More good news about the potential benefits of meniscal allograft transplantation!

 

10-Year Survival and Clinical Improvement of Meniscal Allograft Transplantation in Early to Moderate Knee Osteoarthritis
Romandini et al. American Journal of Sports Medicine 2024; 52(8): 1997-2007
https://pubmed.ncbi.nlm.nih.gov/38857030/

Everyone knows that if you lose one of your meniscal cartilages in your knee, then there’s a very significantly increased risk that you’ll end up with premature osteoarthritis in that side of your knee. What a lot of people still don’t seem to know, however, is that a missing meniscus can very effectively be replaced with a new meniscus from a donor, by meniscal allograft transplantation.

Meniscal transplantation is known to have a success rate in the region of about 80 to 85% at 5-year follow-up.1 What is also known is that the longer a knee is left without a meniscus, and more degenerative damage develops in the joint, then the lower the chances are that a good outcome will actually be achieved from meniscal transplantation surgery. For this reason, whilst it is not normally considered appropriate to replace a missing meniscus in someone with no actual symptoms (i.e. for just prophylactic reasons only), it is also accepted that the sooner a meniscus is replaced (particularly in a younger patient), then the better the long-term prognosis for their knee is likely to be.

At the other end of the spectrum, we often see patients who have previously torn one of their meniscal cartilages and who may have had surgery to trim the torn cartilage (to relieve them of the symptoms of their meniscal tear), but who have simply left their knee for years, and they may present with more advanced degenerative changes in their knee.

In ‘older’ (> 50 years) patients with fully-blown arthritis (where the articular cartilage in the knee has worn away completely, and where there is bare bone exposed in the joint), the solution is normally artificial joint replacement with either a partial or a total knee replacement. Modern day knee replacement surgery, with the very best custom-made knee prostheses, gives excellent results. However, the younger a patient is when they have a knee replacement, then the bigger the risk of the prosthesis wearing out within their lifetime and needing a re-do (a revision). This is why we try to avoid / delay knee replacement surgery in younger patients, if possible.

There is a cohort of patients, however, who have previously lost a meniscus in their knee, who have developed degenerative changes as a result, but whose knees are not bad enough yet and who are too young still for knee replacement surgery – this group of patients represent a particular challenge!

In this recent paper by Romandini et al., from Bologna, the authors looked at the outcomes of 47 patients with symptomatic early to moderate knee osteoarthritis (Kellgren-Lawrence Grade 2 or 3) undergoing meniscal allograft transplantation, with a minimum of 10 years follow-up. They showed a significant improvement in all clinical outcomes scores. Of their 47 patients, 5 required re-operation, and were considered ‘surgical failures’. A further 15 patients had low knee outcomes scores (using the Lysholm knee score) and were therefore considered ‘clinical failures’. This means, however, that nearly 60% of the patients could be considered as ‘successes’ at 10-year follow-up, which (considering how very difficult this group of patients is to treat successfully) is a very positive outcome.

This latest research suggests that meniscal allograft transplantation can actually be offered to patients even if early, or even moderate osteoarthritis has already developed in the patient’s knee, with nearly 60% positive outcomes to be expected at 10-year follow-up.

What this paper suggests quite strongly to me is that there are probably far more people out there who would actually benefit from meniscal transplantation than are actually even aware of the existence of this surgical option. With time, hopefully more clinicians and more patients will actually become aware of meniscal allograft transplantation surgery and its indications and its potential benefits.

To find out more about meniscal transplantation:

 

  1. The results of meniscal allograft transplantation surgery: what is success? Searle H, Asopa V, Coleman S and McDermott I.BMS Musculoskeletal Disorders 2020; 21(1): 159. https://doi.org/10.1186/s12891-020-3165-0

 

 

 

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30 October 2024

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