Meniscal Allografts & Cartilage Surgery in ACL revision surgery

Transcription

1 Meniscal Allografts & Cartilage Surgery in ACL revision surgery Peter Verdonk, MD, PhD Department of Orthopaedic Surgery, Ghent University Hospital, Belgium 1

2 Introduction Outcome after ACL reconstruction 2

3 Introduction 10 years follow-up Dejour H, Dejour D, Ait Si Selmi, RCO 1999 Hertel P, KSSTA 2005 Lerat JL, Chotel F, RCO 1998 Salmon LJ, Am J Sports Med 2006 Shelbourne KD, Am J Sports Med 2000 Wu WH, Am J Sports Med years follow-up Ait Si Selmi T, T Fithian D, D Neyret P, P The Knee 2006 Chol C, C Ait Si Selmi T,Chambat T P, P Neyret P, P RCO 2002 Drogset JO,Engebretsen L, JBJS Am years follow-up Yamaguchi S, Sasho T, Tsuchiya A, Wada Y, Moriya H., KSSTA 2006 Jerome Pernin These, Lyon, Centre Livet, Prof Neyret et Prof Massin 2006

4 Meniscus & ACL reconstruction 4

5 Meniscus & ACL reconstruction history of medial meniscectomy Arthrosis

6 Meniscus & Osteoarthritis after ACL reconstruction follow-up 11.5 years follow-up 24.5 years

7 Meniscus & AP laxity after ACL reconstruction history of medial meniscectomy increased AP laxity 7

8 Meniscus & ACL reconstruction meniscectomy x osteoarthritis medial meniscectomy... greater AP laxity 8

9 Cartilage & ACL reconstruction 9

10 Cartilage & ACL reconstruction 5-17x osteoarthritis 10

11 protection Conclusion...of the introduction!!! ACL reconstruction protection protection The three musketeers: all for one & one for all meniscus protection cartilage 11

12 So...is there an indication for cartilage and meniscus transplantation in combination with ACL surgery? 12

13 Meniscus allograft transplantation in combination with ACL surgery 13

14 Surgical Technique Surgical technique mini-open or arthroscopic tunnels for ACL Open surgery for meniscus transplant MCL or LCL+Pop release by osteotomy of femoral side All inside sutures Fixation to meniscal rim and horns Additional tag for anterior horn Arthroscopy for meniscus transplant two bony tunnels all inside, inside-out out, outside-in in Fixation of ACL graft

15 Surgical Technique Surgical Technique: open Verdonk P et al. Surgical Technique: Viable Meniscal allograft Transplantation. JBJS Am 2006

16 Surgical Technique Surgical technique: Artroscopy 16 16

17 Survivorship analysis of meniscus transplantation Only two true survival analysis available in the literature: van Arkel ER, de Boer HH. Survival analysis of human meniscal transplantations. JBJS (B )2002 ;84(2): CRYOPRESERVED (mean follow-up 5 years) Verdonk PCM et al. Viable meniscal allograft transplantation... JBJS (A) VIABLE (mean follow-up 7.2 years) Mean Survival Time / Survival Rate at 10 y anterior cruciate ligament deficient knees Medial allografts: 5.75 y / 50.6% vs 11.6 y / 74.2% Lateral allografts: 9.25 y / 76.54% vs 11.6 y / 69.8% Failure rate: 13/63 (21%) vs 21/100 (21%)

18 MMT+ACL Rueff D, Nyland J, Kocabey Y, Chang HC, Caborn DN. Selfreported patient outcome at a minimum of 5 years after allograft ACL recon with or without medial meniscal allograft transplant. Arthroscopy 2006;22: Graf KW, Sekiya JK, Wojtis EM. Long-term results after combined medial meniscal allograft transplantation and ACL recon. Arthroscopy 2004;20: comparable clinical and functional outcome 18

19 Cartilage Surgery in combination with ACL Reconstruction 19

20 Surgical Technique first procedure biopsy second procedure ACL tunnel preparation defect debridement and suturing of the membrane ACL graft fixation injection of cell suspension 20

21 Results of cartilage surgery in combination with ACL reconstruction Cartilage surgery for SYMPTOMATIC lesions+acl good clinical outcome 21

22 Conclusions 22

23 ...meniscal and cartilage defects have a negative effect on the long term outcome after ACL reconstruction... 23

24 meniscus allograft & ACL recon cartilage transplantation & ACL recon...successful procedure in the short run...technically demanding...time comsuming...long TERM RESULSTS????? 24

25 ... future directions arthroscopic less invasive techniques 25

26 meniscus surgery scaffolds... CMI (Regen Biotechnologies) DynaKnee (Orteq) 26

27 cartilage surgery arthroscopic techniques QuickTime en een Cinepak-decompressor zijn vereist om deze afbeelding weer te geven. 27

28 Merci beaucoup pour votre attention 28