Age / Sex : 45 / F

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Courtesy: Sun Ki Kim, Incheon St. Mary’s Hospital

Meniscal allograft transplantation

Discussion

Findings:

Plain film and MRI shows “Keyhole” shaped bone defect and bone graft, in lateral tibial plateau.

On coronal proton density weighted spin echo MR image, there is “Keyhole” shaped bone graft or bone bridge in lateral proximal tibia, which is connecting the anterior and posterior horn attachment of lateral meniscus.

Differential Diagnosis:

Diagnosis:  

Meniscal allograft transplantation

(Keyhole technique for lateral meniscal allograft transplantation)

Discussion:

Meniscal allograft transplantation has emerged as a treatment option for selected meniscus-deficient patients to restore normal meniscal function and forestall progressive joint degeneration. Meniscal transplantation has become an accepted treatment option for selected symptomatic patients who have undergone a complete or near-complete meniscectomy. Meniscal transplantation is indicated in patients aged <40 years with an absent or nonfunctioning meniscus.

Contraindications include diffuse subchondral bone exposure, axial malalignment, and uncorrected knee joint instability.

Currently, meniscal allograft transplantation should be considered a salvage operation for

symptomatic meniscal deficiency in the young patient.

A "keyhole" technique can be used for lateral meniscal allograft transplantation. Lateral meniscal allograft fashioned using the keyhole technique. Note that the deeper portion of the bone bridge for the meniscal allograft is fashioned larger than the superficial portion, which is matched to the corresponding recipient in the lateral tibia. This allows the lateral meniscal allograft to “lock” into the tibial attachment.

References:

1. Jon K. Sekiya, Christopher I. Ellingson. Meniscal allograft transplantation. J Am Acad Orthop Surg 2006;14(3):164-174


2. David Hergan, David Thut, Orrin Sherman. Meniscal allograft transplantation. The Journal of Arthroscopic and Related Surgery, 2011 Jan;27(1):101-12.


3. Matthew J. Matava. Meniscal allograft transplantation : a systematic review. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 2007; 455: 142–157


4. Packer JD, Rodeo SA. Meniscal allograft transplantation. Clin Sports Med. 2009, 28(2):259-83