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Bone mineral density changes in the knee after meniscal allograft transplantation. A 2-year follow-up.


- candidate number23535
- NTR NumberNTR5633
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR24-dec-2015
- Secondary IDsMETC 15-069  
- Public TitleBone mineral density changes in the knee after meniscal allograft transplantation. A 2-year follow-up.
- Scientific TitleBone mineral density changes in the knee two years after meniscal allograft transplantation
- ACRONYM
- hypothesisThere seems to be a biphasic process of bone mineral density (BMD) changes in osetoarthritis (OA). An increased bone mineral density (BMD) and a specific distribution of BMD in the cortical of the subchondral plates and below in the trabecular bone is found in the medial compartment after partial or total medial meniscectomy in patients with isolated medial meniscal tears. Other studies documented that patients with high tibial BMD had increased joint space narrowing We expect to see the same biphasic model after meniscal allograft transplantation.
- Healt Condition(s) or Problem(s) studiedTibial meniscus, Bone mineral density (BMD)
- Inclusion criteriadisabling unicompartmental pain after a (sub)total meniscectomy, patient under the age of 55 years, stable knee joint or stabilized by concomitant ACL reconstruction (ACLR) and normal knee alignment.
- Exclusion criteriagrade IV chondropathy, PCL insufficiency, abnormal and uncorrected knee or lower limb alignment, chronic pain syndrome of the knee, arthrofibrosis, muscular atrophy and a history of knee sepsis.
- mec approval receivedyes
- multicenter trialno
- randomisedno
- group[default]
- TypeSingle arm
- Studytypeobservational
- planned startdate 1-mrt-2010
- planned closingdate1-mrt-2016
- Target number of participants26
- InterventionsKnee injury and Osteoarthritis Outcome Score (KOOS) preopertive and postoperative after 6 months, 1 year and 2 year
Preoperatively and 6 months, 1 year and 2 years postoperative, a DXA scan and a bone scintigraphy were made
- Primary outcomeBone mineral density, semi-quantitatively bone scan scores
- Secondary outcomeKnee injury and Osteoarthritis Outcome Score (KOOS)
- Timepointspre-operative (baseline)
6 months, 1 year and 2 years postoperative
- Trial web site
- statusopen: patient inclusion
- CONTACT FOR PUBLIC QUERIESDrs. B.J.W. Thomassen
- CONTACT for SCIENTIFIC QUERIESDrs. B.J.W. Thomassen
- Sponsor/Initiator Medical Center Haaglanden
- Funding
(Source(s) of Monetary or Material Support)
MCH wetenschapsfonds
- Publications
- Brief summarySince the first meniscal allograft transplantation (MAT) in 1984, many papers are published in literature regarding different aspects of MAT: indications and contraindications, preoperative graft sizing, methods of graft preservation, surgical techniques, fixation of the allograft, relevance of associated chondral and ligamentous damage, concomitant procedures, histologic evaluation, clinical and radiographic outcomes, and rehabilitation.
Despite all this research, a chondroprotective effect, as shown in sheep, remains still unclear in humans. This may partially because of the lack of standardized evaluation methods and the lack high-quality studies. Nonetheless, MAT seems to provide good clinical results at the short and medium term, with improvement in knee function and acceptable complication/failure rates.
Concerning the development of osteoarthritis (OA) previous studies suggest that changes in bone play a role in the development and progression of OA. Already in the 1980ís bone scintigraphy in patients with a suspected meniscal tear has shown an increased uptake, and a pattern of uptake claimed to be specific for meniscal pathology was seen in the subchondral bone of the proximal tibia, which might be the first sign of adaptive bone remodelling leading to degenerative changes of the postmeniscectomized knee.
A positive bone scintigraphy can predict subsequent loss of joint space in patients with established OA of the knee joint. The finding suggests that the activity of the subchondral bone may determine loss of cartilage. That subchondral BMD (sBMD) and subchondral bone remodelling play important roles in OA pathology was confirmed by Dore et al. It is shown that an increased bone mineral density (BMD) and a specific distribution of BMD in the cortical of the subchondral plates and below in the trabecular bone in the medial compartment after partial or total medial meniscectomy in patients with isolated medial meniscal tears. Some studies have demonstrated that knee OA was associated with lower sBMD, while another study documented that patients with high tibial sBMD had increased joint space narrowing over 1 year. These findings suggest a biphasic process of BMD changes in OA: a reduction in BMD early on followed by an increase during more advanced phases. We are interested in the effect of MAT on BMD early in the process of AO development
To our knowledge, the potential chondroprotective effect of MAT was never investigated using Dual-energy X-ray Absorptiometry (DXA) scans and bone scintigraphy. The purpose of our observational prospective cohort study was to determine BMD changes in the knee after arthroscopic MAT without bone plugs during a 2-year follow-up period and to determine BMD changes between the knee with meniscal transplant and the contralateral knee. Furthermore, we assessed the presence of interaction between BMD changes during follow-up and clinical outcome scores.
- Main changes (audit trail)
- RECORD24-dec-2015 - 27-feb-2016


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