Clinical And Experimental Study On The Allograft Meniscal Transplantation

Objective:To provide the theory basis for the technique of allograft meniscal transplantation through experimental study of allograft meniscal transplantation and healing and outcome evaluation of allograft.To discuss the clinical problems of allograft meniscal transplantation based on clinical practical results including the drawing and storing,surgical technique,rehabilitation plan and side-effect, combining the recent publishes,so as to provide reference for further clinical practice and research.Method:36 adult New Zealand white rabbits were in the experiment and divided equally into group A and group B with their left posterior extremities.The procedures of allograft meniscal transplantation were performed for Group A and controlled surgeries for Group B with autograft meniscal transplantation.Each 6 rabbits were killed for pathological observation at week 6,month 3 and month 6 postoperative.The rabbits were observed the situation of vessels and cartilage cells proliferation in the grafted meniscus.Clinical research:12 patients with severe meniscal injuries and insufficiency were transplanted allograft meniscal. Rehabilitation plans were drawn up and preliminary reports of some recent follow up results were accomplished including symptoms alleviation,motion of joint recovery and so on.Result:The allograft meniscal transplanted in animal experiment presented its normal morphology inside joint,agglutinated favorably with the capsula articularis and not found immunological rejection reaction.While,we could find that arthrodial under cartilage meniscus wasn't obviously frayed from the 6-week observation,because of the protection of meniscal transplantation.Patients' meniscal transplantation under the arthroscope had no side injuries clinically.Mild joint swelled at early stage but no vulnus cataclysm,which agglutinated well in two weeks after operation.6 weeks later,joint swelling basically abolished.In the following 6～17 months(average 10.3 months),patients recovered walking and their motion of knee joint mean were close to the one of pre-operation.Knee joint Ache grade(VAS) of post-operation was obviously lower than pre-operation (P＜0.01) while Lysholm and IKDC grade was higher(P＜0.05 ).Every immunology index was all in their normal range after operation.MRI demonstrate that the transplanted meniscus was on its location and fixed reliably.Patients' ROM recovered smoothly.Conclusion:After allograft meniscal transplantation,the transplanted meniscal agglutinated well with host capsula articularis,host synovial cell differentially grew into cartilage cells instead of cell component in meniscal transplantation so that the transplanted meniscal will keep favorable morphological structure and protect arthrodial cartilage.In view of the problem exists in retention and restoration of meniscal treatment with severe meniscal injury patients as well as the characteristics of its immunity shielding organ,allograft meniscal transplantation will probably be one of the important technology of healing severe meniscal injury and insufficiency.However,this technology need further observation at present,while some problems are expected to be studied forward such as disinfection storage of the transplanted subject,technology of surgical operation,function recovery training and so on.