The meniscus is an important fibrocartilaginous structure of the knee joint with a semilunar shape. In each knee there is an internal and an external meniscus, located between the femur and tibia. These two structures contribute to a better distribution of body weight resulting in reduced stress on the layer of cartilage covering the joint surfaces. The menisci also help the ligaments to stabilize the knee. Traumatic injuries of the meniscus are quite common, especially in young and athletic people, and are caused by acute trauma; these injuries should be distinguished from degenerative injuries, which do not result from a traumatic event, and occur mainly after the fourth decade of life. Removal (meniscectomy) of more than about 50 percent of a meniscal portion leads to an alteration of the joint structures known as osteoarthritis of the knee. [1]

Meniscus transplantation (or donor meniscus grafting) (Fig. 1) is the most viable therapeutic option available to attempt to slow the process of arthrosis degeneration without resorting to a metal prosthesis in patients who have undergone sub-total or total meniscectomy. The menisci used for this procedure are taken from deceased donors and are stored in musculoskeletal tissue banks.

Protesi menisco
Fig.v1 Minimally invasive arthroscopic meniscus transplantation.
Protesi menisco
Fig.v2 Minimally invasive arthroscopic biological meniscal prosthesis (for partial meniscus tear).
Protesi menisco
Fig.v3 Minimally invasive arthroscopic “closed” surgical technique

No immunosuppressive therapy is required for musculoskeletal tissue transplants, and the risk of infection is virtually zero (comparable to that of a blood transfusion). Once the right size meniscus is found, it will be transplanted by suturing it to the surrounding soft tissues and attaching it to the bone. To minimize the trauma of this surgery as much as possible, we have developed a minimally invasive technique that allows the surgery to be performed totally arthroscopically, without “opening the knee.” [2-4]

Collagen “biologic meniscal prostheses” (Fig. 2) are indicated in cases of post-meniscectomy partial pain syndrome as they can restore normal meniscal continuity, reduce/eliminate pain symptoms and protect the knee from arthritic evolution. Again, it is possible to operate with minimally invasive technique totally arthroscopically (Fig. 3), without “opening the knee.” [5-7]

The results are good, even long-term in professional athletes. [3, 8] Postoperatively, the patient will begin the rehabilitation course, which, if done in the right way, will lead to resumption of normal daily activity about 35 days after surgery.
Return to sports will be allowed at approximately 90 days after surgery.

Curriculum of Prof. Marcheggiani Muccioli

Giulio Maria Marcheggiani Muccioli, MD, PhD has distinguished himself in the field of orthopedics, starting with a degree with honors in Medicine and Surgery, obtained from the University of Bologna in 2006, followed by a specialization with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute of Bologna and a PhD in Surgical Sciences.

His career includes the academic role of Associate Professor in Orthopedics at the Faculty of Medicine and Surgery of the University of Bologna, where he researches in the field of biomechanics and pathology of the lower and upper limbs.

He has expanded his skills through international fellowships, including experiences in the United Kingdom, Japan and USA, consolidating himself as an Orthopedic Surgeon with extensive practical experience (he performs over 250 operations per year).

Finally, he contributes significantly every year to the training of new generations of doctors through university teaching in multiple medical and surgical disciplines.

He is one of the 10 Italian surgeons who over the last 20 years have been selected by the American Knee Society to participate in the prestigious John Insall Fellowship on Prosthetic Knee Surgery.

His wrote over 250 scientific publications. He attended more than 100 international meetings. This demonstrates his commitment towards innovation in the treatment of knee and shoulder pathologies, and in the advancement of new surgical techniques.

Bibliography
  1. Knee joint changes after meniscectomy. Fairbank TJ. J Bone Joint Surg Br. Nov 1948;30B(4):664-670.
  2. Meniscal Allograft Transplantation Without Bone Plugs: A 3-Year Minimum Follow-up Study. Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, et al. Am J Sports Med. 2012 Feb;40(2):395-403.
  3. Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up study. Marcacci M, Marcheggiani Muccioli GM, Zaffagnini S, et al. Am J Sports Med. 2014 Feb;42(2):382-8.
  4. Survivorship and clinical outcomes of 147 consecutive isolated or combined arthroscopic bone plug free meniscal allograft transplantation. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1432-9.
  5. Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10-year follow-up study. Zaffagnini S, Marcheggiani Muccioli GM, Lopomo N, et al. Am J Sports Med. May 2011;39(5):977-985.
  6. Arthroscopic collagen meniscus implantation for partial lateral meniscal defects: a 2-year minimum follow-up study. Zaffagnini S, Marcheggiani Muccioli GM, et al. Am J Sports Med. 2012 Oct;40(10):2281-8.
  7. Two-Year Clinical Results of Lateral Collagen Meniscus Implant: A Multicenter Study. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Arthroscopy. 2015 Jul;31(7):1269-78.
  8. A professional athlete functionally active 10 years after an arthroscopic lateral collagen meniscus implant. Marcheggiani Muccioli GM, Lullini G, Cammisa E, Leardini A, Zaffagnini S. Knee Surg Sports Traumatol Arthrosc. 2020 Feb 3. doi: 10.1007/s00167-020-05876-y.

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