A case report of semitendinosus tendon autograft for reconstruction of the meniscal wall supporting a collagen implant

Juan D Ayala Mejias, Roselyn C Alvarez Sciamanna, Manuel Perez-España Muniesa, Luis Alcocer Pérez-España, Juan D Ayala Mejias, Roselyn C Alvarez Sciamanna, Manuel Perez-España Muniesa, Luis Alcocer Pérez-España

Abstract

Purpose: Describe the evolution of the reconstruction of meniscal rim with semitendinosus tendon in a patient with knee pain after a subtotal meniscectomy and absence of meniscal wall.

Method: 32 years old male with a six-month history of the left knee pain after a subtotal meniscectomy. The MRI indicated a small internal meniscal remainder without posterior horn attachment. Taking this absence as a relative contraindication for implant and meniscal transplantation, the reconstruction of a new meniscal wall with semitendinosus tendon autograft was considered. A collagen meniscal implant was attached to the new wall five months later.

Results: After two years the patient referred only non specific discomfort with full pain relief in the medial compartment. The MRI revealed integration of implants without significant degenerative changes compared to previous images.

Conclusions: This staged technique was designed to restore medial meniscus-like biologic tissue in a symptomatic patient following arthroscopic subtotal meniscectomy with a significant loss of the peripheral meniscus rim. Symptomatic improvement was obtained at two years follow-up.

Figures

Figure 1
Figure 1
Post-meniscectomy arthroscopy. A. Middle area of medial compartment 6 months after a total medial meniscectomy. No meniscal rim is observed, only a small reparative tissue is seen and had to be removed. B. Posterior area of medial compartment. Tunnelization of posterior tibial tunnel is performed.
Figure 2
Figure 2
Semitendinosus graft technique. A. Semitendinosus autograft is inserted through the antero-medial portal and fixed with several sutures “inside-out” and “outside-in”. Observe the pulling sutures through the tibial tunnel. B. Arthroscopic view of semitendinosus tendon once passed the first suture.
Figure 3
Figure 3
MRI in T1 sequences after semitendinosus graft implantation. In coronal plane (3A) the double semitendinosus tendon reaches the lateral margin of the lateral tibial plateau where CMI will be attached. In sagittal plane (3B) the posterior graft is adapted to the posterior tibial plateau near the PCL insertion.
Figure 4
Figure 4
Arthroscopic view before CMI implantation. Arthroscopic view of posterior (4A) and anterior (4B) zones of semitendinosus tendon covered by sinovial tissue five months after the implantation.
Figure 5
Figure 5
Arthroscopic view after CMI implantation. CMI inserted in posterior (5A) and anterior (5B) zones of the new “meniscal wall”.
Figure 6
Figure 6
MRI in T1 sequences 10 months after CMI implantation. In coronal plane (6A) the meniscal complex remains in contact with medial collateral ligament and triangular meniscal shape is observed. In the sagittal plane (6B) posterior graft lies completely over the posterior tibial plateau.
Figure 7
Figure 7
MRI in T2 at final follow-up. MRI in coronal (7A) and parasagittal (7B) planes in T2 sequences showing the correct fitting of the meniscal complex implantation at 24 months. In the coronal plan (7A) size and shape are preserved at last follow up. A mild anterior extrusion is seen in the sagittal plane (7B).

References

    1. Petty CA, Lubowitz JH. Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years´ follow-up. Arthroscopy. 2011;27(3):419–424. doi: 10.1016/j.arthro.2010.08.016.
    1. Papalia R, Del Buono A, Osti L, Denaro V, Mafulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull. 2011;99:89–106. doi: 10.1093/bmb/ldq043.
    1. Jones CK, Shelton WR. In: Artroscopia Quirúrgica. McGinty JB, Burkhart SS, Jackson RW, Johnson DH, Richmond JC, editor. Madrid, España: Marban; 2005. Meniscal substitution: allografts y collagen scafolds ; pp. 257–264. Edition in Spanish of: Operative Arthroscopy, 3rd McGinty JB, et al. Philadelphia, USA: Lippincott Williams & Wilkins.
    1. Charrois O. In: The Meniscus. Verdonk BP, editor. Paris (France): Springer; 2010. Enquete de practique SFA/ESSKA/SOFCOT Symposium: le ménisque latéral. Congrès de la Société Francaise d’Arthroscopie, December 2008; p. 107.
    1. Bulgheroni P, Murena L, Ratti C, Bulgheroni E, Ronga M, Cherubino P. Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Knee. 2010;17(3):224–229. doi: 10.1016/j.knee.2009.08.011.
    1. Harston A, Nyland J, Brand E, McGinnis M, Caborn DN. Collagen meniscus implantation: a systematic review including rehabilitation and return to sports activity. Knee Surg Sports Traumatol Arthrosc. 2011;22 Epub.
    1. Monllau JC, Gelber PE, Abat F, Pelfort X, Abad R, Hinarejos P. Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years’ fllow-up. Arthroscopy. 2011;27(7):933–943. doi: 10.1016/j.arthro.2011.02.018.
    1. Zaffagnini S, Marcheggiani Muccioli GM, Lopomo N, Bruni D, Giordano G, Ravazzolo G. Propective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10 year follow up study. Am J Sports Med. 2011;39(5):977–985. doi: 10.1177/0363546510391179.
    1. Linke RD, Ulmer M, Imhoff AB. Replacement of the meniscus with a collagen implant (CMI) Oper Orthop Traumatol. 2006;18(5–6):453–462.
    1. Johnson LL, Feagin JA Jr. Autogenous tendon graft substitution for absent knee joint meniscus: a pilot study. Arthroscopy. 2000;16(2):191–196. doi: 10.1016/S0749-8063(00)90035-5.
    1. Kohn D, Wirth CJ, Reiss G, Plitz W, Maschek H, Erhardt W. Medial meniscus replacement by a tendon autograft. Experiments in sheep. J Bone Joint Surg Br. 1992;74:910–917.
    1. Kohn D. Autograft meniscus replacement: Experimental and clinical results. Knee Surg Sports Traumatol Arthrosc. 1993;1:123–125. doi: 10.1007/BF01565466.
    1. Bruns J, Kahrs J, Kampen J, Behrens P, Plitz W. Autologous perichondral tissue for meniscal replacement. J Bone Joint Surg Br. 1998;80-B:918–923.
    1. Lee DH, Kim SB, Kim TH, Cha EJ, Bin SI. Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med. 2010;38(2):247–254. doi: 10.1177/0363546509346399.
    1. Bullough PG, Munuera L, Murphy J, Weinstein AM. The strength of the menisci of the knee as it relates to their fine structure. J Bone Joint Surg. 1970;52B(3):564–570.
    1. Kohn D, Moreno B. Meniscus insertion anatomy as a basis for meniscus replacement: a morphological study. Arthroscopy. 1995;11(1):96–103. doi: 10.1016/0749-8063(95)90095-0.
    1. Arnoczky SP, Cooper TG, Stadelmaier DM, Hannafin JA. Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy. 1994;10(5):552–557. doi: 10.1016/S0749-8063(05)80013-1.
    1. Lee DH, Kim TH, Lee SH, Kim CW, Kim JM, Bin SI. Evaluation of meniscus allograft transplantation with serial magnetic resonance imaging during the first postoperative year: focus on graft extrusion. Arthroscopy. 2008;24(10):1115–1121. doi: 10.1016/j.arthro.2008.01.016.
    1. Puig L, Monllau JC, Corrales M, Pelfort X, Melendo E, Cáceres E. Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings. Knee Surg Sports Traumatol Arthrosc. 2006;14(4):394–398. doi: 10.1007/s00167-005-0688-8.
    1. Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG. Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. Am J Sports Med. 2010;38(12):2448–2455. doi: 10.1177/0363546510375550.
    1. Jung YH, Choi NH, Victoroff BN. Arthroscopic stabilization of the lateral capsule of the knee in meniscal transplantation. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):189–191. doi: 10.1007/s00167-010-1196-z.
    1. Milachowski KA, Kohn D, Wirth CJ. Meniscus replacement using Hoffa´s infrapatellar fat bodies. Initial clinical results. Unfallchirurgie. 1990;16(4):190–195. doi: 10.1007/BF02588774.
    1. Arnozcky SP, Di Carlo EF, O’Brien SJ, Warren RF. Cellular repopulation of deep-frozen meniscalautografts: an experimental study in the dog. Arthroscopy. 1992;8:428–436. doi: 10.1016/0749-8063(92)90003-T.
    1. Messner K. Meniscal regeneration or meniscal transplantation? Scand J Med Sci Sports. 1999;9:162–167.
    1. Kang SW, Son SM, Lee JS. Regeneration of whole meniscus using meniscal cells and polymer scaffolds in a rabbit total meniscectomy model. J Biomed Mater Res A. 2006;78(3):659–671.
    1. Kon E, Chiari C, Marcacci M, Delcogliano M, Salter DM, Martin I. Tissue Engineering for total meniscus substitution: animal study in sheep model. Tissue Eng Part A. 2008;14(6):1067–1080. doi: 10.1089/ten.tea.2007.0193.
    1. Ibarra C, Jannetta C, Vacanti CA, Cao Y, Kim TH, Upton J. Tissue engineered meniscus: a potential new alternative to allogenic meniscus transplantation. Transplant Proc. 1997;29:986–988. doi: 10.1016/S0041-1345(96)00337-5.

Source: PubMed

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