MENISCAL ALLOGRAFT TRANSPLANTATION MAT Preliminary results Clinical protocol

“GRUPO DE ESTUDIO DE MADRID” PROTOCOL Drs. Luis Alcocer, Juan Ayala Mejías (Hospital Monográfico

PREOPERATIVE PROTOCOL Donor measurements • Meniscus • Tibial plateau Recipient measurements • True PA

INDICATIONS 1. Total meniscectomy , body and posterior horn 2. Age: < 55 y-o.

Material and method 11 cases (4 rejected < 12 m f/u) OR Nov. 2001

Material and method Months post-meniscectomy 35 (2 – 90) Nº of previous arthroscopies 2.

Tibial plateau measurements (mean) Donor 35 mm x 49 mm Patient 32 mm x

Material and method Outerbridge chondral lesions

IKDC: subjective assessment Pre-op Post-op Symptoms 23. 75 25. 33 Sport activ. 27. 75

IKDC: objective assessment PRE-OP/ POST-OP A (Normal) B (Nearly normal) C (Abnormal) D (Severely

IKDC: objective assessment PRE-OP/ POST-OP TOTAL Lysholm 45/65. 75 (Abnormal/Fair) Tegner WOMAC 4. 5/3.

Follow-up: arthroscopy 2 revision arthroscopy • arthrofibrosis (4 th month) • infection vs. inmunologic

Follow-up: arthroscopy/MRI Revision MRI (5 cases) • 5 peripherically healed • 4 body and/or

OUR SURGICAL TECHNIQUE • • • With or without bone plugs (? ) Peripheral

CONCLUSIONS • • • Promissing byological and mechanical results Good preliminary clinical results “Dissappointing”

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MENISCAL ALLOGRAFT TRANSPLANTATION (MAT) "“Preliminary results. Clinical protocol” Drs. J. D. Ayala Mejías, 1 L. Alcocer, 1 A. Estévez, 2 R. Canosa, 3 C. Gavín, 3 C. Vidal 4 1. Hospital Monográfico de Traumatología, Cirugía Ortopédica y Rehabilitación. ASEPEYO. Coslada, Madrid. 2. Clínica Nuestra Sra. de América. Madrid. 3. Hospital Fundación Alcorcón. Madrid. 4. Hospital Universitario 12 de Octubre. Madrid.

“GRUPO DE ESTUDIO DE MADRID” PROTOCOL Drs. Luis Alcocer, Juan Ayala Mejías (Hospital Monográfico de Traumatología, Cirugía Ortopédica y Rehabilitación. ASEPEYO. Madrid) Canosa R, Gavín C. (Fundación Hospital Alcorcón) Estévez A. (Clínica N. S. de América) Vidal C. (Hospital Universitario 12 de Octubre)

PREOPERATIVE PROTOCOL Donor measurements • Meniscus • Tibial plateau Recipient measurements • True PA and lateral xray • CT: tibial plateau

INDICATIONS 1. Total meniscectomy , body and posterior horn 2. Age: < 55 y-o. 3. Sports and physical activities 4. Local untractable pain 5. No instability (? ) 6. Normal axial limb aligment (? ) 7. Outerbridge I and II grade (III, IV? )

Material and method 11 cases (4 rejected < 12 m f/u) OR Nov. 2001 – Jul 2003 Mean F/U (months) = 13. 6; r(8, 22) Labour activ.

Material and method

Material and method Months post-meniscectomy 35 (2 – 90) Nº of previous arthroscopies 2. 3 (1 -5)

Tibial plateau measurements (mean) Donor 35 mm x 49 mm Patient 32 mm x 46 mm

Material and method

Material and method Outerbridge chondral lesions

IKDC: subjective assessment Pre-op Post-op Symptoms 23. 75 25. 33 Sport activ. 27. 75 35. 76 TOTAL 38. 27 48. 72

IKDC: objective assessment PRE-OP/ POST-OP A (Normal) B (Nearly normal) C (Abnormal) D (Severely abnormal) Compartmental findings 2/4 1/1 3/1 1/1 Range of motion 5/6 2/1 Functional test 3/4 3/2 TOTAL 3/5 4/2 1/1

IKDC: objective assessment PRE-OP/ POST-OP TOTAL Lysholm 45/65. 75 (Abnormal/Fair) Tegner WOMAC 4. 5/3. 5 85. 5/86. 3 (120) (Mod. heavy work/recreational sports)

Follow-up: arthroscopy 2 revision arthroscopy • arthrofibrosis (4 th month) • infection vs. inmunologic response (11 th month)

Follow-up: arthroscopy/MRI Revision MRI (5 cases) • 5 peripherically healed • 4 body and/or anterior horn extruded • 5 intrasubstance degeneration

Follow-up: MRI 6 th month post-op

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

CONCLUSIONS • • • Promissing byological and mechanical results Good preliminary clinical results “Dissappointing” mid-term results (5 -10 years)

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