[Meniscus replacement with quadriceps tendon--a long-term analysis]

Abstract

Aim: Early osteoarthritis of the knee is a common consequence ofA'complete meniscectomy. In order to prevent degenerative changes, meniscus replacement by autogenous quadriceps tendon was performed from 1986 until 1999 in 45 patients. In 29 patients, a reconstruction of the anterior cruciate ligament was done simultaneously. This study was intended to detect whether this meniscus replacement led to better subjective, clinical and radiological results in comparison to meniscectomised knees or meniscal allografts reported in the literature.

Methods: A standardised examination of the patients (4-17 years postoperatively, average 9 years) was carried out using the KOOS questionnaire, the IKDC examination form and a weight-bearing radiograph of the knee.

Results: 34 patients took part in the study. KOOS subgroups showed fair results for symptoms (25-96 points, average 65), butA'bad results for sports and quality of life (0-100, average 52; QoL 6-94, average 54). Clinical and radiological examination demonstrated on average stable knee joints without effusion (IKDC group A), but X-rays showed in most cases a clear or severe osteoarthritis of the knee (IKDC group C). Clinical and radiological findings demonstrated similar results in comparison with studies investigating results after meniscectomy without meniscus replacement. Concerning subjective results, meniscus replacement with quadriceps tendon was inferior to cryopreserved meniscal allografts. However, patients after meniscal allograft transplantation also show increasing degenerative changes of the respective joint in radiological follow-up studies.

Conclusion: In the patient group studied here with pre-existing chondromalacia of the respective knee joint compartment and preoperative anterior instability, no advantage of meniscus replacement using quadriceps tendon over the normal course after meniscectomy could be proven. Therefore, this procedure cannot be generally recommended.