Between May 1984 and December 1986, 23 patients with a history of medial meniscectomy and anterior knee instability were entered into a long-term prospective study of the results of medial meniscal transplantation combined with reconstruction of the anterior cruciate ligament. In 17 cases a lyophilized meniscal allograft was used and in 6 cases a deep-frozen meniscal allograft was used. The patients' clinical outcomes were evaluated 3 and 14 years postoperatively by clinical assessment, Lysholm score, radiographs, magnetic resonance imaging, arthrography, and, in some cases, arthroscopy. Two anterior cruciate ligament reconstruction control groups were used for comparison, one group having previously undergone meniscectomy and one with intact menisci. The follow-up rate was 100% after 14 years. The Lysholm score was 84 +/- 12 points at 3 years postoperatively and 75 +/- 23 points at 14 years. Patients with deep-frozen meniscal transplants generally had better results than patients with lyophilized meniscal transplants. Magnetic resonance imaging evaluation showed good preservation of the deep-frozen meniscal transplants, even after 14 years. The lyophilized meniscal transplants were reduced in size at the second-look arthroscopy and as seen on magnetic resonance imaging examination. When the control groups were compared with the study group, the deep-frozen meniscal allografts were found to be more comparable with an intact meniscus and the lyophilized meniscal allografts were more comparable with the control group knees that had undergone meniscectomy.

The increase in severe ligament injuries of the knee has led to consideration of the need for meniscal transplantation in reconstructive operations for chronic rotational instability. Transplantation of the medial meniscus was carried out in two groups of 15 sheep. In one group lyophilised, gamma-sterilised allogenic menisci were transplanted and these underwent a complete remodelling in 48 weeks. In the other group, deep frozen allogenic menisci were used and these remained fully functional without remodelling. We then carried out meniscal transplantation in 22 patients who were followed-up for a mean of 14 months. Arthroscopy was possible in two-thirds of the cases at an average of 8 months after operation. Both types of transplanted menisci, lyophilised and deep frozen, decreased in size, as small as a regenerated meniscus in some cases. In general the deep frozen menisci showed better results.

The purpose of this study was to determine the objective and subjective long-term outcomes of the first free meniscal allograft transplantations in five patients with complete absence or non-repairable lesion of the medial meniscus after 20 years. Between 1984 and 1986 five patients underwent concomitant medial meniscal transplantation with a deep frozen meniscal allograft, ACL reconstruction and femoral advancement or temporary detachment of the MCL. The clinical outcome of the patients was evaluated 20 years postoperatively using clinical assessment, Lysholm-score, KOOS, IKDC-score, radiographs and magnetic resonance imaging. The Lysholm-score ranged between 21 and 97 points of 100 maximal available points. Corresponding to this the total KOOS ranged between 28.4 and 91.1%. The results of the IKDC-score were evaluated as nearly normal (B) (n = 2), abnormal (C) (n = 2) and severely abnormal (D) (n = 1). The radiological evaluation according to the Kellgren-Lawrence classification showed an increase of the degenerative changes between one and four grades. The radiological results revealed clear degenerative changes with long-term follow-up after meniscal allograft transplantation even though some patients did relatively well regarding the subjective and clinical results in the 20-year follow-up examination in comparison with the literature. Despite these relative clear results the question if medial meniscal transplantation can protect against development of arthritis cannot definitely be answered because in this first case series some aspects of meniscus transplantation that have not been considered which turned out to be of importance during the last 20 years. Furthermore, it has to be taken into account that all patients revealed a cartilage damage at the time of surgery and an ACL reconstruction was performed in addition. Nevertheless from biomechanical point of view it might be taken into consideration to combine the medial meniscus transplantation at least with a high tibial osteotomy. Level of evidence was (IV, case series).

Twenty patients undergoing orthopaedic surgery for total hip replacement received a single prophylactic intravenous dose of 2.2 g Augmentin (2 g amoxycillin + 200 mg clavulanate). Bone samples removed during the operation were saved for amoxycillin and clavulanate assay. The proportion of inorganic matter in the bone samples was determined to calculate the concentrations of the drugs in their distribution volume. The cortical and cancellous bone were penetrated to a comparable extent by both compounds yielding maximum concentrations at one hour after the end of the infusion. The mean concentrations of amoxycillin in the cortex and spongy layer were 26.0 and 18.2 mg/kg within 1 h, 23.8 and 19.8 mg/kg in the interval from 1 to 2 h after infusion, and 9.2 and 5.9 mg/kg between 2 and 5 h. The corresponding values for clavulanate were 2.3 and 1.6 mg/kg, 2.5 and 1.6 mg/kg, and 1.0 and 0.7 mg/kg, respectively. No postoperative wound infections occurred in these patients.

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