Viabilni i smrznuti transplantat meniska. Rana klinička i radiološka evaluacija

Aim: To perform a clinical and imaging short term evaluation of viable and frozen meniscus allografts. Methods and materials: Between 2005 and 2006, 12 meniscal allograft transplantations were performed in our institution. The study population consisted of 5 men and 7 women with a mean age of 36.4 years (range 17.1-42.5). Six patients received a viable allograft and six a deep-frozen one. All allografts were harvested from donors who died after a short disease. All patients were operated with an open surgical technique (medial or lateral arthrotomy) and soft tissue fixation with secure anterior and posterior horn fixation, performed by one senior surgeon. All patients were scored pre-operatively, at 6 weeks, 3 months, 6 months, 1 and 2 years postoperatively. Three questionnaires were used to score the patients clinically (KOOS, modified HSS and SF-36 questionnaire). Every patient received radiographs pre-operatively and at 6 months and 1 year. Results: Clinically, there was no difference in patient self-reported results through questionnaires or in a questionnaire based on clinical examination. There was no significant progress in joint space narrowing on weight bearing and Rosenberg view radiographs. Conclusion: Our results suggest that there are no clinical significant differences between the viable and the deep frozen subgroup after two years.Cilj: Učiniti ranu kliničku i radiološku evaluaciju vijabilnog i smrznutog transplantata meniska. Metoda i materijali: Tijekom 2005. i 2006. godine, u našoj ustanovi izvedeno je 12 alotransplantacija meniska. U studiju je bilo uključeno 5 muškaraca i 7 žena, s prosječnom dobi od 36,4 godina (raspon od 17,1 do 42,5). U šest pacijenata presađen je vijabilni transplantat, u šest duboko smrznuti transplantat. Svi transplantati su dobiveni od davatelja koji su umrli nakon kratke bolesti. Svi pacijenti operirani su otvorenim kirurškim zahvatom (medijalna ili lateralna artrotomija), uz fiksaciju mekih tkiva i fiksaciju prednjeg i stražnjeg roga. Svi pacijenti su evaluirani preoperativno, te 6 tjedana, 3 mjeseca, 6 mjeseci, jednu i dvije godine nakon operacije. Za kliničku evaluaciju bolesnika korištena su tri upitnika (KOOS, adaptirani HSS i SF-36 upitnik). Svakom pacijentu je učinjena rendgenska slika preoperativno, nakon 6 mjeseci i nakon jedne godine. Rezultati: Klinički, nije bilo razlika između rezultata koje su bolesnici samostalno naveli u upitnicima i onih dobivenih temeljem kliničkog pregleda. Rendgenska slika po Rosenbergu nije pokazala značajni pomak u suženju zglobne pukotine pod opterećenjem. Zaključak: Naši rezultati ukazuju na to da nakon dvije godine ne postoje klinički značajne razlike između transplantacije vijabilnog i duboko smrznutog transplantata

Traumatic lesions in a stable knee : masterly neglect - meniscectomy - repair

Traumatic meniscal tears are common injuries of the knee joint. In order to choose the treatment modality that best suits the needs of the individual patient, a well-structured assessment and thorough clinical examination are mandatory. An MRI is helpful for planning the procedure and defining the exact tear location. Small asymptomatic tears can often be treated conservatively (“masterly neglect”). If surgical treatment is necessary, as much viable meniscus tissue as possible should be preserved. Tears of the vascular zone usually can be treated by refixation, whereas tears of the avascular zone are treated by partial resection. Due to its biomechanical properties and chondroprotective function, preserving the meniscus is of high importance to avoid early degenerative changes of the knee joint