850 Boylston Street Chestnut Hill, MA 02467 T: 617-732-9967 F: 617-732-9272 www.cartilagerepaircenter.org Cartilage Repair Center Brigham and Women’s Hospital Harvard Medical School Safety, feasibility, and radiographic outcomes of the anterior meniscal takedown technique to approach chondral defects on the tibia and posterior femoral condyle: a matched control study Gergo Merkely MD 1, 2 Tom Minas MD, MS 1, 5 Takahiro Ogura MD 1, 3 Jakob Ackermann MD 1 Alexandre Barbieri Mestriner MD 1, 4 Andreas H. Gomoll, MD 1, 6 1 Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical Center, Boston, MA, USA 2 Department of Traumatology, Semmelweis University, Budapest, Hungary 3 Sports Medicine Center Funabashi Orthopedic Hospital Funabashi, Chiba, Japan 4 Universidade Federal de São Paulo, São Paulo, Brazil 5 Paley Orthopedic and Spine Institute, West Palm Beach, Florida, USA 6 Hospital for Special Surgery, New York, New York, USA
Transcript
850 Boylston StreetChestnut Hill, MA 02467T: 617-732-9967 F: 617-732-9272www.cartilagerepaircenter.org
Cartilage Repair CenterBrigham and Women’s Hospital
Harvard Medical School
Safety, feasibility, and radiographic outcomes of the anterior meniscal takedown technique to approach chondral defects on the tibia and posterior femoral
condyle: a matched control studyGergo Merkely MD 1, 2 Tom Minas MD, MS 1, 5 Takahiro Ogura MD 1, 3 Jakob Ackermann MD 1 Alexandre
Barbieri Mestriner MD 1, 4 Andreas H. Gomoll, MD 1, 6
1 Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical Center, Boston, MA, USA2 Department of Traumatology, Semmelweis University, Budapest, Hungary
3 Sports Medicine Center Funabashi Orthopedic HospitalFunabashi, Chiba, Japan
4 Universidade Federal de São Paulo, São Paulo, Brazil5 Paley Orthopedic and Spine Institute, West Palm Beach, Florida, USA
6 Hospital for Special Surgery, New York, New York, USA
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DisclosuresGergo Merkely MD• No financial conflicts to disclose.
Cartilage Repair Center
• Articular cartilage defect on the tibial plateau or posteriorfemoral condyle can be challenging to visualize and approach.
• To perform a thorough defect preparation and repair,hyperflexion of the knee and takedown of the anteriormeniscal horn is often necessary.
• After cartilage repair, transosseus sutures are used toreattach the anterior meniscal root to its insertion and theintermeniscal ligament is repaired.
• However, clinical evidence is lacking to support the safety ofthis technique.
Background
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• The aim of this study was to investigate whether meniscalextrusion develops after patients undergo meniscustakedown and transosseous refixation during autologouschondrocyte implantation (ACI).
• We hypothesized that anatomical repair usingtransosseous refixation of the anterior root of themeniscus in addition to repair of the intermeniscalligament would provide secure fixation.
Aim
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• We analyzed data from 124 patients with a mean follow-up of6.8 ± 2.5 years.
• Sixty-two patients who underwent ACI with anterior meniscustakedown and refixation by the senior surgeon, [TM], were comparedwith a matched control group of patients (by age, gender, BMI, defectsize, and affected compartment) who underwent ACI withoutmeniscus takedown.
• Meniscal extrusion was investigated by measuring the absolute valueand the relative percentage of extrusion (RPE) on 1.5-T magneticresonance images (MRI) at final follow-up.
• The number of menisci with radial displacement greater or lesser than3 mm was determined.
• In cases where a preoperative MRI was available, both pre- and post-operative meniscal extrusion was evaluated (n = 30) in those patientsundergoing meniscal takedown.
Methods
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Figure 1. Meniscalextrusion (meniscus iscontoured by the dashedline) is defined as thegreatest distance (a) fromthe most peripheral aspectof the meniscus to theborder of the tibia,excluding any osteophyteson coronal images. PRE isdefined as the percentageof the width of extrudedmenisci (a) compared withthe entire meniscal width (b)(RPE = a/b x 100).
Methods
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• In patients with a tibial plateau and/or posterior femoralcondyle defect, the anterior horn of the meniscus is reflected byincising the intermeniscal ligament and anterior root, and thenmobilizing the meniscus together with the joint capsule by sub-periosteal dissection off the tibia as a complete sleeve (Figures2A and 2B).
• The knee is hyperflexed, and the tibia externally rotated for themedial compartment and internally rotated for the lateralcompartment, providing excellent access to the defects.
• Following ACI, the meniscus was repaired with transosseous 1-0Vicryl sutures (Ethibond) using a tapered needle and theintermeniscal ligament was reduced and repaired. (Figure 2C).
Surgical Procedure
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Figure 2. Perioperative images of a patient who underwent autologouschondrocyte implantation (ACI) for a lateral tibial plateau defect with meniscustakedown and reattachment. (A) Image showing the takedown of theintermeniscal ligament and the anterior horn of the meniscus. (B) Image showingthe defect after ACI procedure. (C) Image showing transosseous refixation of theanterior meniscal horn with non-absorbable sutures and intermeniscal ligament(arrows) repair.
Surgical Procedure
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• Baseline demographics showed no significantdifferences between groups.
• The time to failure after ACI averaged 3.3 ± 1.7 years.
• Mean follow-up period was 3.2 ± 1.5 years (revision toOCA: 3.5 ± 1.7; primary OCA: 2.7 ± 0.9).
• There were no significant differences in reoperationrates and survival rates between the groups.
Results
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Table 1. Patients’ Demographics
Results
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Table 2. Comparison of Radial Displacement between Patients withMeniscal Refixation after Meniscus Takedown and Control Patientswithout Meniscus Takedown.
Results
Table 4. Pre- versus postoperative comparison of displacement inpatients with meniscus takedown
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• In conclusion, our matched cohort study identified overall low meniscus extrusion rates that were not different between patients with and without meniscal takedown during cartilage repair with ACI.
• Meniscal takedown and subsequent transosseousrefixation is a safe and effective technique for exposure of the tibial plateau and posterior femoral condyle.
Conclusion
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