Editorial Commentary: Meniscal Allograft Transplantation Results in Unacceptable Reoperation Rates According to a Large Claims Database —However, Reoperations Do Not Necessarily Equal Failure

The biomechanical and clinical importance of the meniscus is now well-accepted. In accordance with this understanding, recent focus has shifted toward techniques that preserve the meniscus, including repair and meniscal allograft transplantation (MAT). Although MAT is a technically challenging procedure, evidence has suggested that it restores knee kinematics and tibiofemoral contact pressures, which may subsequently delay or prevent cartilage degeneration. Recent literature has reported concerns as to the high rate of reoperations after MAT, bringing into question the clinical utility of this procedure and its place in the realm of knee preservation.
Source: Arthroscopy - Journal of Arthroscopic and Related Surgery - Category: Surgery Authors: Tags: Editorial Commentary Source Type: research

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This study aims to evaluate the role of staging arthroscopy in the diagnosis of knee chondral defects and subsequent surgical planning prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and meniscus allograft transplantation (MAT). All patients who underwent staging arthroscopy prior to ACI, OCA, or MAT at our institution from 2005 to 2015 were identified. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, magnetic resonance imaging (MRI) findings and previous operative records. Operative records of the subsequent staging arthroscopy...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
Cutting the medial collateral ligament (MCL), even in part, seems counterintuitive. However, medial meniscal surgery is not always easy, and iatrogenic articular cartilage damage can be a complication of partial meniscectomy, meniscus repair, and/or allograft transplantation in a tight knee. Fortunately, partial tears of the MCL tend to heal, and most patients do tolerate iatrogenic, partial MCL tearing without negative long-term sequelae. However, rather than accidentally tearing the MCL during medial meniscal surgery, if you need room to operate, partially release the MCL.
Source: Arthroscopy - Journal of Arthroscopic and Related Surgery - Category: Surgery Authors: Tags: Editorial Source Type: research
AbstractAbstractWhen compared to meniscectomy, meniscus allograft transplantation (MAT) may provide superior long-term benefits to young, active patient populations who have lost meniscal function because of irreparable damage, such as, an avascular tear, previous repair failure, and unsalvageable tear types. Positive outcomes are most likely to be achieved when meniscus allograft transplantation is performed in appropriately selected patients. Indications include patients younger than 50  years of age, with a history of subtotal or total meniscectomy without concomitant articular cartilage defects, uncorrectable join...
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Achieving good long-term outcomes while treating chondral defects has always been a challenge. Several surgical techniques for regeneration of the articular cartilage have been proposed. Among them, osteochondral autograft transplantation and 2-step procedures such as autologous chondrocyte implantation have provided good results, promoting formation of new hyaline-like cartilage tissue, whereas other techniques such as microfracture result in fibrous cartilage and a less durable repair. Single-stage cell-based procedures are an attractive treatment option given the potential for cost savings and avoiding a second-stage procedure.
Source: Arthroscopy - Journal of Arthroscopic and Related Surgery - Category: Surgery Authors: Tags: Editorial Commentary Source Type: research
J Knee Surg DOI: 10.1055/s-0039-1692999Osteochondral autograft transplantation (OAT) is a surgical option for repairing cartilage damage in knees, and can be performed using open or arthroscopic procedures. The aim of this review was to report clinical outcomes, postoperative complications, defect location, and defect size between open and arthroscopic OATs. Three electronic databases (EMBASE, PUBMED, and MEDLINE) were searched for relevant articles. In regard to eligibility criteria, knee articular damage cases solely treated with OAT were included and cases concomitant with ligament reconstruction, limb realignment, and ...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
ConclusionsPost-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. Short-term pain relief is provided by non-surgical management, mid-term pain relief by meniscus scaffolds, and long-term relief by MAT, though each has differing indications. In later stages, osteotomies and joint replacements are indicated.Level of evidenceIV.
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Publication date: Available online 25 February 2019Source: Arthroscopy TechniquesAuthor(s): James Gwosdz, Alexander Rosinski, Moyukh Chakrabarti, Brittany M. Woodall, Nicholas Elena, Patrick J. McGahan, James L. ChenAbstractOsteochondritis dissecans (OCD) has been recognized for over 100 years yet still poses treatment challenges owing to both the avascular nature of articular cartilage and the inability to generate hyaline cartilage. The knee is most commonly involved, and without repair, patients have chronic knee pain, loose bodies, and early-onset osteoarthritis. There are a number of surgical techniques for repai...
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
ConclusionsOsteochondral allograft transplantation appears highly cost-effective though the cost per quality adjusted life year varies according to the widely varying costs of allografts. Based on one small study, revision OCA also appears very cost-effective, but more evidence is needed.Level of evidenceII.
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Patients undergoing meniscal allograft transplantation show improvement at 10  years and even 15 years of follow-up. However, it is unclear what factors influence the results, including but not limited to bone plug versus all-suture repair, fresh versus cryopreserved grafts, proper sizing, and rehabilitation.
Source: Arthroscopy - Journal of Arthroscopic and Related Surgery - Category: Surgery Authors: Tags: Editorial Commentary Source Type: research
ConclusionOver ten different techniques are available for cartilage repair in the hip, and most of them have good short- to medium-term outcomes. However, there are no robust comparative studies to assess superiority of one technique over another, and further research is required in this arena.
Source: International Orthopaedics - Category: Orthopaedics Source Type: research
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