Autogenous tendon graft substitution for absent knee joint meniscus: A pilot study

The purpose of this pilot study was to explore the potential of an autogeno us tendon graft to substitute for an absent human knee joint meniscus. Base d on the results of animal studies and human reports, it was hypothesized t hat autogenous tendon tissue would substitute for human knee joint meniscus : maintain mechanical integrity, convert to fibrocartilage, preserve the jo int compartment, and provide symptomatic relief for the patient. Five patie nts, 2 men and 3 women, average age 41 years, had surgical absence of the l ateral meniscus, genu valgum, and severe degenerative arthritis of the late ral compartment, but a stable knee. All patients were offered alternative t reatments: do nothing, medication, arthroscopic debridement, osteotomy, and knee replacement. The operations were performed by arthroscopy. An accompa nying arthroscopic debridement procedure was performed in the same compartm ent. In 4 cases, the donor graft was the semitendinosus tendon. In 1, the p atellar tendon was used because the semitendinosus had been previously used in an anterior cruciate ligament reconstruction. Four of the 5 patients ha d a second-look arthroscopy and biopsy between 9 and 24 months. There was p artial physical integrity to the tendon graft. The tendon graft did not com pletely convert to fibrocartilage. The joint surface was not preserved. Onl y 1 patient had minimal clinical improvement; the others were not improved. No patient was made worse. One patient had a total knee replacement 1 year later. Another had a knee fusion after 4 years. All other patients are con sidering future reconstructive surgery. The autogenous tendon graft as used in this pilot study was not successful as a substitute for an absent menis cus. The hypothesis was not realized. The observations from this pilot stud y should be helpful in future study protocol design.