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Meniscus Transplant
- 1. Meniscus Transplants Kevin R. Stone, MD Ann W. Walgenbach, RNNP Wendy S. Adelson, MS Jonathan R. Pelsis, MHS Stone Research Foundation San Francisco
- 2. The Aging Knee Pediatric Normal Adult OA Adult
- 9. The Three-Tunnel Technique Replacing the Meniscus Stone KR, Walgenbach AW. “Meniscal Allografting: the Three-Tunnel Technique.” Arthroscopy – The Journal of Arthroscopic and Related Surgery. 2003, 19(4):426-30.
- 10. Articular Cartilage Paste Graft Procedure Step 1 Step 5 Step 4 Step 3 Step 2
- 17. Patient Population (N = 119) Neutral / Varus / Valgus Moderate ( 5 – 7°) / Severe ( > 7°) Grade III / Grade IV Medial / Lateral Male / Female None / Mild–Moderate / Severe (Kellgren-Lawrence)
- 20. Subsequent Surgeries – 1 4 2 Meniscus Allograft Revision – 2 1 12 Meniscus Allograft Repair – 1 9 22 Meniscectomy 1 1 – 4 Microfracture / Articular Cartilage Paste Grafting 1 4 6 20 Chondroplasty / Debridement – 1 1 2 Other 4 th N = 2 3 rd N = 10 2 nd N = 21 1 st N = 62 Subsequent Surgeries Primary Procedure
- 34. Patient Example: JL OB III/IV far-posterior aspect LFC, Microfracture LFC
- 38. JA: Preoperative X-ray Lateral AP
- 40. JA Operative Images A B C Deficient Lateral Meniscus Chondral Lesion of LFC Microfracture of Lesion
- 41. JA Operative Images A B C Absent Meniscus Lateral Meniscus Transplant Transplant Placement
- 43. JA: 2Yr Postoperative X-ray PA Flexion AP
- 45. JA: 5Yr Postoperative X-Ray PA Flexion AP
- 47. Patient Example: GC 7 o varus L-knee Medial joint space narrowing Active 53 y.o. male. Meniscectomy: 1986, 1996 Medial meniscus-allograft 3/99 Paste Graft MFC & MTP High medial tibial osteotomy (Bionx wedge and allograft bone)
- 48. GC: Preoperative Images Sagittal MRI Loss of cartilage MFC PA Flexion Medial joint space narrowing
- 49. GC: Operative Images A B Bipolar lesions Morselization of MFC & MTP Loss of medial meniscus
- 50. GC: Operative Images A B C Placement of medial meniscal allograft Impaction of paste graft Paste Grafted Lesion
- 51. GC: Postoperative X-Ray Long-leg AP
- 52. GC: 3yr Postoperative X-ray AP Long-leg
- 53. GC: 3Yr Postoperative Images 3 Years post-op L-medial allograft, osteotomy, & paste graft
- 54. GC: Comparison of healing 3-Years post-op allograft and paste graft to MFC Operative 3 yrs Post-op 3 yrs Post-op
- 57. DB: Right Knee 10 Yr PostOp MRI
- 58. DB: 10 Yr Post Op XRAY
- 59. DB: 10 Yr PostOp 63 YO, Tegner = 6, Skis 30+ days/yr, Snow skis 50+ days/yr.
- 65. Excellent joint space, intact meniscus allograft and ACL, but right knee clicking and catching RT: 18 Months Post
- 66. Intact meniscus allograft and ACL with diffuse thinning of patellofemoral cartilage RT: 18 Months Post
Notes de l'éditeur
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD Rath = severe arthritis excluded
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD The procedure step by step.
- Kevin R. Stone, MD
- Examine the coefficients for each explanatory variable. Positive Coefficient means that the hazard is higher WORSE PROGNOSIS Negative Coefficient implies a lower hazard BETTER PROGNOSIS
- Kevin R. Stone, MD Bryan Kelly
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD
- Kevin R. Stone, MD A= MRI confirming articular cartilage loss of the MFC B= Long leg x-ray demonstrating varus deformity of (L-knee??? I think it should be the Right knee: see x-rays and chart notes ) of about 5-7 degrees C= PA Flexion view demonstrating medial joint space narrowing bialterally L worse than R (nearly bone on bone on the Left). 51 yo ♂ real estate broker both knees w/ problems L worse than R. He has a long hx/o degenerative changes in the medial compartment, loss of the medial meniscus and previous efforts at surgical debridement in order to relieve his medial compartment pain. Pre-operative x-rays revealed medial joint space narrowing and loss of articular cartilage. Pre-operative MRI confirmed loss of the medial meniscus and loss of the artircular cartilage of the medial compartment. He stood in varus. In view of his young age and atheletic activities he requested an effort at biological reconstruction of the medial compartment. 03/10/1999 L-med-Allo/ ArtCart-MFC & MTP/ Open high tib med wedge opening osteotomy using BionX implants and allograft bone/ chon-LFC/ debridement/ Sx: developed a “clicking soreness” on upper MFC thought to be scar tissue requested an effort at operative debridement 03/20/2002 L-knee arthros/ chon-troch/ partial (M)ectomy of Allo where at the posterior 1/3 there was a small flap tear
- Kevin R. Stone, MD A= Kissing lesion, MFC, MTP w/ loss of medial meniscus B= Morcellation of the MFC & MTP lesions and loss of medial meniscus
- Kevin R. Stone, MD A= Placement of medial meniscal allograft B&C= Articular cartilage paste grafting MFC.
- Kevin R. Stone, MD
- Kevin R. Stone, MD A= MRI (03/18/02) documenting site of medial meniscus allograft and cartilage paste graft B= Long-leg x-ray (03/14/02) demonstrating post-op alignment C= PA Flexion view (03/14/02) documenting previous osteotomy and preservation of some joint space. 03/14/02 Patient seen 3 years post-op. He noted that before surgery he was unable to do certain activities that he would like to do, and he noted that the knee just pops w/ squatting. He is otherwise quite happy. Px: He had 2 prominent bumps at the medial side of his femoral condyle that he is complaining about. He had patellofemoral crepitus. His pain level is minimal, and his activity level is high. Dx: Arthrofibrosis and bursitis of L-knee. Sx: developed a “clicking soreness” on upper MFC thought to be scar tissue requested an effort at operative debridement 03/20/2002 L-knee arthroscopy/ chond-troch/ partial (M)ectomy of Allo where at the posterior 1/3 there was a small flap tear
- Kevin R. Stone, MD
- Kevin R. Stone, MD A= Medial meniscus allograft 3 years S/P transplantation B= Medial meniscus allograft 3 years S/P transplantation C= Biopsy MFC 3 years S/P ArtCart
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004
- Kevin R. Stone, MD Rhonda Topple
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
- Kevin R. Stone, MD Kevin R. Stone, Biological Knee Reconstruction Annual Joint Preserving Meeting, Johns Hopkins 2004 RT
- Kevin R. Stone, MD