Allograft Meniscus Transplantations More Successful in Younger Patients

Today during a media briefing at the American Academy of Orthopaedic Surgeons' 70th Annual Meeting in New Orleans, Brian J. Cole, MD, Medical Director, Rush Cartilage Restoration Center, Division of Sports Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, discussed the indications, and surgical techniques used in meniscus replacement surgery.

"Transplanting an allograft or donor meniscus, the crescent-shaped cartilage cushion in the knee joint that helps the joint bear weight, glide, and turn, may be indicated in a patient with a defective meniscus or in one who has undergone the removal of the meniscus because of a tear or other injury," explained Dr. Cole. "The patient usually has symptoms of joint overload, such as pain and swelling."

Dr. Cole and his researchers recommend doing only toe-touch weight-bearing exercises with the knee in full extension for the first four weeks following the procedure, with progression to full weight-bearing exercises after four weeks. Squatting and hyper-flexion are discouraged for the first six months following transplantation. A light running program may begin at three to four months, followed by return to light recreational activities by five to six months following the procedure.

"High-load, repetitive impact activities have generally been discouraged for patients, although as transplants are performed earlier, patients are successfully returning to these higher load activities," explained Dr. Cole.

Cole and his colleagues have found that allograft meniscus transplantation is most often successful in younger patients (upper age limits of 50 to 55 years) with a stable knee joint and undamaged cartilage and whose symptoms of pain and swelling are localized in the affected joint. Magnetic resonance imaging (MRI) with high-resolution cartilage pulse-sequences, weight-bearing radiographs, and long-leg films are often the best means of evaluating and selecting patients for the transplant procedure.

"As with any allograft transplantation, appropriate donor screening and careful implant sterilization and preservation are vital to a successful outcome," stated Dr. Cole. "The risks associated with allograft meniscus for viral contamination are one out of every 1,600,000 to one in every 1.2 billion, and HIV one out of every 1,667,000. The tissue has to be transplanted within 24 hours."

The 26,047-member American Academy of Orthopaedic Surgeons (www.aaos.org or http://orthoinfo.aaos.org) is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals, and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (http://www.usbjd.org ) the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research, and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy's Annual Meeting is being held February 5-9, 2003, at the Ernest N. Morial Convention Center in New Orleans, La.