Literature DB >> 25069570

Partial meniscus substitution with a polyurethane scaffold does not improve outcome after an open-wedge high tibial osteotomy.

Pablo Eduardo Gelber1, Anna Isart, Juan Ignacio Erquicia, Xavier Pelfort, Marc Tey-Pons, Juan Carlos Monllau.   

Abstract

PURPOSE: The aim of the study was to determine whether medial meniscal substitution with a polyurethane scaffold (Actifit(®)) improves the outcome of medial meniscal-deficient varus knees undergoing open-wedge high tibial osteotomy.
METHODS: Sixty patients with symptomatic varus knees those who underwent open-wedge high tibial osteotomies were prospectively studied. In 30 patients, the medial meniscus was left with a defect larger than 25 mm (Group M). An Actifit(®) device was implanted (Group A) in the remaining 30 patients. Patients were functionally evaluated with WOMET, IKDC and VAS. Patient satisfaction was graded from 0 (not satisfied) to 4 (very satisfied).
RESULTS: Both groups were comparable preoperatively. They had similar follow-up periods (31.2 months; range 24-47.5; n.s.). WOMET improved a mean of 53.4 ± 8.4 and 42.4 ± 17.2 points in Groups M and A, respectively (p = 0.002). IKDC improved a mean of 56.7 ± 12 and 50.3 ± 15.6 points in Groups M and A, respectively (n.s.). VAS dropped 5.9 ± 2.1 and 4.7 ± 2.8 points in Groups M and A, respectively (p = 0.006). Patient satisfaction averaged 3.3 ± 0.8 and 3.3 ± 1 in Groups M and A, respectively (n.s.).
CONCLUSIONS: Patients with symptomatic varus knees were treated with open-wedge high tibial osteotomies, and a meniscectomy was improved more at short-term follow-up in most of the evaluated functional scores than those patients with concomitant implantation of a medial Actifit(®) implant. However, there was no difference in terms of patient satisfaction with the procedure. Based on the short-term functional results of this study, no data were provided to support medial meniscal substitution with a polyurethane scaffold when an open-wedge high tibial osteotomy is being performed. LEVEL OF EVIDENCE: Prospective comparative study, Level II.

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Year:  2014        PMID: 25069570     DOI: 10.1007/s00167-014-3206-z

Source DB:  PubMed          Journal:  Knee Surg Sports Traumatol Arthrosc        ISSN: 0942-2056            Impact factor:   4.342


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1.  Polyurethane-based cell-free scaffold for the treatment of painful partial meniscus loss.

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Review 5.  [Indication and limitations of meniscus replacement].

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Review 6.  Treatment options for the symptomatic post-meniscectomy knee.

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7.  Polyurethane meniscal scaffolds lead to better clinical outcomes but worse articular cartilage status and greater absolute meniscal extrusion.

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9.  Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial.

Authors:  J A D van der Woude; K Wiegant; R J van Heerwaarden; S Spruijt; P M van Roermund; R J H Custers; S C Mastbergen; F P J G Lafeber
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Review 10.  Meniscal substitution, a developing and long-awaited demand.

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