Do meniscal allograft transplants really work?

[Juha_74]

Mark, thanks for presentation. I have been reading clinical studies about HTO and I believe too that it will help slow down prolong development of knee arthrosis in many cases. I have to consider HTO to my knee too.

What do you think about about OA- or unloader brace after medial meniscectomy? [ame=http://www.tetongravity.com/forums/showthread.php?p=2986982]Here's[/ame] couple of questions about OA braces.

[BadGalSkiier]

Well it's been 4 months since my ACL recon and some other stuff. My doc decided to leave the torn cartilage alone since he says it's still better to have torn cartilage than no cartilage. He had to clip away a few small chunks because they were in the way but left the rest alone. If the torn peices become a problem down the road I can have them removed. At the last minute he decided to use some osteochondral allograft to fill in the defect on the medial side of my femur instead of microfracture. If it was on the lateral side he would have left the defect alone. He also checked for alignment and said that an osteotomy was not necessary at the moment but likely will be needed at some point. I already have arthritis in both knees. I have been told to ease up on things and stay off the moguls forever.

[Juha_74]

I'm so sorry about arthritis in you're knees :-/ . How are you doing with pain?
Maybe OA brace would help you too.

[Juha_74]

Splat, have you considered meniscus transplant? How old are you? I have read that best results are with young patience.
I'm 35- years old now and I haven't decided yet about MT surgery.

[splat]

I've considered it heavily, even though I'm 55 freakin years old. It might take. My doc didn't seem to hesitate and suggested it himself.

I have, for the time being, managed to manage the arthritis that developed in my knee and I can focus on getting some muscle back and skiing without the pain I was getting every time I hit a bump and the dull ache that was always there. I gave up moguls 20 years ago after thrashing both knees and over time, they healed. I thought I should give this healing some time again. Turns out, I could calculate the days of pain and did so here:

[ame="http://www.tetongravity.com/forums/showthread.php?t=203898"]Meniscus surgery: Is it worth it? - Teton Gravity Research Forums[/ame]

[roserobert]

I had one done in December 2008 because I'm young, very active, and had 70% or more of my meniscus removed from 3 prior tears. I was symptomatic daily, and had trouble simply walking a golf course. I had the surgery done in December and rode a metric century on my road bike 6 months later. At 9 months I started playing cutting sports (basketball, etc. wearing a functional brace), and at 1 year I snowboarded. At two years I started skiing again, and I'm just about to order my season pass for next year. I'm not pain free, and I have occasional issues, but nothing like I had before. However, I'm a former professional athlete, in pretty good shape (rode over 5,000 miles on my road bike the past two years), and I was prepared physically and mentally for a very tough rehab. So for me, yes, it was great. Will I avoid a knee replacement? I have no idea, but I've already had two awesome years of sports I would not have had but for my surgery. If you have it done by the wrong surgeon, or aren't ready and able to go through a brutal first 4 months of rehab (pretty much like an ACL rehab but with NWB and the associated complications), then I can't imagine you'll be satisfied. Be careful, it's no new knee, and you better find the best guy or gal you can to do it. I've heard of some poor results out there to go along with my outstanding result (so far...knock on wood). Good luck.

http://padanagloves.com

[Juha_74]

Hi,

You might like to read this chapter from the book called 'The Meniscus'.
Here's a variety of clinical studies about meniscus transplants.
Here's Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage.
Here's Stone clininic: Lessons learned from our first 100 meniscus allograft transplants in arthritic knees.
Here's Stone clininic: Long-term survival of concurrent meniscus allograft transplantation and articular cartilage repair.
Here's about meniscal transplant sizing.

Here's video about medial meniscus transplant operation, made by Kevin Stone.
[nomedia="http://www.youtube.com/watch?v=ypDI3L74FwA][b]Here\'s[/b"]YouTube - Lateral Meniscus Replacement Surgical Technique[/nomedia] video about lateral meniscus transplant operation, made by Kevin Stone.

In the majority of studies, a clinical success rate of 70% and higher has been reported at the final follow-up. Based on the available survivorship data, a clinical survivorship of 70% at 10 years can be anticipated for both medial and lateral allografts. Ligament instability, axial malalignment and cartilage degeneration are con-sidered by most authors to be associated with a higher failure rate and inferior results, although some authors have reported satisfactory results in degenerative knees.

Meniscus transplants have a very limited lifespan. Average lifespan is more or less 7 years, and that cryopreserved menisci are much more prone to tearing. I talked with Rene Verdonk and I did ask the question: Is it possible to transplant another meniscus allograft if the prime allograft wears out, for instance within 5-years? He answered: Yes, it possible to transplant the second allograft and I don't see any problems in this procedure.

[Juha_74]

Professional skier, Matt Reardon is talking about his meniscus allograft transplant surgery and current activities.

[Juha_74]

Hi,

Interesting topic -> http://www.bris.ac.uk/news/2011/8038.html , but is stem cell treatment safe? I understood that stem cell treatment is still in trial phase and need more research?
Here's more about technology Azellon uses -> http://www.azellon-ltd.com/technology.php .

[schuyler ricketts]

drmark your a fucking joke, and badgirlskiier, to bad you'll never be a goodgirlskiier since you've been too trusting on old world practices that are being held on to dearly by people who rely on half ass work to pay their bills. I bet drmark is oblivious on how alot of things work, since he hasnt experienced them himself, and hasn't saved the careers of athletes more valuable than his own, thus his words are just ideas of others he has gazed his eyes upon. there's professionals, then theres wanna bee's, then theres should not bee's, then theres drmark.. sad but true, theres a joker in every profession.

[splat]

Orthoradiograms are weight bearing X-rays that include the hip, knee, and ankle on the same cassette. The angles are drawn out and if you need an osteotomy, that can be determined.

Meniscal alllografts have not yet been shown to reduce arthritis. An owner of a meniscal allograft needs to give up sports, although there are probably several out here that have not and will soon post about what a jerk I am to say that. But time will prove that meniscal allografts deteriorate.

You, yourself, said that MF results deteriorate with tiime. Thats putting it mildly. Considering that MF requires you to be nonweight bearing for at least six weeks, and that builds in a flexion contracture after ACL surgery, I just ignore the osteochondral lesion when I do ACL surgery.

Dr. Don Shelbourne has published a huge series of ACL cases in which he ignored these lesions, and provided the knee was stable, and had full motion, the results were comparable to those cases with normal cartlage. That says alot.

I look back at this thread and can assure everyone reading it that stem cells saved my meniscus - and thus, my knee!

Orthoradiograms - Yeah, I went to jokers like Dr. Mark who suggested cutting a wedge in my tibial plateau and I told them I'd wait for stem cells. Damn glad I did. My advice - stop buying these jerks new cars while they take pieces out of your joints and cripple you forever. Heal yourselves, suckers. Do the stem cells. Assholes like Dr. Mark don't have to live in your body for the rest of your life, but they'd be happy to suck your life out of you, as well as your life savings, while they experiment on you. Stem cells.

[Restoked]

I just happened to check back in and I'm glad to see Splat is doing well. I'm almost 5 years out from my meniscus transplant, and still going strong. Just finished my 3rd season of adult ice-hockey, and let the league in points...moving up levels. I started playing 18 months ago, and would NEVER had tried it without my MT being done. So glad I did it.

Stay healthy my friends!

Restoked.

[splat]

Glad to hear you're on it, man!

[unsafehaven]

I look back at this thread and can assure everyone reading it that stem cells saved my meniscus - and thus, my knee!

Hey Splat, i am in a very similar situation as you and am wondering if you could tell me a little more about what you had done and where. I freaking hate my life right now and need to find something to get me going again .

[intheways]

I'm glad to see some people having good results with various therapies. After a 70% lateral meniscectomy and microfracture, I was pretty freakin' depressed about the outlook. I started reading about the Stone Clinic then and now that I am pretty close to the clinic, I am considering checking it out.

I haven't been on skis for 4 yrs and really miss the mountains

[Juha_74]

Hey Splat, i am in a very similar situation as you and am wondering if you could tell me a little more about what you had done and where. I freaking hate my life right now and need to find something to get me going again .

Yep. Why don't you visit Stone clinic and him what he thinks about meniscus allograft transplant surgery.

[splat]

Hey Splat, i am in a very similar situation as you and am wondering if you could tell me a little more about what you had done and where. I freaking hate my life right now and need to find something to get me going again .

You could always read the thread I posted about all of it that has all the info you seek.

[rspencer]

Where did you happen to have your done?

I had one done in December 2008 because I'm young, very active, and had 70% or more of my meniscus removed from 3 prior tears. I was symptomatic daily, and had trouble simply walking a golf course. I had the surgery done in December and rode a metric century on my road bike 6 months later. At 9 months I started playing cutting sports (basketball, etc. wearing a functional brace), and at 1 year I snowboarded. At two years I started skiing again, and I'm just about to order my season pass for next year. I'm not pain free, and I have occasional issues, but nothing like I had before. However, I'm a former professional athlete, in pretty good shape (rode over 5,000 miles on my road bike the past two years), and I was prepared physically and mentally for a very tough rehab. So for me, yes, it was great. Will I avoid a knee replacement? I have no idea, but I've already had two awesome years of sports I would not have had but for my surgery. If you have it done by the wrong surgeon, or aren't ready and able to go through a brutal first 4 months of rehab (pretty much like an ACL rehab but with NWB and the associated complications), then I can't imagine you'll be satisfied. Be careful, it's no new knee, and you better find the best guy or gal you can to do it. I've heard of some poor results out there to go along with my outstanding result (so far...knock on wood). Good luck.

[Maker]

to provide some balance to this thread.....meniscus transplants are more invasive (because you are monkeying in the joint and replacing tissue) than HTOs so that should be a consideration. Plus you may need an HTO just to be a candidate for a meniscus transplant because your joint alignment may be messed up.

I just had an HTO done to my knee, which marks my 5th surgery in past 2.5 years from a very serious tibia plateau fracture, lateral meniscus shredding and MCL, LCL tear so I am reasonably knowledgeable. This was required because my joint was out of alignment and going directly to a meniscus transplant was not the right answer. Now I am in a position to potentially have a meniscus transplant but that involves cadaver tissue and cartilage which is inherently more risky.

[Juha_74]

to provide some balance to this thread.....meniscus transplants are more invasive (because you are monkeying in the joint and replacing tissue) than HTOs so that should be a consideration. Plus you may need an HTO just to be a candidate for a meniscus transplant because your joint alignment may be messed up.

I just had an HTO done to my knee, which marks my 5th surgery in past 2.5 years from a very serious tibia plateau fracture, lateral meniscus shredding and MCL, LCL tear so I am reasonably knowledgeable. This was required because my joint was out of alignment and going directly to a meniscus transplant was not the right answer. Now I am in a position to potentially have a meniscus transplant but that involves cadaver tissue and cartilage which is inherently more risky.

Here's some previous topics of meniscus transplant surgery If you are considering one in the future.

[intheways]

So far it's worked for me, but I'm only a few months out.

[Restoked]

Seven Years after my MT, I'm still playing ice hockey year round, mountain biking, and generally going for it. Not skiing much because my kids hate it, and I generally don't have time, but I could without pain. I have little pain in my knee, and it's still 100% better than it was before the MT. If I didn't love contact sports and speed, I'm sure it would last longer, but it was the best $$$ I ever spent. Looking back on this thread makes me laugh at what a douche Mark the Medical Troll is in this forum. 6.5 years (you do have 6 months of rehab) of pain free hard-charging later, I can safely say I made the right call. Heal well boys and girls...don't give up.

[patjshanks]

how was the MT?
Im 29 and my active life sucks.
Im looking into Dr. Stone.

[intheways]

1 yr postop update. Just did the Downieville XC over the weekend. The climb kicked my ass, but the knee felt great. Hardly any swelling.

I'm a believer. I'm hoping to get some AT gear in prep for some snow (being optimistic).

[drmark]

There has been a lot of debate about meniscal allografts. Lot sof claims, pro and con, but little science. A large scale study of long term results is now available. Here it its.

http://jbjs.org/content/97/15/1209

At the end of the day, it is certain that in the active individual with a meniscal allograft further surgery is invariable, and people with meniscal allografts, if they want to give the operation the best chance of being successful for the rest of their lives probably shouldn't do extreme things. The results of proximal tibial osteotomy without a meniscal allograft in young and active people are considerably more durable in the extreme athlete.
But that's my take. Read the article.