It is widely known that there is a relationship between the amount of meniscal tissue resected and the appearance of degenerative changes in the knee as the years go by. Because of this, current techniques tend to be relatively conservative—if the tear allows for it—with the goal of repairing the damaged meniscal tissue or replacing the previously meniscectomised tissue.

In 2001, Equilae performed the first allogenic meniscal transplant. This technique aimed to reduce the symptoms of a patient who had been meniscectomised in the past (a condition that was called ‘post-meniscectomy syndrome’).

Since then, more than 200 meniscal transplants have been performed, with improvements continuously made over time.

In recent years, Equilae has incorporated capsulodesis into the lateral meniscal transplant technique, in order to avoid or reduce the extrusion of the transplanted meniscus. This is achieved by passing the sutures through the articular capsule and inserting them into two tunnels through the tibia.

Regarding this technique, we would like to share the article that we recently published in the journal Arthroscopy, which constitutes a level II study. It presents the results obtained after comparing the first series of meniscal transplants with bone plugs to the current series, in which the capsulodesis technique was incorporated into the replacement surgery.

You will find that in the group of patients who underwent capsulodesis, there was a lesser degree of meniscal extrusion, along with similar improvements in functionality and pain relief.

Capsulodesis is a reliable and replicable technique that does not require the use of implants.

We hope that you find it of interest.

You can access the full article here.

The technique in question can also be viewed at the following link.

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Today we would like to share the preventative approach that Equilae takes towards knee surgery infections, as well as the development of a new technique that has allowed us to completely eliminate the risk of infection after anterior cruciate ligament reconstruction.

The newspaper La Vanguardia covered this story:

A new technique eliminates infections related to knee ligament injuries

Degenerative knee injuries (arthrosis or joint wear and tear) can greatly affect quality of life by causing pain and getting in the way of everyday activities. On the other hand, knee ligament injuries (of which ACL injuries are the most well known) make regular athletic activity impossible, which also negatively impacts active individuals.

At Equilae, when we operate on a patient due to a degenerative injury or a knee ligament injury, the goal is to restore their quality of life and athletic ability. Patient satisfaction is our mission.

However, complications can occur that slow down this return to normalcy, such as post-surgical infections. Recovery can be made even more difficult if an infection is not treated properly. Below, we first explain prosthetic infections (occurring after total knee replacement surgery) and then ligament surgery infections (occurring after anterior cruciate ligament reconstruction, ACLR).

 

Infection after total knee replacement surgery

The average rate of knee replacement surgery infection in Europe is about 2.5-3%. Equilae has managed to reduce this rate to 1.5%. This has been achieved through the implementation of various measures:

• Bacterial decolonisation prior to surgery: through the utilisation of antiseptic agents in the days leading up to surgery, it is possible to reduce the possibility of bacteria being present on the patient’s skin, which can lead to infection.
• Optimisation of antibiotic prophylaxis: when a prosthesis is implanted, antibiotics are always administered before performing the surgery. This results in a reduced risk of infection. In addition, at Equilae this prophylaxis is adapted to the risk factors of each patient (obesity, previous antibiotic treatments, rheumatic diseases, etc.), according to the most recent studies on the subject.
• Use of antibiotic-loaded cement: biological cements are used in order to anchor the knee prosthesis to the bone (both the femur and the tibia). These cements can be loaded with antibiotics, making them an effective method according to the prosthesis records of Scandinavian countries.

What happens if the knee replacement prosthesis becomes infected despite these measures?

Fortunately, the Equilae team is accustomed to managing prosthetic infections; we belong to prestigious European organisations dedicated to studying this subject (e.g. ESSKA and the Pro-Implant Foundation).

The most important part of managing an infection after total knee replacement surgery is the diagnosis, since these infections often only cause pain, and are not accompanied by the symptoms that indicate infection to patients and many professionals: pus, fever, etc. This lack of knowledge can have serious consequences, because if the infection is not diagnosed, it will not be properly treated. Therefore, when presented with a patient who has been experiencing pain after a total knee replacement, it is crucial to rule out the possibility that this pain is due to a prosthetic infection. This type of infection, which only presents itself as pain, is known as a low-grade infection, since the bacteria are able to infiltrate the prosthesis and form a biofilm that prevents antibiotics from working. For this reason, if a total knee replacement prosthetic infection is diagnosed, it is necessary to perform surgery while antibiotics are being administered.

 

Infections after anterior cruciate ligament reconstruction (ACLR)

This type of infection is fairly less common than that of total knee prosthesis, but it is equally important. European records indicate a rate of infection between 1 and 2%. In recent years, Equilae has managed to reduce the rate of ACLR infections to 0. This has been achieved through the implementation of a technique developed together with Australian researchers. The technique consists of immersing the ACL plasty (the new ligament that will be implanted to replace the broken ligament) in a vancomycin solution. This practice has been endorsed by several scientific studies and has allowed Equilae to join the prestigious ACL Study Group, as well as to participate in scientific research conventions with renowned hospitals like Berlin’s Charité. These partnerships have enhanced our knowledge of the origin, prevention and treatment of ACLR infections.

 

Ultimately, it is a matter of employing measures aimed at reducing the risk of infection, and optimising treatment in order to improve the patient’s quality of life.

 

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As members of Equilae, it is always a pleasure to have Dr. Monllau share his experience with us. This time, he’s discussing the evolution of meniscal surgery from the early 1980s to today. We hope you find it as interesting as we do.

For many years, complete meniscectomy was the treatment of choice for a meniscal tear. This technique provided good clinical results in the short term, but these results deteriorated over time.

In the 1940s, Dr. Fairbank described the appearance of radiographic arthritic changes after a complete meniscectomy. Over the years, a relationship has been shown to exist between the quantity of meniscal tissue resected, chondral damage and subsequent degenerative changes appearing in the meniscectomized compartment.

Meniscectomies have grown increasingly conservative, mainly since the advent of arthroscopy in the early 1960s.

Towards the end of the 1980s, the concept of suture-based meniscal repair arose.  Despite this, and for various reasons (the vascularization of the meniscus, progression time, the type of injury, etc.), not all meniscal tears should or can be sutured. It some cases it is still necessary to perform a partial meniscectomy.

During the 1990s, in an effort to prevent the deterioration of the joint after a meniscectomy, meniscal transplant appeared on the scene, through implants in cases with partial meniscal defects, or allografts or “donor meniscus” for complete meniscal defects.

Dr. Monllau and his team have made numerous relevant scientific contributions to the field of meniscal replacement over the last 10 years. To date, more than 150 collagen and polyurethane implants and around 200 meniscal transplants have been performed at Equilae.

Over the years, the technique used by the team for meniscal transplants has evolved (initially, the transplant focused only on sutures, later with bone plugs and most recently using capsulodesis) in order to obtain better results in terms of pain reduction, increased quality of life, the prevention of wear of the joint and the optimization of extrusion of the transplanted tissue.

When can a meniscal transplant be performed?

The most common surgical indication for a meniscal transplant is the emergence of post-meniscectomy syndrome. That is, the appearance of pain, discomfort and/or effusion in a patient who has had a meniscectomy and is at an early age for the use of a prosthesis.  Also, the joint must show limited articular degeneration, integrity of the ligaments and correct alignment of the extremity.

What postoperative care should follow?

Postoperative care will be adapted to each patient based on the surgical procedures that have been carried out.

In general, the patient will remain at rest and with the knee extended for the first two weeks. Then, they will progressively increase weight-bearing using crutches until the sixth week.  The joint’s range of motion will increase, allowing for flexion greater than 90° after the sixth week.

The concept of joint preservation

After 16 years of experience and more than 200 patients operated on at Equilae, it can be concluded that after meniscal transplant surgery, patients attain a decrease in pain and improved quality of life, changing the natural history of a degenerative knee and delaying possible prosthetic surgery.

 

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