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The Influence of Nonanatomical Insertion and Incongruence of Meniscal Transplants on the Articular Cartilage in an Ovine Model

Gabriela von Lewinski, MD, PhD^,*, Dieter Kohn, MD, PhD, Carl Joachim Wirth, MD, PhD and Djordje Lazovic, MD, PhD

From the Orthopaedic Department, Hannover Medical School, Hannover, the Orthopaedic Department, University Homburg/Saar, and the Orthopaedic Department, Pius-Hospital Oldenburg, Germany

^* Address correspondence to Gabriela von Lewinski, MD, PhD, Orthopaedic Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, D-30625 Hannover, Germany (e-mail: gabriela.von.lewinski{at}annastift.de).

Background: Adequate size matching and anatomically correct positioning must be recognized as essential factors influencing the outcome of meniscal transplantation.

Hypothesis: Nonanatomical insertion and incongruence of meniscal transplants has an influence on the development of degenerative changes.

Study Design: Controlled laboratory study.

Methods: Ten female sheep were used for this animal study. Both knees (N = 20) were divided into 3 groups, subjected to either meniscectomy (group I; n = 10), to a medial meniscal autograft transplantation with a nonanatomical insertion of the anterior and posterior horn (group II; n = 5), or a meniscal autograft transplantation from the opposite knee as an incongruent meniscal autograft (group III; n = 5). After 6 months, radiographic (Fairbank’s criteria), macroscopic (Jackson score), and histological evaluation by light microscopy (Mankin score) and scanning electron microscopy of the articular cartilage was performed.

Results: All applied evaluation methods demonstrated that nonanatomical insertion of meniscal transplants resulted in the highest amount of degenerative cartilage changes. The histological assessment even revealed a significantly enlarged cartilage damage for the non-anatomic–positioned meniscal transplants in relation to the meniscectomized knees. Furthermore, the incongruent meniscal transplants demonstrated a significantly better cartilage situation than nonanatomically inserted meniscal transplants.

Conclusion: The histological evaluation demonstrated clearly that a nonanatomically inserted meniscal transplant leads to degenerative cartilage changes that are worse than that after meniscectomy.

Clinical Relevance: Precise anatomic positioning is mandatory for the potential chondroprotective effect of meniscal transplants.

Key Words: meniscus • meniscal transplantation • chondroprotective effect • cartilage