Combining Efforts for a Stable KneeSome things are just meant to go together, like a hand in a glove. Or in the case of the knee, the cartilage and the anterior cruciate ligament (ACL).
Cartilage in the knee called the meniscus helps bear the load across the knee joint. It also holds the knee stable. These are two important functions, especially when the ACL is torn. For good function and stability, the knee joint needs both the meniscus and the ACL in place.
Since learning this, doctors have made every effort to save the damaged meniscus. When possible, the meniscus is repaired. If it must be removed, as little as possible is taken out. (Removing meniscus tissue is called meniscectomy). Sometimes it's just not possible to save any of the meniscus. In this case, a new operation is performed. The missing meniscus can be replaced with donated tissue. This is called allograft transplantation. Allograft means it comes from someone else (a donor).
In this study, researchers compare the results of meniscal allograft transplantation when done with ACL repair. For some patients, this was their first ACL operation. For others, this was a second (revision) operation. The researchers were interested in the outcomes of a combined operation of this type. They also wanted to know if it mattered whether this was the first or second operation on the ACL. Results were measured using X-rays, strength testing, range of motion, and symptoms of pain or swelling.
Most patients had a good result with better function and motion in daily activities than the average person without injury. There was no joint swelling or tenderness. The level of function during sports was slightly lower.
The authors conclude that it makes sense to replace the meniscus when patients who've had a prior meniscectomy now need an ACL repair. The meniscus transplant helps protect the ACL graft. It also protects the joint cartilage and helps stabilize the knee joint. They report patients having a second operation on the ACL don't do as well as those having surgery for the first time.
Jon K. Sekiya, LCDR, MC, USNR, et al. Clinical Outcomes after Combined Meniscal Allograft Transplantation and Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. November/December 2003. Vol. 31. No. 6. Pp. 896-906.
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