Long-term results of the use of synthetic implants for meniscal reconstruction
Author(s):
Gómez Gómez Silvia (Spain)
Gómez Gómez Silvia (Spain)
Affiliations:
ESSKA Academy. Gómez Gómez S. 05/09/18; 209740; P14-24
Silvia Gómez Gómez
Silvia Gómez Gómez
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Abstract
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Objectives: There is a direct relationship between loss of meniscal tissue and articular cartilage injuries, especially if it comes to young patients.
Most meniscal tears are not possible to be sutured and may need a meniscectomy.
Those patients who develop a postmeniscectomy syndrome with intense pain can benefit from the reconstruction with a synthetic implant. This pain is translating the articular cartilage damage.
The aim of this study is analyze clinical long-term results of the use of a synthetic meniscal implant.

Methods: A case series of 67 patients between 15 and 50 years is reported. It is a retrospective study. Follow up between 2 and 13 years. 71 implants (several bilateral patients) were put. 28 primary cases associated with anterior cruciate ligament ligamentoplasty and 37 secondary to postmeniscectomy syndrome. Osteotomy was associated in 5 patients to correct deformity by the alteration of mechanical axis. 19 had cartilage lesions grade III or IV, were treated with microfractures.

Results: Nowadays, there are 36 asymptomatic patients.
The Lysholm average scale is 89.1 in primary cases and 83.6 in secondary cases. In general, lower scores are given in patients with cartilage lesions grade III or IV.
The Tegner average scale is in primary surgery 6.8 - 2.7 - 5.5 and in postmeniscectomy syndrome 5.9 - 2.4 - 4.6.
We recorded several complications, the most important of which were 6 failures of implant with rupture of themselves (8.5%), consequently without correct healing. In addition, there has been one case of infection, one case of partial scarring and reactive synovitis.
A knee arthroscopy has recently been done to our first patient with a meniscal implant. He had an important pain. The meniscal implant had disappeared and the patient had grade IV chondropathy. He needs an osteotomy like palliative surgery. Thus, the oldest patient in the series, despite being asymptomatic and with good functional results for 13 years, has now failed regenerated "fibromeniscus".

Conclusions: The reconstruction of the meniscus with synthetic implants is a treatment option for postmeniscectomy syndrome.
So far, the clinical results are positive and the implant is safe from the biological point of view. As a consequence of the case of failure of the "fibromeniscus" in our series, it is questionable if the implant is long-term chondroprotective and if the results are maintained in the time.
Although our series has some patients with long follow-up, more studies are needed to have statistically significant data. On the other hand, due to the great youth of the patients, their follow-up should continue to confirm the chondroprotective effect of the new meniscal tissue formed.

Keywords:
meniscus, meniscectomy, implant meniscal
Objectives: There is a direct relationship between loss of meniscal tissue and articular cartilage injuries, especially if it comes to young patients.
Most meniscal tears are not possible to be sutured and may need a meniscectomy.
Those patients who develop a postmeniscectomy syndrome with intense pain can benefit from the reconstruction with a synthetic implant. This pain is translating the articular cartilage damage.
The aim of this study is analyze clinical long-term results of the use of a synthetic meniscal implant.

Methods: A case series of 67 patients between 15 and 50 years is reported. It is a retrospective study. Follow up between 2 and 13 years. 71 implants (several bilateral patients) were put. 28 primary cases associated with anterior cruciate ligament ligamentoplasty and 37 secondary to postmeniscectomy syndrome. Osteotomy was associated in 5 patients to correct deformity by the alteration of mechanical axis. 19 had cartilage lesions grade III or IV, were treated with microfractures.

Results: Nowadays, there are 36 asymptomatic patients.
The Lysholm average scale is 89.1 in primary cases and 83.6 in secondary cases. In general, lower scores are given in patients with cartilage lesions grade III or IV.
The Tegner average scale is in primary surgery 6.8 - 2.7 - 5.5 and in postmeniscectomy syndrome 5.9 - 2.4 - 4.6.
We recorded several complications, the most important of which were 6 failures of implant with rupture of themselves (8.5%), consequently without correct healing. In addition, there has been one case of infection, one case of partial scarring and reactive synovitis.
A knee arthroscopy has recently been done to our first patient with a meniscal implant. He had an important pain. The meniscal implant had disappeared and the patient had grade IV chondropathy. He needs an osteotomy like palliative surgery. Thus, the oldest patient in the series, despite being asymptomatic and with good functional results for 13 years, has now failed regenerated "fibromeniscus".

Conclusions: The reconstruction of the meniscus with synthetic implants is a treatment option for postmeniscectomy syndrome.
So far, the clinical results are positive and the implant is safe from the biological point of view. As a consequence of the case of failure of the "fibromeniscus" in our series, it is questionable if the implant is long-term chondroprotective and if the results are maintained in the time.
Although our series has some patients with long follow-up, more studies are needed to have statistically significant data. On the other hand, due to the great youth of the patients, their follow-up should continue to confirm the chondroprotective effect of the new meniscal tissue formed.

Keywords:
meniscus, meniscectomy, implant meniscal
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