About 50% of Meniscus Transplants Fail by Ten Years

Frank R. Noyes, M.D. President and Medical Director, Noyes Knee Institute and the Cincinnati Sports medicine Research and Education Foundation Cincinnati, OhioMedicalResearch.com Interview with:
Frank R. Noyes, M.D
.
President and Medical Director, Noyes Knee Institute
and the Cincinnati Sports medicine Research and Education Foundation
Cincinnati, Ohio

MedicalResearch: What is the background for this study?

Dr. Noyes: Meniscectomy, or removal of the meniscus in the knee, frequently leads to early arthritis – especially in younger active individuals. The meniscus provides a cushion between the femur (thigh bone) and tibia (shin bone) and aids in keeping the knee stable. There are two menisci in the human knee; one on the inner portion (medial) and one on the outer portion (lateral). The problem is that once a meniscus is removed, there are no options for patients who experience knee pain other than a transplant. The operation uses human cadaver menisci from young donors that are implanted intact into the recipient’s knee. This operation has been performed at our Center for 25 years in patients who are typically under the age of 50 and who have some arthritis in their knee and experience pain with activity. There are few long-term clinical studies on meniscus transplantation that provide results in patients who are at least 10 years postoperative.

MedicalResearch: What are the main findings?

Dr. Noyes: This study reports the long-term results and survival analysis of 40 consecutive meniscus transplants, with a 100% follow-up obtained an average of 11 years postoperatively. The survivor analysis, which included magnetic resonance imaging (MRI) and x-ray criteria in addition to symptoms and clinical examination, revealed transplant survival rates of 68% at 7 years and 48% at 10 years postoperatively. The results of the symptom and activity level analyses in patients without failure of the transplant showed that only 11% experienced pain with daily activities and 72% were able to participate in low-impact athletics many years after surgery.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Noyes: This data provides reasonable survival percentages regarding the potential to delay the necessity for subsequent major operations and improve knee-related symptoms in younger patients who are symptomatic after meniscectomy. Meniscus transplantation is recommended after total meniscectomy in patients under 50 years of age who have knee pain and in those who also have some arthritis in their joint. However, the longer-term function of meniscus transplants remains questionable because the survivorship rate decreased to 15% at 15 years. Patients should be advised that the procedure is not curative in the long-term. The goal is to buy as much time as possible before other surgery may be necessary.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Noyes: There are several important research areas which may improve the success rates of meniscus transplantation. These include issues related to transplant remodeling; collagen fiber restoration of microarchitecture to resist tensile, compressive, and shear forces; transplant collagen matrix changes with altered material and structural properties; cellular repopulation and function in maintaining transplant homeostasis; role of fresh transplants with viable cells; and the role of meniscus scaffolds, tissue engineering, and possible meniscus prosthetic devices.

Citation:

R. Noyes, S. D. Barber-Westin. Meniscal Transplantation in Symptomatic Patients Under Fifty Years of Age: Survivorship Analysis. The Journal of Bone & Joint Surgery, 2015; 97 (15): 1209 DOI: 10.2106/JBJS.N.01340

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Frank R. Noyes, M.D. (2015). About 50% of Meniscus Transplants Fail by Ten Years MedicalResearch.com

Last Updated on August 8, 2015 by Marie Benz MD FAAD