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Performing Both Meniscal Allograft Transplantation and Autologous Chondrocyte Implantation Appears Effective in Reducing Symptoms Two Years After Surgery

Patients with knee injuries such as tearing of the anterior cruciate ligament, or ACL, often undergo surgical repair to regain full motion and use of the knee. Surgeons have used two techniques to do this repair: meniscal allograft transplantation (MAT) and/or autologous chondrocyte implantation (ACI). Research has been done on the procedures done alone, but no reviews have been found of the two procedures being done together.

The meniscus or cartilage in the knee plays several vital roles. It helps joint movement, lubrication, and helps support the joint load, for example. These roles make it so that even the smallest of injuries can affect the knee's function. Therefore, proper correction is needed to prevent knee problems later on in life.

The authors of this study wanted to evaluate patients who underwent both procedures and review their outcomes. To do this, 48 patients who had undergone both procedures in one or both knees were observed. To be included in the study, the patients had to be followed for two years; of the 48 original patients, only 36 met all the requirements for the study. At the end of the 2 years, 4 patients had what are called "failures" in their knees and required alternative treatment before the two years were up and 3 patients were lost to follow-up, leaving the results for 29 patients to be calculated for the study findings.

The average age of the patients was 36.9 years with a range between 16.1 and 52.1 years, 23 of the patients were men. Patients were evaluated by x-rays at the start of the study and through questionnaires administered before the surgery, 6 months following surgery, 1 year following surgery, and yearly thereafter. The questionnaires used were the Browne modified Clinician Cincinati (objective), the Brown modified Patient Cincinati (subjective), the Lysholm scale, and the Visual Analog Scale (VAS).

Following the surgery and after follow-up, the researchers found that the patients showed significant improvements in all the surveys/questionnaires, including their satisfaction with the surgery's outcome. The authors point out that 4 patients, not included in the final analysis, did experience failure and needed surgery to correct their problems. These failures occurred at 11, 13, 17, and 23 months.

The authors also point out that there are some weaknesses to the study. They include that many patients have complex problems with the knee that requires more than just the repairs described in this study. Another weakness is the lack of x-rays in follow-up. However, despite the short-comings of the study, the authors suggest that continuing this research in a larger number of patients will reveal the best method of managing these knee injuries.

References: Jack Farr, MD, et al. Concomitant Meniscal Allograft Transplantation and Autologous Chondrocyte Implantation. In The American Journal of Sports Medicine. September 2007. Vol. 35. No. 9. Pp. 1459-1466.

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