Meniscus transplant

Last updated
Meniscus transplant
Other namesMeniscal transplant
Specialty orthopedic

A meniscus transplant or meniscal transplant is a transplant of the meniscus of the knee, which separates the thigh bone (femur) from the lower leg bone (tibia). The worn or damaged meniscus is removed and is replaced with a new one from a donor. The meniscus to be transplanted is taken from a cadaver, and, as such, is known as an allograft. Meniscal transplantation is technically difficult, as it must be sized accurately for each person, positioned properly and secured to the tibial plateau. [1] Its success also depends on donor compatibility, stability of the transplant, and long-term health of the underlying articular cartilage. [1]

Contents

Background

Each knee has an inside (medial) and an outside (lateral) meniscus. The menisci play several key roles that are vital in maintaining the health of the knee. [2] Specifically, they act as shock absorbers and load sharers, increase the stability of the knee, and provide lubrication and nutrition to the bearing surface (articular cartilage) of the knee. [3] [4] [5] [6]

They were once thought of as vestigial structures that served no real purpose. [7] If injured and problematic, they were routinely excised through a procedure called meniscectomy. [7] It is now known that a knee joint without healthy menisci is at significantly increased risk of developing wear and tear arthritis (post-traumatic or osteoarthritis). [8] [9] The arthritis is a result of the increased contact forces and shear that results from loss of shock absorption and stability after meniscectomy. [10] [11] [12] [13] For this reason, current surgical strategies are focused on preserving as much of the meniscus as possible or replacing it if necessary. [14]

Certain meniscal tears are repairable with sutures, predominantly those that are freshly torn and involve healthy tissue. [15] The closer the tear is to the peripheral blood supply the higher the likelihood of successful repair. [15] [16] Patients with unrepairable meniscal injuries usually have symptoms of pain, catching, swelling or locking in the knee. [17] The surgeon may perform a partial or complete meniscectomy to alleviate the symptoms in the short-term. [17] The more meniscal tissue removed, the higher the likelihood of subsequently developing arthritis. [9] Recognizing the biomechanical importance of the menisci, surgeons in the late 1980s proposed meniscus transplantation and meniscus reconstruction as two new surgical options for the patient with a meniscus deficient knee. [18] [19] [20]

Recognizing from experiments performed by R.J. Webber, PhD [21] that meniscus cells have the ability to grow in tissue culture, K.R. Stone, M.D. developed the first meniscus reconstruction device called a collagen regeneration template in 1986. [20] The template or scaffold was composed of glycosaminoglycan (sugar/proteins that make up cartilage tissue) and was designed to have pores into which cells could grow. Its cross-linking preserved the scaffold in the knee joint long enough for new meniscus tissue to grow into it. [20] (Patents 5,158,574, 5,116,374, 5,007,934) This scaffold was tested in animals and subsequently in people and was found to successfully replace lost segments of meniscus tissue [19] [20] [22] (Fig 1). It became widely available in Europe and temporarily in the US in 2009. However, in cases where large areas of meniscus are missing, full intact meniscus transplantation has been suggested. [22] [23]

Indications for meniscus transplantation

Most people who are meniscus deficient already have some arthritic changes in their knee. [24] Early reports of meniscus transplantation done in arthritic knees suggested a higher incidence of transplantation failure if the irregular cartilage surfaces were not simultaneously addressed with cartilage grafting techniques. [25] [26] Therefore, the standard orthopaedic literature recommended that meniscus transplantation be performed in meniscus deficient patients only if they are young and free from arthritis of the knee. [26] [27] [28] [29] The most recently published indications for meniscal transplantation include: [26]

In the same textbook, contraindications are listed as:

Debate of indications

Many orthopaedists have challenged these contraindications and have advocated meniscal transplantation, in conjunction with cartilage repair, ACL reconstruction or osteotomy in patients with evidence of arthritic deterioration, instability or malalignment. [18] [24] One paper demonstrated that results of meniscus transplantation in patients with arthritic changes were similar to that of previous reports of meniscus transplantation in patients without arthritic changes, so long as articular cartilage defects were addressed at the time of surgery. [24] In the same paper, the success of meniscus transplantation was not affected by mal-alignment. [24]

Meniscus transplant preparations

Meniscus tissue processing

Meniscal allograft processing, sterilization and storage procedures vary from center to center. [30] Some surgeons, particularly in Europe, prefer to harvest the meniscal graft themselves in a sterile fashion and use them when they are fresh, usually within two weeks of procurement. [30] On the other hand, some American centers harvest the graft outside of a sterile operating room environment and then perform a sterilization wash. [30] These grafts are then packaged and frozen at -80 °C, until they are to be transplanted. To decrease the risk of disease transmission, irradiating the graft has been used in the past to enhance sterilization. [30] However, it has been shown to degrade most collagen-based tissues and the meniscus is particularly susceptible. [31] Tissue preservation techniques such as cryo-preservation and freeze-drying have shown little benefit and have generally been abandoned except by a few tissue banks. [30]

Meniscus tissue sizing

Matching the size of the donor knee to the size of the recipient knee is crucial for successful meniscus transplantation. [32] [33] Studies by Pollard et al. noted the radiographic (x-ray) measurements provided an indication of meniscus size based on the width of the tibial plateau. [34] However, inherent variability in both the positioning of the knee and the direction of the x-ray beam, as well as human error contribute to some inaccuracy of these measurements. Sizing has been made more accurate with the use of MRI. [35] Matching by sex, height, and weight has been shown to be nearly as accurate as radiographic techniques (0.72 correlation of height to tibial width) and has been adopted by a number of centers. [36]

Surgical technique

Various meniscal transplant techniques have been described, all of which are considered surgically demanding. [30] All involve arthroscopy and some require open surgery, as well. Some surgeons leave the allograft anchored to its bony attachments and fix these bone bridges or plugs into size matched slots, troughs or holes. [29] [37] [38] Other surgeons use tunnels through which they pass sutures that hold the allograft in place. [24] [39] Additional sutures are also used to attach the allograft to the remnant of native meniscus. [37] Important points include obtaining stable and anatomic fixation of the horns of the meniscus and securing the meniscus rim to the tibia. Securing the graft in this way preserves the hoop (concentric) stresses of the meniscus. [40] [41] Meniscus extrusion or shrinking has been noted and may be in part a function of sewing the meniscus too tightly to the synovium rather than restoring the meniscus tibial ligamentous attachments. [40] [42]

Post-op meniscus transplantation programs

Post-operatively, meniscus transplant patients enter specific rehabilitation programs, aimed at decreasing pain and swelling, optimizing range of motion and strength, while avoiding injury to the healing meniscal allograft. [37] Most patients are allowed partial weight bearing in extension immediately as it stabilizes the meniscus on the surface of the tibia. [37]

Results

Multiple articles report the results of meniscal transplantation. [43] Unfortunately, because these studies are mainly uncontrolled, retrospective case series, drawing conclusions regarding meniscal transplantation is difficult. [43] No study has compared meniscus deficient patients who received meniscal transplantation with those who did not. [43] Designing and conducting a study in this way is difficult. [43] A recent systematic review of the literature determined that “good early and midterm results of cryo-preserved or fresh-frozen, non-irradiated meniscal allograft transplantation can be achieved in a relatively young patient with only mild chondromalacia (lower than Outerbridge grade 3) [cartilage degeneration] who is not overweight and has a stable, mechanically aligned lower extremity, if the allograft is sized radiographically by use of anteroposterior and lateral films and the allograft meniscal horns have bony attachments and are fixed by bony techniques..." [43] However, Stone et al. published long-term results of meniscus transplantation with simultaneous repair of the articular cartilage and demonstrated a mean estimated procedure survival time of 9.9 years. Significant improvements in pain relief, activity, and function were found over the course of follow-up indicating patients improve significantly within the first two years after surgery and that these improvements are maintained over time. [24]

Controversies

There is a lack of consensus between surgeons in key areas of meniscal transplantation. [30] [43] Questions remain concerning indications, long-term efficacy, as well as allograft sizing, processing and fixation techniques. [1] [43] Most surgeons, however, agree that meniscal transplantation seems to afford at least short- to medium-term benefit. [17] [27] [37] [38] [43] [44]

Meniscal transplantation is a novel surgical technique designed to improve the biology and biomechanics of a meniscus deficient knee. [1] Improvements in short-term and long-term subjective and objective outcome measures have been demonstrated. [1]

Related Research Articles

<span class="mw-page-title-main">Knee</span> Leg joint in primates

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

<span class="mw-page-title-main">Arthroscopy</span> Medical procedure

Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed during ACL reconstruction.

<span class="mw-page-title-main">Posterior cruciate ligament</span> One of four major ligaments of the knee

The posterior cruciate ligament (PCL) is a ligament in each knee of humans and various other animals. It works as a counterpart to the anterior cruciate ligament (ACL). It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.

<span class="mw-page-title-main">Anterior cruciate ligament</span> Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are also called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate translates to cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an "X". It is composed of strong, fibrous material and assists in controlling excessive motion. This is done by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most injured ligament of the four located in the knee.

<span class="mw-page-title-main">Osgood–Schlatter disease</span> Inflammation of the patellar ligament

Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis). It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.

<span class="mw-page-title-main">Anterior cruciate ligament reconstruction</span> Surgical process

Anterior cruciate ligament reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament can either be removed from the knee, or preserved before reconstruction through an arthroscopic procedure. ACL repair is also a surgical option. This involves repairing the ACL by re-attaching it, instead of performing a reconstruction. Theoretical advantages of repair include faster recovery and a lack of donor site morbidity, but randomised controlled trials and long-term data regarding re-rupture rates using contemporary surgical techniques are lacking.

<span class="mw-page-title-main">Meniscus (anatomy)</span> Fibrocartilaginous part of a bone joint

A meniscus is a crescent-shaped fibrocartilaginous anatomical structure that, in contrast to an articular disc, only partly divides a joint cavity. In humans, they are present in the knee, wrist, acromioclavicular, sternoclavicular, and temporomandibular joints; in other animals they may be present in other joints.

<span class="mw-page-title-main">Osteochondritis dissecans</span> Ischemic bone disease

Osteochondritis dissecans is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. OCD usually causes pain during and after sports. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement.

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<span class="mw-page-title-main">Meniscal cartilage replacement therapy</span>

Meniscal cartilage replacement therapy is surgical replacement of the meniscus of the knee as a treatment for where the meniscus is so damaged that it would otherwise need to be removed.

<span class="mw-page-title-main">Unhappy triad</span> Medical condition of the knee

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

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<span class="mw-page-title-main">Meniscus tear</span> Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

Articular cartilage repair treatment involves the repair of the surface of the articular joint's hyaline cartilage, though these solutions do not perfectly restore the articular cartilage. These treatments have been shown to have positive results for patients who have articular cartilage damage. They can provide some measure of pain relief, while slowing down the accumulation of damage, or delaying the need for joint replacement surgery.

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Mesenchymal stem cells (MSCs) are multipotent cells found in multiple human adult tissues, including bone marrow, synovial tissues, and adipose tissues. Since they are derived from the mesoderm, they have been shown to differentiate into bone, cartilage, muscle, and adipose tissue. MSCs from embryonic sources have shown promise scientifically while creating significant controversy. As a result, many researchers have focused on adult stem cells, or stem cells isolated from adult humans that can be transplanted into damaged tissue.

Kevin Robert Stone is an American physician, orthopedic surgeon, clinician, researcher, and company founder of The Stone Clinic and the Stone Research Foundation in San Francisco.

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References

  1. 1 2 3 4 5 Twomey-Kozak J, Jayasuriya CT (January 2020). "Meniscus Repair and Regeneration: A Systematic Review from a Basic and Translational Science Perspective". Clinics in Sports Medicine. 39 (1): 125–163. doi:10.1016/j.csm.2019.08.003. PMC   6884076 . PMID   31767102.
  2. ↑ Swenson, TM; Harner, CD (Jul 1995). "Knee ligament and meniscal injuries. Current concepts". The Orthopedic Clinics of North America. 26 (3): 529–46. doi:10.1016/S0030-5898(20)32014-9. PMID   7609964.
  3. ↑ Henning, CE; Lynch, MA (Apr 1985). "Current concepts of meniscal function and pathology". Clinics in Sports Medicine. 4 (2): 259–65. doi:10.1016/S0278-5919(20)31233-3. PMID   3838702.
  4. ↑ Levy, IM; Torzilli, PA; Gould, JD; Warren, RF (Mar 1989). "The effect of lateral meniscectomy on motion of the knee". The Journal of Bone and Joint Surgery. American Volume. 71 (3): 401–6. doi:10.2106/00004623-198971030-00014. PMID   2925713.
  5. ↑ Levy, IM; Torzilli, PA; Warren, RF (Jul 1982). "The effect of medial meniscectomy on anterior-posterior motion of the knee". The Journal of Bone and Joint Surgery. American Volume. 64 (6): 883–8. doi:10.2106/00004623-198264060-00011. PMID   6896333.
  6. ↑ Seedhom, BB; Dowson, D; Wright, V (Jan 1974). "Proceedings: Functions of the menisci. A preliminary study". Annals of the Rheumatic Diseases. 33 (1): 111. doi:10.1136/ard.33.1.111. PMC   1006215 . PMID   4821376.
  7. 1 2 McMurray, T. P. (1 April 1942). "The semilunar cartilages". British Journal of Surgery. 29 (116): 407–414. doi:10.1002/bjs.18002911612. S2CID   72803852.
  8. ↑ Wilson W, van Rietbergen B, van Donkelaar CC, Huiskes R (Jun 2003). "Pathways of load-induced cartilage damage causing cartilage degeneration in the knee after meniscectomy". Journal of Biomechanics. 36 (6): 845–51. doi:10.1016/s0021-9290(03)00004-6. PMID   12742452.
  9. 1 2 Peña, E; Calvo, B; Martínez, MA; Palanca, D; Doblaré, M (Jun 2005). "Finite element analysis of the effect of meniscal tears and meniscectomies on human knee biomechanics". Clinical Biomechanics (Bristol, Avon). 20 (5): 498–507. doi:10.1016/j.clinbiomech.2005.01.009. PMID   15836937.
  10. ↑ McNicholas, MJ; Rowley, DI; McGurty, D; Adalberth, T; Abdon, P; Lindstrand, A; Lohmander, LS (Mar 2000). "Total meniscectomy in adolescence. A thirty-year follow-up". The Journal of Bone and Joint Surgery. British Volume. 82 (2): 217–21. doi:10.1302/0301-620x.82b2.0820217. PMID   10755429.
  11. ↑ Rockborn, P; Messner, K (2000). "Long-term results of meniscus repair and meniscectomy: a 13-year functional and radiographic follow-up study". Knee Surgery, Sports Traumatology, Arthroscopy. 8 (1): 2–10. doi:10.1007/s001670050002. PMID   10663312. S2CID   24847895.
  12. ↑ Roos, H; Laurén, M; Adalberth, T; Roos, EM; Jonsson, K; Lohmander, LS (Apr 1998). "Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls". Arthritis and Rheumatism. 41 (4): 687–93. doi:10.1002/1529-0131(199804)41:4<687::AID-ART16>3.0.CO;2-2. PMID   9550478.
  13. ↑ Roos, EM; Ostenberg, A; Roos, H; Ekdahl, C; Lohmander, LS (May 2001). "Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls". Osteoarthritis and Cartilage. 9 (4): 316–24. doi: 10.1053/joca.2000.0391 . PMID   11399095.
  14. ↑ Lee, SJ; Aadalen, KJ; Malaviya, P; Lorenz, EP; Hayden, JK; Farr, J; Kang, RW; Cole, BJ (Aug 2006). "Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee". The American Journal of Sports Medicine. 34 (8): 1334–44. doi:10.1177/0363546506286786. PMID   16636354. S2CID   26404505.
  15. 1 2 Venkatachalam, S; Godsiff, SP; Harding, ML (Jun 2001). "Review of the clinical results of arthroscopic meniscal repair". The Knee. 8 (2): 129–33. doi:10.1016/s0968-0160(01)00061-8. PMID   11337239.
  16. ↑ Arnoczky, SP; Warren, RF (May–Jun 1983). "The microvasculature of the meniscus and its response to injury. An experimental study in the dog". The American Journal of Sports Medicine. 11 (3): 131–41. doi:10.1177/036354658301100305. PMID   6688156. S2CID   36627496.
  17. 1 2 3 McDermott, I (Apr 2011). "Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee". British Journal of Sports Medicine. 45 (4): 292–7. doi:10.1136/bjsm.2010.081257. PMID   21297172. S2CID   1234837.
  18. 1 2 Milachowski, KA; Weismeier, K; Wirth, CJ (1989). "Homologous meniscus transplantation. Experimental and clinical results". International Orthopaedics. 13 (1): 1–11. doi:10.1007/bf00266715. PMID   2722311. S2CID   21438778.
  19. 1 2 Stone, KR; Steadman, JR; Rodkey, WG; Li, ST (Dec 1997). "Regeneration of meniscal cartilage with use of a collagen scaffold. Analysis of preliminary data". The Journal of Bone and Joint Surgery. American Volume. 79 (12): 1770–7. CiteSeerX   10.1.1.1016.5479 . doi:10.2106/00004623-199712000-00002. PMID   9409790. S2CID   23551862.
  20. 1 2 3 4 Stone, KR; Rodkey, WG; Webber, RJ; McKinney, L; Steadman, JR (Mar 1990). "Future directions. Collagen-based prostheses for meniscal regeneration". Clinical Orthopaedics and Related Research (252): 129–35. doi:10.1097/00003086-199003000-00018. PMID   2406067.
  21. ↑ Webber, RJ; York, JL; Vanderschilden, JL; Hough AJ, Jr (May–Jun 1989). "An organ culture model for assaying wound repair of the fibrocartilaginous knee joint meniscus". The American Journal of Sports Medicine. 17 (3): 393–400. doi:10.1177/036354658901700314. PMID   2729490. S2CID   6787273.
  22. 1 2 Stone, KR (Jul 1996). "Meniscus replacement". Clinics in Sports Medicine. 15 (3): 557–71. doi:10.1016/S0278-5919(20)30112-5. PMID   8800536.
  23. ↑ Kuhn, JE; Wojtys, EM (Jul 1996). "Allograft meniscus transplantation". Clinics in Sports Medicine. 15 (3): 537–6. doi:10.1016/S0278-5919(20)30111-3. PMID   8800535.
  24. 1 2 3 4 5 6 Stone, KR; Adelson, WS; Pelsis, JR; Walgenbach, AW; Turek, TJ (Jul 2010). "Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage: a prospective two- to 12-year follow-up report". The Journal of Bone and Joint Surgery. British Volume. 92 (7): 941–8. doi: 10.1302/0301-620X.92B7.23182 . PMID   20595111. S2CID   11758400.
  25. ↑ Cameron, JC; Saha, S (Apr 1997). "Meniscal allograft transplantation for unicompartmental arthritis of the knee". Clinical Orthopaedics and Related Research. 337 (337): 164–71. doi:10.1097/00003086-199704000-00018. PMID   9137187. S2CID   36984788.
  26. 1 2 3 Noyes, FR; Barber-Westin, SD (2005). "Meniscus transplantation: indications, techniques, clinical outcomes". Instructional Course Lectures. 54: 341–53. PMID   15948463.
  27. 1 2 Verdonk, R; Almqvist, KF; Huysse, W; Verdonk, PC (Sep 2007). "Meniscal allografts: indications and outcomes". Sports Medicine and Arthroscopy Review. 15 (3): 121–5. doi:10.1097/JSA.0b013e318140002c. PMID   17700371. S2CID   2425860.
  28. ↑ Cole, BJ; Carter, TR; Rodeo, SA (2003). "Allograft meniscal transplantation: background, techniques, and results". Instructional Course Lectures. 52: 383–96. PMID   12690865.
  29. 1 2 Friel, Nicole A.; Cole, Brian J. (1 January 2010). "Sports Medicine". Current Orthopaedic Practice. 21 (1): 22–26. doi:10.1097/BCO.0b013e3181c78f8d. S2CID   75849935.
  30. 1 2 3 4 5 6 7 McDermott, ID (Feb 2010). "What tissue bankers should know about the use of allograft meniscus in orthopaedics". Cell and Tissue Banking. 11 (1): 75–85. doi:10.1007/s10561-009-9127-2. PMID   19387868. S2CID   23882232.
  31. ↑ Cheung, DT; Perelman, N; Tong, D; Nimni, ME (May 1990). "The effect of gamma-irradiation on collagen molecules, isolated alpha-chains, and crosslinked native fibers". Journal of Biomedical Materials Research. 24 (5): 581–9. doi:10.1002/jbm.820240505. PMID   2324128.
  32. ↑ Sekaran, SV; Hull, ML; Howell, SM (Jan–Feb 2002). "Nonanatomic location of the posterior horn of a medial meniscal autograft implanted in a cadaveric knee adversely affects the pressure distribution on the tibial plateau". The American Journal of Sports Medicine. 30 (1): 74–82. doi:10.1177/03635465020300012601. PMID   11799000. S2CID   3900315.
  33. ↑ Dienst, M; Greis, PE; Ellis, BJ; Bachus, KN; Burks, RT (Jan 2007). "Effect of lateral meniscal allograft sizing on contact mechanics of the lateral tibial plateau: an experimental study in human cadaveric knee joints". The American Journal of Sports Medicine. 35 (1): 34–42. doi:10.1177/0363546506291404. PMID   16923825. S2CID   1238880.
  34. ↑ Pollard, ME; Kang, Q; Berg, EE (Dec 1995). "Radiographic sizing for meniscal transplantation". Arthroscopy. 11 (6): 684–7. doi:10.1016/0749-8063(95)90110-8. PMID   8679029.
  35. ↑ Haut, TL; Hull, ML; Howell, SM (Mar 2000). "Use of roentgenography and magnetic resonance imaging to predict meniscal geometry determined with a three-dimensional coordinate digitizing system". Journal of Orthopaedic Research. 18 (2): 228–37. doi:10.1002/jor.1100180210. PMID   10815823. S2CID   3889006.
  36. ↑ Stone, KR; Freyer, A; Turek, T; Walgenbach, AW; Wadhwa, S; Crues, J (May 2007). "Meniscal sizing based on gender, height, and weight". Arthroscopy. 23 (5): 503–8. doi:10.1016/j.arthro.2006.12.025. PMID   17478281.
  37. 1 2 3 4 5 Noyes, FR; Heckmann, TP; Barber-Westin, SD (Mar 2012). "Meniscus repair and transplantation: a comprehensive update". The Journal of Orthopaedic and Sports Physical Therapy. 42 (3): 274–90. doi: 10.2519/jospt.2012.3588 . PMID   21891878.
  38. 1 2 Lee, AS; Kang, RW; Kroin, E; Verma, NN; Cole, BJ (Jun 2012). "Allograft meniscus transplantation". Sports Medicine and Arthroscopy Review. 20 (2): 106–14. doi:10.1097/JSA.0b013e318246f005. PMID   22555208. S2CID   27719328.
  39. ↑ Verdonk, PC; Demurie, A; Almqvist, KF; Veys, EM; Verbruggen, G; Verdonk, R (Mar 2006). "Transplantation of viable meniscal allograft. Surgical technique". The Journal of Bone and Joint Surgery. American Volume. 88 Suppl 1 Pt 1: 109–18. doi:10.2106/JBJS.E.00875. hdl: 1854/LU-384762 . PMID   16510805.
  40. 1 2 Stone, KR; Walgenbach, AW (Apr 2003). "Meniscal allografting: the three-tunnel technique". Arthroscopy. 19 (4): 426–30. doi:10.1053/jars.2003.50133. PMID   12671626.
  41. ↑ Jones, RS; Keene, GC; Learmonth, DJ; Bickerstaff, D; Nawana, NS; Costi, JJ; Pearcy, MJ (Jul 1996). "Direct measurement of hoop strains in the intact and torn human medial meniscus". Clinical Biomechanics (Bristol, Avon). 11 (5): 295–300. doi:10.1016/0268-0033(96)00003-4. PMID   11415635.
  42. ↑ Alhalki, MM; Howell, SM; Hull, ML (May–Jun 1999). "How three methods for fixing a medial meniscal autograft affect tibial contact mechanics". The American Journal of Sports Medicine. 27 (3): 320–8. doi:10.1177/03635465990270030901. PMID   10352767. S2CID   3951812.
  43. 1 2 3 4 5 6 7 8 Hergan, D; Thut, D; Sherman, O; Day, MS (Jan 2011). "Meniscal allograft transplantation". Arthroscopy. 27 (1): 101–12. doi:10.1016/j.arthro.2010.05.019. PMID   20884166.
  44. ↑ Anz, AW; Rodkey, WG (Jun 2012). "Biological enhancement of meniscus repair and replacement". Sports Medicine and Arthroscopy Review. 20 (2): 115–20. doi:10.1097/JSA.0b013e31824483e9. PMID   22555209. S2CID   42268920.
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