJoaquín SOPENA

Mónica RUBIOMariluz ORTIZMireia GARCIABelén CUERVO

Deborah CHICHARROElena DAMIÁ

.- Universidad de Murcia:José Joaquín CERÓN

Asta TVARIJONAVICIUTE.- Universidad de Córdoba:Juan Manuel DOMÍNGUEZ

Andrés FERNÁNDEZMª del Mar GRANADOS

Rafael GÓMEZRocío NAVARRETE

Juan MORGAZSetefilla QUIRÓSDaniel AGUILARAlfonso BLANCO

.-Universidad de Las Palmas de Gran Canaria:José VILAR

Manuel MORALES

REHABILITATION DEPARTMENTSilvia RAMON Elena MORALES Rafael ALCOVERFerrán VIDIELLA Nieves LAMA Lorena PAINOXavier ÁLVAREZ Joan BOSCH Carles SALVOMiguel MARÍN Juan Carlos ALEMANY Albert BADOSAM Ángeles ENGUITA Montserrat VERGES Rosa TEIXIDÓ

BANC DE SANG I TEIXITSBTI

Previous MeniscectomyPain< 50 years oldNormal femoro-tibial axisCartilage

BULLET POINT: Pre-evaluationIncreasing Bone Marrow Lesion size (on preoperative MRI) in MAT patients is correlated with worse postoperative pain mesures

BM Saltzman, EJ Cotter, JP Stephens, GL Cvetanovich, B Madden, K Wang, AB Yanke & BJ Cole. 2018 AJSM

Better graft survival after MAT can be expected when articular cartilage is intact or the damage is limited to a unipolar lesion

B-S Lee, S-L Bin, J-M Kim, W-K Kim & JW Coi. 2017 AJSM

Meniscal Transplantation: When?

Meniscal allograft: Preservation

BULLET POINT: Allograft preservation

Chemically decellurarized meniscal allografts proved their biocompatibility and durability without inducing immunogenic reactions. Insufficient recellularizationand inferior stiffness of the graft hampered chondroprotective effects

K Gelse, L Körber, M Schöne, K Raum, P Koch, M Pachowsky, G Welsch & R Breiter. 2016 Cartilage

Cryopreserved menisci showed higher elastic modulus and point of rupture thanother methodes. It retains meniscus biomechanical properties

S Ahmad, VA Singh & SI Hussein. 2017 J Orthop Surg

BULLET POINT: Allograft sizeThe height of the meniscal segments may be a new variable in preoperative meniscal mesurement.

A dos Santos Netto, C Cohen Kaleka, M Kei Toma, JC de Almeida e Silva, RP Leite Cury, PM de Morales Barros Fucs& N Roberto Severino. 2017 KSSTA

Accepting an allograft that is more than 5mm smaller in width than preoperative templating increases the likelihood of clinical and mechanical failure.

P Myers et al. 2018 Meniscus Transplantation Study GroupMeeting

Meniscal allograft: Size

BULLET POINT: Bone-Block vs Suture-only FixationNo demostrative difference between soft tissue fixation and bonefixation for MAT root fixation on clinical outcome

JJ Jauregui, ZD Wu, S Meredith, C Griffith, J Packer & RF Henn III. 2017 AJSM

Favorable long-term clinical survival rate after MAT using bone fixationtechnique. Contact sports are not recommended

J-M Kim, S-I Bin, B-S Lee, N-K Kim, J-H Song, J-W Choi & C-R Lee. 2016 Arthroscopy

Bone-plug technique: lower mean contact pressure and rigid fixation Wang H et al. 2014 AJSM

Meniscal Technique

Meniscal Technique: Fixation

Alentorn-Geli E, Seijas R, Garcia-Balletbó M, Alvarez-Diaz P, Steinbacher G, Cuscó X, Rius M & Cugat R Arthroscopic meniscal allograft transplantation without boneplugs. KSSTA 2011. 19:174-82Alentorn-Geli E, Seijas R, Alvarez-Diaz P, Cuscó X & Cugat R Arthroscopic meniscal transplants in soccer players: outcomes at 2- to 5- year follow-up. Clin J Sport Med2010. 20:340-3

May 2001 – Dec 2017 184 Allograft

Study group 2001 – 2006 35 Patients37 Allograft

Follow-up 12–65 m (Average 38.62)

Activity 14 Athletes21 No Athletes

24 Medial meniscus 11 Right knee13 Left knee

13 Lateral meniscus 7 Right knee6 Left knee

Lysholm Test 52.52IKDC 44.87VAS Scale 68.71

86.6278.9022.14

EVALUATION PREOP POSTOPGroup of studyAll patients underwent surgical procedure during that time:- Frozen allograft- Same surgical technique- Same surgeon

Meniscal Transplantation: Results

BULLET POINT: Review

Midterm (5-10 years) survival of MAT (85-89%) isgreater than long term (>10 years) survival (52-56%)

Seong-Li Bin, Kyung-Wook Nha, Ji-Young Cheong, Young-Soo Shin. 2017 AJSM

MAT is associated eith high reoperation and failure rates. But the number of studies evaluating MAT and scaffolds is limited (comparision studies)

Sean Dangelmajer, Filippo Familiari, Roberto Simonetta, Mehmet Kaymakoglu, Gazi Huri. 2017 KSRR

MAT is a viable solution for the younger patient with chronic pain in the meniscectomed knee joint. But cannot be seen as a definitive solution

Manolito De Bruycker, Peter C.M. Verdonk, René C. Verdonk. 2017 SICOT

Transplant failure rates increase with the passage of time, the review showed short follow-up periods. Aftermeniscus transplantation return t low-impact activities

Sue D. Barber-Westin, Frank R. Noyes. 2017 KSSTA

Meniscal Transplantation: Follow-up

Meniscal Transplantation: 17 years later!

17 years old MAT

Meniscal Transplantation: Extrusion

BULLET POINT: Meniscal extrusion

Lateral meniscal allograft transplant through medial arthrotomy is preferred to decrease extrusion

N-H Choi, J-K Choi, B-S Yang, D-H Lee & BN Victoroff. 2017 AJSM

Ensuring the correct possitioning of the bone block in both coronal and axial planes is essential for minimizingextrusion

SY Lee, J Yoon, YS Cho, RCh Son, SK Kim, SH Ahn& H-K Lee. 2015 KSSTA

No association between preoperative subluxation of meniscus and extruson after transplant

B-S Lee, S-L Bin, J-M Kim, J-H Kim & EJ Lim. 2016 KSSTA

Extrusion did not significantly progress either in coronal or sagittal plane after MAT in midterm period

N-K Kim, S-L Bin, J-M Kim, C-R Lee & J-H Kim. 2016 AJSM

Including the slope angle as a parameter into meniscalallograft sizing method could diminish the risk of extrusion. High slope angle is a risk factor.

P Luczkiewicz, K Daszkiewicz, J Chróscielewski, W Witkowski & L Kuik. 2017. Medical Hypotheses

Oversizing meniscal, wrong anchorage of the anterior and posterior hornes, capsular laxity & No meniscal ring

P Myers et al. 2018 Meniscus TransplantationStudy Group Meeting

Meniscal Transplantation

BULLET POINT: Chondral preservation & Knee stability

T2 mesurement can be a useful tool and more sensitive biomarker for a quantitative evaluation of postoperative cartilage changes compared to MRI

Sun-Young Park, Sang Hoon Lee, Min Hee Lee, HyeWon Chung, Myung Jin Shin. 2016 Eur Radiol

MAT could protect articular cartilage and delay therecessive prgress better than meniscectomy

Shengtao Li, Xiaoyang Fang, Tao You. 2017 BiomedRes

Medial and lateral meniscal transplantation improve clinical scores. Medial meniscal transplantation improve A-P stability & rotational stability. Lateral meniscal transplantation didn´t change A-P stability nor rotational stability

Yoon K et al. ESSKA Congress 2018

PRGF-Endoret®

Meniscal Transplantation & ACL surgery

Meniscal Transplantation & Osteotomy

Meniscal Transplantation & Cartilage repair

Meniscal Transplantation & Cartilage repair

Adipose Derived Regenerative Cell’s (ADRC’s)

Ø The meniscus must be preserved so as to maintain the anatomy and function of the knee in optimal conditions

Ø The arthroscopic meniscal transplantation with frozen allograft without bone-blocks reduces the morbidity associated to other techniques

TAKE HOME MESSAGE

Thank you for your attention

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