Authors present their experiences with deep frozen medial meniscus transplantation in young patients with weight bearing pain and chondromalacy in injured compartment after menisectomy with contemporary varus angulation of the injured knee.
Chondromalacy and pain begins usually in some years after subtotal menisectomy in injured compartment, especially in varus axis of the injured knee. Meniscus transplantation could improve forces transmission and lubrication in the joint and could help to cartilage healing if it is changed. There is problems with contemporary varus angulation of the knee and overloading implanted meniscus and cartilage too. Open wedge valgus osteotomy improved condition for meniscus transplant and cartilage healing.
From September 2007 to June 2011 authors operated 15 medial meniscus transplantations with contemporary open wedge osteotomy in 15 patients. 8 women and 7 men, in age 32-47 years, 4-10 years post menisectomy. In 8 patients were local CHM defect gr. III sec Outerbridge, treated by microfracture, 7 patients were with CHM gr II. All meniscus transplantation were done arthroscopically, valgus osteotomies were fixed by Tomofix plate with allogenous bone substitution to the osteotomy. Patient outcome evaluations were performed using Lysholm and IKDC scores.
All patients were healed without complications. Three months after operation had 12 patients knee movement S-0-0-120. All patients had no walking pain in 4 months after operation and 11 patients had no pain in jogging 6 months after operation. Control arthroscopy was made in 9 patients. In all patients were healed meniscus and chondral defect with fibrocartilage too. The mean follow-up was 24 months. The mean Lysholm score improved from 62.4 to 88.9. The IKDC subjective knee score improved from 56.4 to 83.7. Joint medial space was enlarge on control X ray in all patients, from average 2mm to average 4mm.
Meniscus transplantation and valgus proximal tibia osteotomy could be a promissing method for improving of the injured knee after medial subtotal menisectomy in young patients with contemporary varus axis.