MENISCAL ALLOGRAFT TRANSPLANTATION (MAT) 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 R. Canosa, 3 C. Gavín, 3 C. Vidal 4 1. Hospital Monográfico de Traumatología, 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 GRUPO DE ESTUDIO DE MADRID PROTOCOL Drs. Luis Alcocer, Juan Ayala Mejías (Hospital Monográfico de Traumatología, Cirugía Ortopédica y Rehabilitación. ASEPEYO. Madrid) (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

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?) INDICATIONS

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

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

Outerbridge chondral lesions

IKDC: subjective assessment Pre-opPost-op Symptoms Sport activ TOTAL

IKDC: objective assessment PRE-OP/POST-OP A (Normal) B (Nearly normal) C (Abnormal) D (Severely abnormal) Compartmental findings 2/41/13/11/1 Range of motion 5/62/1 Functional test 3/43/21/1 TOTAL3/54/2

IKDC: objective assessment PRE-OP/POST-OPLysholmTegnerWOMAC TOTAL45/65.75(Abnormal/Fair)4.5/3.5 (Mod. heavy work/recreational sports) 85.5/86.3(120)

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

Follow-up: MRI 6 th month post-op

OUR 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 Fix ® MI, Sharp Shutter ® ME)Posterior horn suture (Fast Fix ® MI, Sharp Shutter ® ME) Meniscus body (Sharp Shutter ® )Meniscus body (Sharp Shutter ® ) Anterior horn suture (outside-in)Anterior horn suture (outside-in)

CONCLUSIONS Promissing byological and mechanical resultsPromissing byological and mechanical results Good preliminary clinical resultsGood preliminary clinical results Dissappointing mid-term results (5-10 years)Dissappointing mid-term results (5-10 years)

¡MUCHAS GRACIAS! THANK YOU !