1
|
Husen M, Wang AS, Levy BA, Saris DBF, Stuart MJ, Krych AJ. Influence of Concomitant Meniscal Allograft Transplantation on Midterm Outcomes After Osteochondral Allograft Transplantation: A Comparative Matched-Pair Analysis. Am J Sports Med 2024; 52:1238-1249. [PMID: 38523473 DOI: 10.1177/03635465241234534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Osteochondral allograft transplantation (OCAT) is an accepted knee joint-preserving treatment strategy for focal osteochondral lesions that is often conducted in combination with meniscal allograft transplantation (MAT). Despite its frequent and simultaneous utilization, there remains a lack in the literature reporting on outcomes and failure rates after concomitant procedures. PURPOSE To determine (1) the midterm clinical success rate after OCAT+MAT in comparison with a matched-pair cohort undergoing isolated OCAT, (2) whether patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A single-center matched-pair cohort study was conducted investigating outcomes in patients who underwent OCAT of the medial or lateral femoral condyle with and without MAT between 2004 and 2020. Patients were matched 1:1 by age (±5 years), sex (male or female), body mass index (±5), and grouped Kellgren and Lawrence grade (grades 0-1 or 2-4). The minimum follow-up time was 2 years. Radiographic variables (International Cartilage Regeneration & Joint Preservation Society [ICRS] grade and Kellgren and Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery for graft failure or conversion to total knee arthroplasty. Patient-reported, clinical, and radiographic outcomes were compared between groups. RESULTS In total, 66 patients (33 treated with isolated OCAT, 33 treated with OCAT+MAT; 57.6% male) with a mean age of 26.3 years (range, 18-62 years) were followed for a mean of 5.6 years (minimum, 2 years; range, 24-218 months). The 2 cohorts showed no difference in Kellgren and Lawrence grade postoperatively (P = .59). There was a significantly higher ICRS grade detected at follow-up in the OCAT+MAT group (2.81 ± 1.10) compared with the OCAT group (2.04 ± 0.96) (P < .05). There were no statistically significant differences between the groups regarding reoperation rate (OCAT: n = 6; OCAT+MAT: n = 13; P = .116), time to reoperation (OCAT: 46.67 ± 47.27 months vs OCAT+MAT: 28.08 ± 30.16 months; P = .061), and failure rate (OCAT: n = 4 [12.1%] vs OCAT+MAT: n = 5 [15.2%]; P = .66). In the OCAT+MAT group, an increase of tibial slope by 1° conferred a 1.65-fold increase in the hazard for failure over decreased slope (hazard ratio, 1.65; 95% CI, 1.10-2.50; P < .05). The overall survival rate was 86% at a mean follow-up of 5.6 years. Patient-reported outcome scores were significantly improved at the final follow-up compared with preoperative status. No significant differences were seen between groups with respect to subjective IKDC, Lysholm, Tegner, and KOOS results, except for the KOOS Symptoms subscale score, which was significantly higher in the OCAT+MAT group than in the OCAT group (mean difference, 14.6; P < .05) and did exceed the minimal clinically important difference threshold of 10.7. CONCLUSION Midterm results after isolated OCAT and OCAT+MAT show high rates of healing and sustainable subjective improvement of knee function and quality of life. However, it should be noted that the difference in reoperation rate and time to reoperation between the groups is arguably clinically important and that lack of statistical significance may be because of low power. These results imply that isolated OCAT is an efficient joint-preserving treatment that can be combined with MAT in well-selected patients with meniscal insufficiency without negative influence on global clinical outcomes.
Collapse
Affiliation(s)
- Martin Husen
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Allen S Wang
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniël B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, UMC Utrecht, Utrecht, the Netherlands
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Kinoshita T, Hashimoto Y, Nishino K, Iida K, Nakamura H. Effect of inside-out meniscal repair on meniscal dimension in meniscal tear patients. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:50-57. [PMID: 38618526 PMCID: PMC11010801 DOI: 10.1016/j.asmart.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/17/2024] [Accepted: 03/17/2024] [Indexed: 04/16/2024] Open
Abstract
Background It remains controversial whether meniscal repair causes meniscal extrusion. This study aimed to investigate the effect of inside-out meniscal repair on meniscal dimensions in patients with meniscal tear of the mid-body-posterior horn. Methods This retrospective study included 75 patients who underwent meniscal repair followed by MRI within 2 weeks after surgery between 2020 and 2022. Patients with a discoid lateral meniscus, pull-out repair, concomitant osteotomy, all-inside repair only, and revision surgery were excluded. Thirty-three meniscal tear treated using an inside-out arthroscopic repair technique were included in the lateral meniscus (LM, n = 19) and medial meniscus (MM, n = 14) tear groups. Thirty-six participants with intact meniscus were included as controls. Meniscal extrusion and posterior shift were measured on coronal and sagittal MRI pre-operatively and within 2 weeks postoperatively. Results Preoperative coronal extrusion was significantly greater in the LM tear group than in the control group (P = 0.001). Coronal extrusion and posterior shift were significantly smaller postoperatively than preoperatively in the LM tear group (P < 0.001 and, P = 0.008, respectively). Pre- and postoperative coronal extrusion in the MM tear group were not significantly different (P = 0.291). Postoperative coronal extrusion in both LM and MM tear groups were not significantly correlated with the number of sutures required for repair (LM: P = 0.765, R = -0.076, MM: P = 0.1, R = 0.497). Conclusions The torn meniscus of the mid-body - posterior horn before surgery was extruded and shifted posteriorly in both LM and MM tears, and repair using an inside-out arthroscopic technique was effective in reducing meniscal extrusion and posteriors shift in the LM tear immediately after surgery.
Collapse
Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Health and Sport Management, Osaka University of Health and Sports Science, Graduate School of Sport and Exercise Science, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Husen M, Poudel K, Wang A, Saul D, Stuart MJ, Levy BA, Saris DBF, Krych AJ. Survivorship of 157 Arthroscopic Meniscal Allograft Transplants Using Bone Fixation at a Mean of 7 Years and Prognostic Factors Analysis. Am J Sports Med 2024; 52:96-108. [PMID: 38164687 DOI: 10.1177/03635465231212667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) is an accepted and effective treatment option in the context of unsalvageable menisci, particularly in young and active patients. It has been shown to reduce pain and improve knee function in previously symptomatic patients. However, there is still limited knowledge about the long-term survival rates of allografts, the durability of clinical results, and the influence of patient-specific parameters, such as leg alignment, tibial slope, and preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade. PURPOSE To determine (1) the long-term clinical success rate after MAT with bony fixation in a large, single-center cohort of consecutive patients, and (2) if patient-specific and procedural variables influence the clinical, anatomic, and subjective outcomes and risk of failure. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data on 185 consecutive knees undergoing MAT in a single institution were prospectively collected and screened for inclusion in this study. The minimum follow-up time was 2 years. Radiographic variables (ICRS grade and Kellgren-Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (PROMs) (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale [VAS] score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery due to graft failure or conversion to total knee arthroplasty. Anatomic failure was considered a tear covering >20% of the allograft, any peripheral tear, and unstable peripheral fixation leading to dislocation of the graft. Subjective failure was defined as Lysholm score ≤65. Preoperative tibial slope and leg alignment were assessed. Survival analyses were performed using the Kaplan-Meier estimate. Univariate and multivariate analyses were performed to determine risk factors for clinical and anatomic failure. RESULTS A total of 157 knees met inclusion criteria. After a mean follow-up time of 7 ± 3.5 years, 127 (80.9%) knees were free of clinical, anatomic, and subjective failure. Fourteen (8.9%) knees experienced clinical failure, 26 (16.6%) knees were identified as having experienced anatomic failure, and 13 (8.3%) patients experienced subjective failure with a reported Lysholm score of ≤65 at a mean follow-up of 7 years. Concurrent osteochondral allograft transplantation was identified as a predictor of both clinical (hazard ratio [HR], 4.55; 95% CI, 1.46-14.17; P = .009) and anatomic (HR, 3.05; 95% CI, 1.34-6.92; P = .008) failure. Cartilage damage of ICRS grade 3 or 4 of the index compartment conveyed an increased risk for clinical (HR, 3.41; 95% CI, 1.05-11.01; P = .04) and anatomic (HR, 3.04; 95% CI, 1.31-7.11; P = .01) failure. High-grade cartilage damage preoperatively (HR, 10.67; 95% CI, 1.037-109.768; P = .046), patient age >25 years (HR, 5.44; 95% CI, 0.120-246.070; P = .384), and a body mass index >30 (HR, 2.24; 95% CI, 0.748-6.705; P = .149) were associated with subjective failure. PROMs including KOOS and IKDC were significantly improved at final follow-up compared with preoperative scores across all measurements (P < .005). CONCLUSION MAT showed good to excellent clinical results at a mean follow-up of 7 years. Low ICRS lesion grade was associated with a higher clinical and anatomic survival rate. Patients with concurrent OCA transplantation are at a higher risk of clinical and anatomic failure, but still report significantly improved PROMs. These results suggest that MAT has a lasting beneficial effect both in isolation and in complex cases with ≥1 concurrent procedures.
Collapse
Affiliation(s)
- Martin Husen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Keshav Poudel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dominik Saul
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniël B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Mallory N, Qin C, Gibbs D, Milliron E, Cavendish P, Magnussen RA, Flanigan DC. Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00006. [PMID: 37561839 DOI: 10.2106/jbjs.rvw.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
Collapse
Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Parker Cavendish
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
5
|
Gupta A, Sanchez M, Storaci HW, Rohde MS, Shea KG, Sherman SL. Biomechanical Forces of the Lateral Knee Joint Following Meniscectomy and Meniscus Transplantation in Pediatric Cadavers. J Am Acad Orthop Surg 2023; Publish Ahead of Print:00124635-990000000-00718. [PMID: 37285585 DOI: 10.5435/jaaos-d-22-00832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Lateral meniscus transplantation successfully treats symptomatic meniscus deficiency in children. Although clinical outcomes are well-characterized, joint forces in meniscus-deficient and transplant states are unknown. The purpose of this study was to characterize contact area (CA) and contact pressures (CP) of transplanted lateral meniscus in pediatric cadavers. We hypothesize that (1) compared with the intact state, meniscectomy will decrease femorotibial CA and increase CP, and increase contact pressure (CP) and (2) compared with the meniscectomy state, meniscus transplantation will improve contact biomechanics toward the intact meniscus state. METHODS Pressure-mapping sensors were inserted underneath the lateral meniscus of eight cadaver knees aged 8 to 12 years. CA and CP on the lateral tibial plateau were measured in the intact, meniscectomy, and transplant states each at 0°, 30°, and 60° of knee flexion. Meniscus transplant was anchored with transosseous pull-out sutures and sutured to the joint capsule with vertical mattresses. The effects of meniscus states and flexion angle on CA and CP were measured by a two-way analysis of variance repeated measures model. One-way analysis of variance measured pairwise comparisons between meniscus states. RESULTS Regarding CA, at 0°, no differences between the groups reached significance. Meniscectomy reduced CA at 30° (P = 0.043) and 60° (P = 0.001). Transplant and intact states were comparable at 30°. At 60°, transplant significantly increased CA (P = 0.04). Regarding contact pressure, the average pressure increased with meniscectomy at all angles of flexion (0° P = 0.025; 30° P = 0.021; 60° P = 0.016) and decreased with transplant relative to respective intact values. Peak pressure increased with meniscectomy at 30° (P = 0.009) and 60° (P = 0.041), but only reached intact comparable values at 60°. Pairwise comparisons support restoration of average CP with transplant, but not peak CP. DISCUSSION Pediatric meniscus transplantation improves average CP and CA more than peak CP, but does not completely restore baseline biomechanics. Net improvements in contact biomechanics after transplant, relative to the meniscectomy state, support meniscus transplant. STUDY DESIGN Descriptive laboratory study, Level III.
Collapse
Affiliation(s)
- Anshal Gupta
- From the Department of Orthopedic Surgery, Stanford University, Stanford, CA
| | | | | | | | | | | |
Collapse
|
6
|
Bone Marrow-Derived Fibrin Clots Stimulate Healing of a Meniscal Defect in a Rabbit Model. Arthroscopy 2022:S0749-8063(22)00838-6. [PMID: 36574822 DOI: 10.1016/j.arthro.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the in vivo effectiveness of bone marrow aspirate-derived (BMA) fibrin clots for avascular meniscal defect healing in a rabbit model. METHODS In 42 Japanese white rabbits, a 2.0-mm cylindrical defect was introduced into the avascular zone of the anterior part of the medial meniscus in the bilateral knees. The rabbits were grouped according to implantation of a BMA fibrin clot (BMA group) or a peripheral blood (PB)-derived clot (PB group) into the defect and nonimplantation (control group). Macroscopic and histological assessments were performed using a scoring system at 4 and 12 weeks after surgery. At 12 weeks after surgery, compressive stress was analyzed biomechanically. RESULTS The meniscal score in the BMA group (12.1) was greater than that in the PB group (5.5; P = .031) and control group (4.4; P = .013) at 4 weeks. The meniscal score in the BMA group (13.1) was greater than that in the control group (6.4; BMA = 13.1; P = .0046) at 12 weeks. In the biomechanical analysis, the BMA group demonstrated significantly higher compressive strength than the PB group (6.6 MPa) (BMA = 15.4 MPa; P = .0201) and control group (3.6 MPa; BMA = 15.4 MPa; P = .007). CONCLUSIONS Implantation of BMA fibrin clots into the meniscal defect of the avascular zone in a rabbit model improved the meniscal score at 4 weeks and strengthened the reparative meniscal tissue at 12 weeks compared with the implantation of PB fibrin clots. CLINICAL RELEVANCE Healing in the avascular zone of the meniscus can be problematic. Approaches to improving this healing response have had variable results. This study provides additional information that may help improve the outcomes in patients with these injuries.
Collapse
|
7
|
Ow ZGW, Cheong CK, Hai HH, Ng CH, Wang D, Krych AJ, Saris DBF, Wong KL, Lin HA. Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis. Am J Sports Med 2022; 50:4008-4018. [PMID: 34633225 DOI: 10.1177/03635465211042014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal allograft transplant (MAT) is an important treatment option for young patients with deficient menisci; however, there is a lack of consensus on the optimal method of allograft fixation. HYPOTHESIS The various methods of MAT fixation have measurable and significant differences in outcomes. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A single-arm meta-analysis of studies reporting graft failure, reoperations, and other clinical outcomes after MAT was performed. Studies were stratified by suture-only, bone plug, and bone bridge fixation methods. Proportionate rates of failure and reoperation for each fixation technique were pooled with a mixed-effects model, after which reconstruction of relative risks with confidence intervals was performed using the Katz logarithmic method. RESULTS A total of 2604 patients underwent MAT. Weighted mean follow-up was 4.3 years (95% CI, 3.2-5.6 years). During this follow-up period, graft failure rates were 6.2% (95% CI, 3.2%-11.6%) for bone plug fixation, 6.9% (95% CI, 4.5%-10.3%) for suture-only fixation, and 9.3% (95% CI, 6.2%-13.9%) for bone bridge fixation. Transplanted menisci secured using bone plugs displayed a lower risk of failure compared with menisci secured via bone bridges (RR = 0.97; 95% CI, 0.94-0.99; P = .02). Risks of failure were not significantly different when comparing suture fixation to bone bridge (RR = 1.02; 95% CI, 0.99-1.06; P = .12) and bone plugs (RR = 0.99; 95% CI, 0.96-1.02; P = .64). Allografts secured using bone plugs were at a lower risk of requiring reoperations compared with those secured using sutures (RR = 0.91; 95% CI, 0.87-0.95; P < .001), whereas allografts secured using bone bridges had a higher risk of reoperation when compared with those secured using either sutures (RR = 1.28; 95% CI, 1.19-1.38; P < .001) or bone plugs (RR = 1.41; 95% CI, 1.32-1.51; P < .001). Improvements in Lysholm and International Knee Documentation Committee scores were comparable among the different groups. CONCLUSION This meta-analysis demonstrates that bone plug fixation of transplanted meniscal allografts carries a lower risk of failure than the bone bridge method and has a lower risk of requiring subsequent operations than both suture-only and bone bridge methods of fixation. This suggests that the technique used in the fixation of a transplanted meniscal allograft is an important factor in the clinical outcomes of patients receiving MATs.
Collapse
Affiliation(s)
| | - Chin Kai Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hao Han Hai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dean Wang
- Department of Orthopedic Surgery, University of California, Irvine, Orange County, California, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keng Lin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Orthopedic Surgery, Sengkang General Hospital, Singapore, Singapore.,Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Heng An Lin
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
| |
Collapse
|
8
|
Wang DY, Zhang B, Li YZ, Meng XY, Jiang D, Yu JK. The Long-term Chondroprotective Effect of Meniscal Allograft Transplant: A 10- to 14-Year Follow-up Study. Am J Sports Med 2022; 50:128-137. [PMID: 34797194 DOI: 10.1177/03635465211054022] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The long-term chondroprotective effect of meniscal allograft transplant (MAT) and its superiority over meniscectomy have rarely been reported. HYPOTHESIS MAT would reduce osteoarthritis (OA) progression when compared with the meniscus-deficient knee. Graft extrusion distance would strongly affect the chondroprotective effect of the MAT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 17 knees receiving MAT were followed up as the MAT group. The MAT group was further divided into the nonextrusion subgroup (n = 9) and the extrusion subgroup (n = 8) according to 3-mm extrusion on the magnetic resonance imaging (MRI) coronal section. A further 26 consecutive patients receiving meniscectomy in the same period were followed up as the ME group. The healthy control group consisted of healthy contralateral legs chosen from the MAT and ME groups (n = 27). Joint space width (JSW) narrowing was measured on radiographs. Three-dimensional MRI with a T2 mapping sequence was used to quantitatively analyze cartilage degeneration and meniscal allograft extrusion in 5 directions (0°, 45°, 90°, 135°, and 180°). The cartilage degeneration index (CDI) was calculated according to the size and degree of the chondral lesions on MRI scans. The correlation between the CDI increase and the extrusion distance was analyzed. RESULTS The mean follow-up time was 11.3 years (range, 10-14 years). The MAT group had moderate superiority in chondral protection with less JSW narrowing (0.58 ± 0.66 mm) and CDI increase (1132 ± 1589) compared with the ME group (JSW narrowing: 1.26 ± 1.13 mm, P = .025; CDI increase: 2182 ± 1958, P = .079). The JSW narrowing (0.71 ± 0.80 mm; P = .186) and CDI increase (2004 ± 1965; P = .830) of the extrusion subgroup were close to those of the ME group, demonstrating that a 3-mm extrusion led to complete loss of the meniscal chondroprotective effect. The nonextrusion group had significantly less JSW narrowing (0.48 ± 0.48 mm; P = .042) and CDI increase (358 ± 249; P = .011) than the ME group. The JSW narrowing of the healthy control group was 0.22 ± 0.27 mm. The cartilage T2 values of the extrusion subgroup were similar to those of the ME group, with more OA features, whereas the T2 values of the nonextrusion subgroup were closer to those of the healthy control group. The extrusion distance in the 90° direction (P = .002) and the follow-up time (P = .019) significantly affected the CDI increase in the multivariate regression model. The average extrusion distance in the 45°, 90°, and 135° directions better predicted chondroprotection compared with the other individual directions. CONCLUSION MAT had moderate advantages in chondroprotection compared with meniscectomy in the long term. Graft extrusion distance strongly affected the chondroprotective effect of MAT. The chondroprotective effect of the nonextruded meniscal allograft was close to that of the native meniscus, whereas the allografts with an extrusion >3 mm completely lost their function after meniscectomy.
Collapse
Affiliation(s)
- Ding-Yu Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Bo Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Yan-Zhang Li
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Xiang-Yu Meng
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Jia-Kuo Yu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| |
Collapse
|
9
|
Sukopp M, Schall F, Hacker SP, Ignatius A, Dürselen L, Seitz AM. Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review. Front Bioeng Biotechnol 2021; 9:765596. [PMID: 34926419 PMCID: PMC8681859 DOI: 10.3389/fbioe.2021.765596] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Menisci transfer axial loads, while increasing the load-bearing tibiofemoral contact area and decreasing tibiofemoral contact pressure (CP). Numerous clinical and experimental studies agree that an increased CP is one predominant indicator for post-traumatic osteoarthritis (PTOA) of the knee joint. However, due to the immense variability in experimental test setups and wide range of treatment possibilities in meniscus surgery, it is difficult to objectively assess their impact on the CP determination, which is clearly crucial for knee joint health. Therefore, the aim of this systematic review is to investigate the influence of different meniscal injuries and their associated surgical treatments on the CP. Secondly, the influence of different test setups on CP measurements is assessed. On the basis of these results, we established the basis for recommendations for future investigations with the aim to determine CPs under different meniscal states. Methods: This review was conducted in accordance with the PRISMA guidelines. Studies were identified through a systematic literature search in Cochrane, PubMed and Web of Science databases. Literature was searched through pre-defined keywords and medical subject headings. Results: This review indicates a significant increase of up to 235% in peak CP when comparing healthy joints and intact menisci with impaired knee joints, injured or resected menisci. In addition, different test setups were indicated to have major influences on CP: The variety of test setups ranged from standard material testing machines, including customized setups via horizontal and vertical knee joint simulators, through to robotic systems. Differences in applied axial knee joint loads ranged from 0 N up to 2,700 N and resulted unsurprisingly in significantly different peak CPs of between 0.1 and 12.06 MPa. Conclusion: It was shown that untreated traumatic meniscal tears result in an increased CP. Surgical repair intervention were able to restore the CP comparable to the healthy, native condition. Test setup differences and particularly axial joint loading variability also led to major CP differences. In conclusion, when focusing on CP measurements in the knee joint, transparent and traceable in vitro testing conditions are essential to allow researchers to make a direct comparison between future biomechanical investigations.
Collapse
Affiliation(s)
- Matthias Sukopp
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Steffen P Hacker
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| |
Collapse
|
10
|
Zhang S, Li H, Li H, Hua Y. Bone bridge fixation has superior biomechanics on posterior knees to bone plug fixation after lateral meniscal allograft transplantation - A biomechanical study simulating partial weight-bearing conditions. Knee 2021; 32:64-71. [PMID: 34419690 DOI: 10.1016/j.knee.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND It remains unknown how biomechanics change in posterior lateral knee using different fixation techniques in lateral meniscal allograft transplantation (MAT)during simulated toe-touch partial weight-bearing. This study aimed tocompare the biomechanical effects on posterior knee between bridgeand bone plug fixation in lateral MAT. METHODS Intact knee, bone bridge fixation, and bone plug fixation were tested with 500 N of axial load during knee flexion at 0°, 30°, and 60°, which simulated toe-touch partial weight-bearing. Contact area and peak pressure were assessed on posterior knee and the shift of peak pressure position were measured. RESULTS On the posterior lateral compartment, the contact mechanics of bone bridge fixation were similar to those of the intact knee (allP-values > 0.05), but its peak pressure was higher than that of intact knee at 60° (P = 0.002). For bone plug fixation, the contact area of the posterior lateral knee was significantly lower than those of intact knee and bone bridge fixation at 30° and 60° (allP-values < 0.05). The peak pressure of the posterior lateral knee was higher than that of the intact knee at all flexions and higher than that of bone bridge fixation at 30° and 60° (allP-values < 0.05). The peak pressure position of bone plug fixation shifted more laterally and posteriorly compared with intact knee and bone bridge fixation during knee flexion. CONCLUSION Bone bridges could maintain posterior knee biomechanics better than bone plug fixation during knee bending during partial weight-bearing.
Collapse
Affiliation(s)
- Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China; Sports Medicine Institute of Fudan University, Shanghai, China.
| |
Collapse
|
11
|
Patsch C, Dirisamer F, Schewe B. [Relevance of meniscus loss for the progression of osteoarthritis and treatment options for early arthritis]. DER ORTHOPADE 2021; 50:366-372. [PMID: 33847792 DOI: 10.1007/s00132-021-04101-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
Meniscal tears are still one of the most frequent lesions in the knee joint. The relevance of meniscus loss for the development of osteoarthritis is undisputed. Meniscus repair, replacement and transplantation play an important role in the treatment of early arthritis, especially when they are a part of a master plan including alignment correction, stabilization and cartilage surgery, if needed. Scientific data show evidence concerning the protection of osteoarthritis, even though a lack of studies including comparison groups has to be admitted.
Collapse
Affiliation(s)
- C Patsch
- Orthopädie & Sportchirurgie, Karl-Leitl-Straße 1, 4048, Linz-Puchenau, Österreich.
| | - F Dirisamer
- Orthopädie & Sportchirurgie, Karl-Leitl-Straße 1, 4048, Linz-Puchenau, Österreich
| | - B Schewe
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Deutschland
| |
Collapse
|
12
|
Meniskus-Allograft-Transplantation (MAT). ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
13
|
Kester CR, Caldwell PE, Pearson SE. Lateral Meniscal Allograft Transplant: Dovetail Bone Bridge Preparation. Arthrosc Tech 2021; 10:e969-e973. [PMID: 33981538 PMCID: PMC8084757 DOI: 10.1016/j.eats.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 02/03/2023] Open
Abstract
Meniscal tears are among the most common knee injuries encountered by an orthopaedic surgeon. Once treated with total meniscectomy, meniscal preservation is now the standard of care. Not all meniscal tears are repairable, and meniscal allograft transplantation has become an integral part of the preservation algorithm. This procedure is often recommended in a young active patient with healthy articular cartilage who has undergone a previous subtotal or total meniscectomy. There are many surgical methods for meniscal allograft transplantation, and the bone bridge technique has shown good improvement in outcome scores and good long-term survival. We describe our preferred technique for preparation of the dovetail bone bridge meniscal allograft for lateral meniscal allograft transplantation.
Collapse
Affiliation(s)
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell, III, M.D., 1501 Maple Ave., Suite 200, Richmond, VA 23226.
| | | |
Collapse
|
14
|
Fanelli D, Mercurio M, Gasparini G, Galasso O. Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review. J Knee Surg 2021; 34:303-321. [PMID: 31461756 DOI: 10.1055/s-0039-1695043] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's (p = 0.0102) and International Knee Documentation Committee (IKDC; p = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation (p = 0.0008). Fresh frozen allografts had higher Lysholm's scores (p < 0.0001) and showed significantly lower failure rates (p < 0.0001) than cryopreserved allografts. Age (p < 0.015, β = 0.80), sex (p < 0.034, β = - 8.52), and body mass index (BMI; p < 0.014, β = -4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.
Collapse
Affiliation(s)
- Daniele Fanelli
- Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, United Kingdom
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), Catanzaro, Italy
| |
Collapse
|
15
|
Bin SI. Meniscus Allograft Transplantation—Basic Principle. KNEE ARTHROSCOPY 2021:251-264. [DOI: 10.1007/978-981-15-8191-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
16
|
Lucidi GA, Grassi A, Al-zu’bi BBH, Macchiarola L, Agostinone P, Marcacci M, Zaffagnini S. Satisfactory clinical results and low failure rate of medial collagen meniscus implant (CMI) at a minimum 20 years of follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:4270-4277. [PMID: 33835226 PMCID: PMC8595163 DOI: 10.1007/s00167-021-06556-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of the study was to evaluate the long-term clinical results, reoperations, surgical failure and complications at a minimum of 20 year of follow-up of the first 8 medial CMI scaffolds implanted by a single surgeon during a pilot European Prospective study. METHODS Seven (88%) out of 8 patients were contacted. The Cincinnati Score, VAS, and Lysholm score were collected. Moreover, magnetic resonance imaging (MRI) was performed on 4 patients at the last follow-up. Complications, reoperations and failures were also investigated. RESULTS The average follow-up was 21.5 ± 0.5 years. One patient underwent TKA after 13 years from CMI implantation; a second patient underwent valgus high tibial osteotomy 8 years after the index surgery and another patient underwent anterior cruciate ligament hardware removal at 21 years of follow-up. At the final follow-up, 3 patients were rated as "Excellent", 1 as "Good" and 2 as "Fair" according to the Lysholm score. The Cincinnati score and the VAS were substantially stable over time. The MRI showed a mild osteoarthritis progression in 3 out of 4 patients according to the Yulish score, and the CMI signal was similar to the mid-term follow-up revealing 3 cases of myxoid degeneration and 1 case of normal signal with reduced scaffold size. CONCLUSION The medial CMI is a safe procedure: satisfactory clinical results and a low failure rate could be expected even at a long-term follow-up. For this purpose, the correct indication as well as correcting axial malalignment and addressing knee instability at the time of the index surgery is mandatory. On the other hand, a mild osteoarthritis progression could be expected even after meniscus replacement. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, via Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Alberto Grassi
- grid.419038.70000 0001 2154 6641IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, via Cesare Pupilli 1, 40136 Bologna, Italy
| | - Belal Bashar Hamdan Al-zu’bi
- grid.419038.70000 0001 2154 6641IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, via Cesare Pupilli 1, 40136 Bologna, Italy
| | - Luca Macchiarola
- grid.419038.70000 0001 2154 6641IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, via Cesare Pupilli 1, 40136 Bologna, Italy
| | - Piero Agostinone
- grid.419038.70000 0001 2154 6641IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, via Cesare Pupilli 1, 40136 Bologna, Italy
| | - Maurilio Marcacci
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089 Rozzano, MI Italy
| | - Stefano Zaffagnini
- grid.419038.70000 0001 2154 6641IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, via Cesare Pupilli 1, 40136 Bologna, Italy
| |
Collapse
|
17
|
Large chondral defect not covered by meniscal allograft is associated with inferior graft survivorship after lateral meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 2021; 29:82-89. [PMID: 31541290 DOI: 10.1007/s00167-019-05713-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to evaluate graft survivorship according to the size and location of chondral defects and its effect on clinical outcomes after meniscal allograft transplantation (MAT). It was hypothesized that large chondral defects would be associated with inferior outcomes. METHODS Patients who underwent lateral MAT with fresh-frozen allografts between 2007 and 2016 were retrospectively reviewed. The inclusion criteria were patients with femoral or tibial chondral defects (International Cartilage Repair Society grade 4) who were followed up more than 2 years with 3.0-T magnetic resonance imaging (MRI) scans. Maximal lesion diameter and location were assessed on MRI. The patients were divided into two groups, with chondral defects of < 3 and ≥ 3 cm2 on the tibial side. Graft survivorship was compared between the two groups. Graft failure was defined as revisional MAT, meniscal tear or meniscectomy greater than one-third of the allograft on MRI. Clinical outcomes were evaluated using the modified Lysholm score. RESULTS Twenty-eight knees in 26 patients (mean age 37.4 ± 10.3 years) with a mean follow-up of 3.6 ± 1.0 (range 2.0-5.4) years were identified. Nineteen knees in 17 patients had both femoral and tibial chondral defects, 7 knees in 7 patients had only femoral chondral defects, and 2 knees in 2 patients had only tibial chondral defects. The mean preoperative femoral and tibial chondral defect sizes were 1.7 ± 1.2 and 3.0 ± 1.4 cm2, respectively. Among the seven graft failures, no graft failure occurred in the cases with tibial chondral defects of < 3 cm2. Tibial chondral defects of ≥ 3 cm2 were significantly associated with graft failure (P = 0.004; odds ratio 28.3; 95% confidence interval 2.5-4006.7). Defects of < 3 cm2 were located primarily in the posterior aspect of the lateral tibial plateau, and most lesions were covered by allograft (7/9, 77.8%). The modified Lysholm scores significantly improved irrespective of chondral defects size (P < 0.001). CONCLUSIONS Larger chondral defects, more than 3 cm2 on the tibial side, were associated with inferior graft survivorship but did not influence the clinical outcomes after MAT at the 3.6-year follow-up. Chondral defect location was associated with defect size. LEVEL OF EVIDENCE IV.
Collapse
|
18
|
Kim SH, Lipinski L, Pujol N. Meniscal Allograft Transplantation With Soft-Tissue Fixation Including the Anterior Intermeniscal Ligament. Arthrosc Tech 2019; 9:e137-e142. [PMID: 32021787 PMCID: PMC6993485 DOI: 10.1016/j.eats.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023] Open
Abstract
Meniscal allograft transplantation has been introduced as a treatment for symptomatic meniscus-deficient patients to improve clinical outcomes. We describe an arthroscopic technique for meniscal allograft with soft-tissue fixation including the anterior intermeniscal ligament (AIML): arthroscopic double soft-tissue fixation technique. The AIML and anterior and posterior roots are detached and sutured using running locked Krackow stitches. After preparation of the meniscal bed, the meniscus is passed into the knee and the posterior meniscal horn is fixed with sutures through bone tunnels. The body of the meniscus is fixed with all-inside sutures. Then, the anterior meniscal suture is fixed on the anatomic point of the anterior root with an anchor. The AIML suture is fixed with an anchor to the bare area of the proximal tibia, anterior to the anterior cruciate ligament insertion. This reliable and reproducible technique is less complex than bone plug methods; it is less invasive but still provides stable and secure graft fixation. It will help surgeons to improve clinical results and to limit early secondary extrusion of the graft.
Collapse
Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Lukasz Lipinski
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Seoul, Republic of Korea
- Orthopedics and Pediatric Orthopedics Clinic, Medical University of Lodz, Lodz, Poland
| | - Nicolas Pujol
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
- Address correspondence to Nicolas Pujol, M.D., Department of Orthopedic Surgery, Centre Hospitalier de Versailles, 177 Rue de Versailles, Le Chesnay, France.
| |
Collapse
|
19
|
Ambra LF, Mestriner AB, Ackermann J, Phan AT, Farr J, Gomoll AH. Bone-Plug Versus Soft Tissue Fixation of Medial Meniscal Allograft Transplants: A Biomechanical Study. Am J Sports Med 2019; 47:2960-2965. [PMID: 31454255 DOI: 10.1177/0363546519870179] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is controversial whether soft tissue fixation only and bone-plug techniques for medial meniscal allograft transplantation provide equivalent fixation and restoration of load distribution. Prior studies on this topic did not re-create the clinical situation with use of size-, side-, and compartment-matched meniscal transplants. HYPOTHESIS Both techniques will provide equivalent fixation of the meniscal transplant and restore load distribution and contact pressures similar to those of the native knee. STUDY DESIGN Controlled laboratory study. METHODS Nine fresh-frozen human cadaveric knees underwent mean contact pressure, mean contact area, and peak contact pressure evaluation in 4 medial meniscal testing conditions (native, total meniscectomy, bone-plug fixation, and soft tissue fixation) at 3 flexion angles (0°, 30°, and 60°) using Tekscan sensors under a 700-N axial load. RESULTS Medial meniscectomy resulted in significantly decreased contact area and increased contact pressure compared with the native condition at all flexion angles (P < .0001). Compared with the native state, soft tissue fixation demonstrated significantly higher mean contact pressure and lower mean contact area at 0° and 30° of flexion (P < .05), while bone-plug fixation showed no significant difference. There was no significant difference in peak contact pressure between study conditions. CONCLUSION Total medial meniscectomy leads to significantly worsened load distribution within the knee. Medial meniscal allograft transplantation can restore load parameters close to those of the native condition. The bone-plug technique demonstrated improved tibiofemoral contact pressures compared with soft tissue fixation. CLINICAL RELEVANCE Medial meniscal allograft transplantation with bone-plug fixation is a viable option to restore biomechanics in patients with meniscal deficiency.
Collapse
Affiliation(s)
- Luiz Felipe Ambra
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil.,Center for Regenerative Medicine and Cartilage Repair Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexandre Barbieri Mestriner
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jakob Ackermann
- Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy T Phan
- Center for Regenerative Medicine and Cartilage Repair Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jack Farr
- OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, Indiana, USA
| | - Andreas H Gomoll
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
20
|
Brial C, McCarthy M, Adebayo O, Wang H, Chen T, Warren R, Maher S. Lateral Meniscal Graft Transplantation: Effect of Fixation Method on Joint Contact Mechanics During Simulated Gait. Am J Sports Med 2019; 47:2437-2443. [PMID: 31314996 PMCID: PMC7063591 DOI: 10.1177/0363546519860113] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy exists regarding the optimal bony fixation technique for lateral meniscal allografts. PURPOSE/HYPOTHESIS The objective was to quantify knee joint contact mechanics across the lateral plateau for keyhole and bone plug meniscal allograft transplant fixation techniques throughout simulated gait. It was hypothesized that both methods of fixation would improve contact mechanics relative to the meniscectomized condition, while keyhole fixation would restore the distribution of contact stress closer to that of the intact knee. STUDY DESIGN Controlled laboratory study. METHODS Six human cadaveric knees were mounted on a multidirectional dynamic simulator and subjected to the following conditions: (1) native intact meniscus, (2) keyhole fixation of the native meniscus, (3) bone plug fixation of the native meniscus, and (4) meniscectomy. Contact area, peak contact stress, and the distribution of stress across the tibial plateau were computed at 14% and 45% of the gait cycle, at which axial forces are at their highest. Translation of the weighted center of contact stress throughout simulated gait was computed. RESULTS Both bony fixation techniques improved contact mechanics relative to the meniscectomized condition. The keyhole technique was not significantly different from the intact condition for the following metrics: contact area, peak contact stress, distribution of force between the meniscal footprint and cartilage-to-cartilage contact, and the position of the weighted center of contact. In contrast, bone plug fixation resulted in a significant decrease of 21% to 28% in contact area at 14% and 45% of the simulated gait cycle, a significant increase in peak contact stresses of 34% at 45% of the gait cycle, and a shift in the weighted center of contact, which increased forces in the cartilage-to-cartilage contact area at 45% of the gait cycle. CONCLUSION While both keyhole and bone plug fixation methods improved lateral compartment contact mechanics relative to the meniscectomized knee, keyhole fixation restored contact mechanics closer to that of the intact knee. CLINICAL RELEVANCE Method of meniscal fixation is under the direct control of the surgeon. From a biomechanics perspective, keyhole fixation is advocated for its ability to mimic intact knee joint contact mechanics.
Collapse
Affiliation(s)
- Caroline Brial
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Moira McCarthy
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Olufunmilayo Adebayo
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Hongsheng Wang
- Orthopaedic Soft Tissue Research Program, Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Tony Chen
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA.,Orthopaedic Soft Tissue Research Program, Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Russell Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.,Orthopaedic Soft Tissue Research Program, Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Suzanne Maher
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA.,Orthopaedic Soft Tissue Research Program, Research Institute, Hospital for Special Surgery, New York, New York, USA.,Address correspondence to Suzanne Maher, PhD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA, ()
| |
Collapse
|
21
|
Novaretti JV, Lian J, Sheean AJ, Chan CK, Wang JH, Cohen M, Debski RE, Musahl V. Lateral Meniscal Allograft Transplantation With Bone Block and Suture-Only Techniques Partially Restores Knee Kinematics and Forces. Am J Sports Med 2019; 47:2427-2436. [PMID: 31251657 DOI: 10.1177/0363546519858085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The ability of lateral meniscal allograft transplantation (MAT) to improve knee stability and the meniscal load-bearing function in patients after meniscectomy is critical for surgical success. PURPOSE To compare the effects of 2 lateral MAT fixation techniques-bone block and suture only-on knee kinematics and forces. STUDY DESIGN Controlled laboratory study. METHODS With a robotic testing system, loads were applied during flexion on 10 fresh-frozen cadaveric knees: 134-N anterior tibial load + 200-N axial compression, 5-N·m internal tibial + 5-N·m valgus torques, and 5-N·m external tibial + 5-N·m valgus torques. Kinematic data were recorded for 4 knee states: intact, total lateral meniscectomy, lateral MAT bone block, and lateral MAT suture-only fixation. In situ force in the anterior cruciate ligament and resultant forces in the lateral meniscus and in the meniscal allograft were quantified via the principle of superposition. A repeated measures analysis of variance was used to analyze variations in kinematics and forces at 0°, 30°, 60°, and 90° of knee flexion. Significance was set at P < .05. RESULTS When anterior loads were applied, a decrease in medial translation of the tibia that was increased after total lateral meniscectomy was observed at 30°, 60°, and 90° of knee flexion for both the lateral MAT bone block (54.2%, 48.0%, and 50.0%) and the MAT suture-only (50.0%, 40.0%, and 34.6%) fixation techniques (P < .05). Yet, most of the increases in knee kinematics after lateral meniscectomy were not significantly reduced by either lateral MAT technique (P > .05 for each MAT technique vs the total lateral meniscectomy state). Resultant forces in the meniscal allograft were 50% to 60% of the resultant forces in the intact lateral meniscus in response to all loading conditions at all flexion angles (P < .05). Overall, no significant differences between lateral MAT techniques were observed regarding kinematics and forces (P > .05). CONCLUSION Lateral MAT partially restored medial translation of the tibia, and the resultant forces in the meniscal allograft were only 50% to 60% of the intact lateral meniscus forces in the cadaver model. In the majority of testing conditions, no significant changes of the in situ force in the anterior cruciate ligament were observed. Surgeons should consider the potential benefits of lateral MAT when deciding the appropriate treatment for symptomatic patients after lateral meniscectomies. Both lateral MAT techniques functioned similarly. CLINICAL RELEVANCE The load-bearing function of the meniscal allograft observed in this study may be beneficial in ameliorating the short- and long-term disability associated with lateral meniscal deficiency.
Collapse
Affiliation(s)
- João V Novaretti
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Orthopaedics and Traumatology Sports Center, Department of Orthopaedics and Traumatology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jayson Lian
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew J Sheean
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Calvin K Chan
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joon H Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Moises Cohen
- Orthopaedics and Traumatology Sports Center, Department of Orthopaedics and Traumatology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
22
|
Zaffagnini S, Di Paolo S, Stefanelli F, Dal Fabbro G, Macchiarola L, Lucidi GA, Grassi A. The biomechanical role of meniscal allograft transplantation and preliminary in-vivo kinematic evaluation. J Exp Orthop 2019; 6:27. [PMID: 31240420 PMCID: PMC6593038 DOI: 10.1186/s40634-019-0196-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Meniscus allograft transplantation (MAT) is a surgical procedure performed in patients complaining post-meniscectomy syndrome. Although the effectiveness of MAT on knee stability has been already demonstrated in cadaveric studies, its biomechanical role has been poorly evaluated in-vivo. METHODS A narrative review of the biomechanical effect of meniscectomy and MAT was performed. Furthermore, two cases were presented, of one patient who underwent Medial MAT and Anterior Cruciate Ligament (ACL) reconstruction, and one who underwent Lateral MAT. During the surgery, knee laxity was evaluated using a surgical navigation system. RESULTS AP laxity and IE rotation were reduced of 25% to 50% at both 30° and 90° of knee flexion after MAT transplantation. DISCUSSION In both cases, almost all the tests performed showed a reduction of knee laxity after meniscus transplant, when compared with pre-operative knee laxity. This assessment confirms the insights of previous in-vitro studies and underline a crucial role of MAT in knee biomechanics.
Collapse
Affiliation(s)
- Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Stefanelli
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giacomo Dal Fabbro
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
| |
Collapse
|
23
|
Murphy CA, Garg AK, Silva-Correia J, Reis RL, Oliveira JM, Collins MN. The Meniscus in Normal and Osteoarthritic Tissues: Facing the Structure Property Challenges and Current Treatment Trends. Annu Rev Biomed Eng 2019; 21:495-521. [DOI: 10.1146/annurev-bioeng-060418-052547] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The treatment of meniscus injuries has recently been facing a paradigm shift toward the field of tissue engineering, with the aim of regenerating damaged and diseased menisci as opposed to current treatment techniques. This review focuses on the structure and mechanics associated with the meniscus. The meniscus is defined in terms of its biological structure and composition. Biomechanics of the meniscus are discussed in detail, as an understanding of the mechanics is fundamental for the development of new meniscal treatment strategies. Key meniscal characteristics such as biological function, damage (tears), and disease are critically analyzed. The latest technologies behind meniscal repair and regeneration are assessed.
Collapse
Affiliation(s)
- Caroline A. Murphy
- Stokes Laboratories, Bernal Institute, School of Engineering, University of Limerick, Limerick V94 PC82, Ireland
| | - Atul K. Garg
- Manufacturing Technology and Innovation Global Supply Chain, Johnson & Johnson, Bridgewater, New Jersey 08807, USA
| | - Joana Silva-Correia
- 3B's Research Group, I3B's: Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho and Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's: PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
| | - Rui L. Reis
- 3B's Research Group, I3B's: Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho and Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's: PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, University of Minho, 4805-017 Barco, Guimarães, Portugal
| | - Joaquim M. Oliveira
- 3B's Research Group, I3B's: Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho and Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's: PT Government Associate Laboratory, 4710-057 Braga, Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, University of Minho, 4805-017 Barco, Guimarães, Portugal
| | - Maurice N. Collins
- Stokes Laboratories, Bernal Institute, School of Engineering, University of Limerick, Limerick V94 PC82, Ireland
- Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| |
Collapse
|
24
|
Kolaczek S, Hewison C, Caterine S, Berardelli R, Beveridge T, Herman B, Hurtig M, Gordon K, Getgood A. 3D strain in native medial meniscus is comparable to medial meniscus allograft transplant. Knee Surg Sports Traumatol Arthrosc 2019; 27:349-353. [PMID: 30043117 DOI: 10.1007/s00167-018-5075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 07/17/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Injury or degeneration of the meniscus has been associated with the development of osteoarthritis of the knee joint. Meniscal allograft transplant (MAT) has been shown to reduce pain and restore function in patients who remain symptomatic following meniscectomy. The purpose of this study is to evaluate and compare the three-dimensional (3D) strain in native medial menisci compared to allograft-transplanted medial menisci in both the loaded and unloaded states. METHODS Ten human cadaveric knees underwent medial MAT, utilizing soft-tissue anterior and posterior root fixation via transosseous sutures tied over an anterolateral proximal tibial cortical bone bridge. The joint was imaged first in the non-loaded state, then was positioned at 5° of flexion and loaded to 1× body weight (650 ± 160 N) during MR image acquisition. Anatomical landmarks were chosen from each image to create a tibial coordinate system, which were then input into a custom-written program (Matlab R2014a) to calculate the 3D strain from the unloaded and loaded marker positions. Six independent strains were obtained: three principal strains and three shearing strains. RESULTS No statistically significant difference was found between the middle and posterior strains in the native knee compared to the meniscus allograft. This would suggest that soft-tissue fixation of meniscal allografts results in similar time zero principal and shear strains in comparison to the native meniscus. CONCLUSION These results suggest that time zero MAT performs in a similar manner to the native meniscus. Optimizing MAT strain behavior may lead to potential improvements in its chondroprotective effect.
Collapse
Affiliation(s)
| | | | | | | | | | - Ben Herman
- Fowler Kennedy Sport Medicine Clinic, Western University, London, UK
| | - Mark Hurtig
- Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Karen Gordon
- School of Engineering, University of Guelph, Guelph, Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, UK.
| |
Collapse
|
25
|
Liu JN, Gowd AK, Redondo ML, Christian DR, Cabarcas BC, Yanke AB, Cole BJ. Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. Orthop J Sports Med 2019; 7:2325967118818462. [PMID: 30643837 PMCID: PMC6322105 DOI: 10.1177/2325967118818462] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery. Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS. Results: A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m2. The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A ), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL). Conclusion: This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers’ compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT.
Collapse
Affiliation(s)
- Joseph N Liu
- Department of Orthopaedics, Loma Linda University, Loma Linda, California, USA
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael L Redondo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - David R Christian
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brandon C Cabarcas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
26
|
|
27
|
Jauregui JJ, Wu ZD, Meredith S, Griffith C, Packer JD, Henn RF. How Should We Secure Our Transplanted Meniscus? A Meta-analysis. Am J Sports Med 2018; 46:2285-2290. [PMID: 28816515 DOI: 10.1177/0363546517720183] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal allograft transplant (MAT) is a salvage procedure for young patients with symptomatic meniscal deficiency. Although many studies report good outcomes, MAT remains controversial, and an optimal fixation technique for the meniscus roots is debated. PURPOSE To assess the overall outcome of MAT and compare the results of different meniscal root fixation techniques. STUDY DESIGN Meta-analysis. METHODS Following specific guidelines, we systematically evaluated all current literature for studies reporting on the outcomes of patients who underwent MAT. Using random effect models of proportions, we determined the tear and failure rates. Standardized mean differences (SMDs) were calculated to determine the improvement in clinical outcomes and pain level. Data were then stratified by root fixation method into 2 groups: fixation that preserved the graft's root insertions on the allograft bone (bone fixation group) and suture fixation of the root soft tissue without the allograft bone (soft tissue suture group). RESULTS A total of 38 studies (1637 MATs, 81% men) involving subjects with a mean age of 34 years (range, 20-48 years) and a mean follow-up of 60 months (range, 25-168 months) met inclusion criteria. This overall cohort had significant improvements in Lysholm scores (from 57.8 to 81.4 points; SMD 1.5, P < .001) and pain level (visual analog scale [VAS], from 56 to 21 points; SMD 1.8, P < .001). The cohort had a tear rate of 9% and a failure rate of 12.6%. No significant differences were found between the soft tissue suture (485 MATs) and bone fixation (489 MATs) groups in terms of meniscal allograft tear rates (13.4% vs 14.9%), failure rates (17.6% vs 18.8%), Lysholm scores (from 52.3 to 82.4, SMD 2.0, and from 60.7 to 82.9, SMD 1.7; respectively), and VAS scores (from 65 points to 18 points, SMD 2.6, and from 63 points to 13 points, SMD 3.1; both P < .001). Meniscal extrusion was similar, with a weighted mean percentage of extrusion of 40.2% in the soft tissue suture group and 43.1% in the bone fixation group. CONCLUSION This meta-analysis demonstrated significant improvements in clinical outcomes for MAT patients with low tear and failure rates. The data do not demonstrate a difference between soft tissue suture and bone fixation for MAT root fixation. This suggests that the technique of root fixation may not have an appreciable influence on clinical outcome, pain reduction, extrusion, or MAT longevity. Further prospective trials are needed.
Collapse
Affiliation(s)
- Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zhan Dong Wu
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sean Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Cullen Griffith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
28
|
Koh YG, Kim YS, Kwon OR, Heo DB, Tak DH. Comparative Matched-Pair Analysis of Keyhole Bone-Plug Technique Versus Arthroscopic-Assisted Pullout Suture Technique for Lateral Meniscal Allograft Transplantation. Arthroscopy 2018; 34:1940-1947. [PMID: 29730213 DOI: 10.1016/j.arthro.2018.01.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes and meniscal extrusion measured by magnetic resonance imaging (MRI) between the keyhole bone-plug technique and arthroscopic-assisted pullout suture technique in lateral meniscal allograft transplantation (MAT). METHODS Between October 2009 and February 2015, patients who underwent lateral MAT were retrospectively reviewed. The inclusion criteria were patients with symptomatic knees that had undergone total or subtotal meniscectomy who were treated with lateral MAT with a minimum follow-up period of 2 years. We excluded 13 patients with anterior cruciate ligament injury to the ipsilateral knee and 6 patients with combined cartilage procedures. In addition, we excluded 19 patients because they did not undergo follow-up MRI and 13 patients who did not undergo more than 2 years of follow-up. Thirty-seven patients who underwent lateral MAT with the keyhole bone-plug technique were identified and assigned to group A. Forty-five patients who underwent lateral MAT with the arthroscopic-assisted pullout suture technique (group B) were then matched by age, body mass index, and time from previous meniscectomy to lateral MAT. Clinical outcome assessments included preoperative and postoperative subjective International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores and the visual analog scale (VAS) score for pain evaluation. MRI was used to assess meniscal extrusion. RESULTS The mean follow-up period was 35.8 ± 6.5 months (range, 24-65 months) in group A and 34.6 ± 6.2 months (range, 24-55 months) in group B. Significant improvements in the VAS pain score, subjective IKDC score, Tegner score, and Lysholm score after lateral MAT were found (P < .001), and there were no significant differences between the 2 groups at final follow-up (VAS score, 1.4 ± 0.8 in group A and 1.2 ± 1.0 in group B [P = .164]; subjective IKDC score, 72.9 ± 8.1 in group A and 74.2 ± 7.3 in group B [P = .427]; Tegner activity score, 4.0 ± 0.9 in group A and 4.1 ± 0.8 in group B [P = .374]; and Lysholm score, 75.5 ± 10.6 in group A and 76.2 ± 11.8 in group B [P = .786]). On MRI, the meniscal extrusion extent was 3.1 ± 0.9 mm in group A and 2.9 ± 0.8 mm in group B (P = .223), and the relative percentages of extrusion were 27.0% ± 3.9% and 26.1% ± 4.2%, respectively (P = .273). CONCLUSIONS Compared with the keyhole bone-plug technique, the arthroscopic-assisted pullout suture technique in lateral MAT showed comparable clinical and MRI results at short-term follow-up. LEVEL OF EVIDENCE Level IV, case series with intragroup comparisons.
Collapse
Affiliation(s)
- Yong Gon Koh
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Yong Sang Kim
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Oh Ryong Kwon
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Dong Beom Heo
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Dae Hyun Tak
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea.
| |
Collapse
|
29
|
Bin SI, Nha KW, Cheong JY, Shin YS. Midterm and Long-term Results of Medial Versus Lateral Meniscal Allograft Transplantation: A Meta-analysis. Am J Sports Med 2018; 46:1243-1250. [PMID: 28609637 DOI: 10.1177/0363546517709777] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is unclear whether lateral meniscal allograft transplantation (MAT) procedures lead to better clinical outcomes than medial MAT. HYPOTHESIS The survival rates are similar between medial and lateral MAT, but the clinical outcomes of lateral MAT are better than those of medial MAT at final follow-up. STUDY DESIGN Meta-analysis. METHODS In this meta-analysis, we reviewed studies that assessed survival rates in patients who underwent medial or lateral MAT with more than 5 years of follow-up and that used assessments such as pain and Lysholm scores to compare postoperative scores on knee outcome scales. The survival time was considered as the time to conversion to knee arthroplasty and/or subtotal resection of the allograft. RESULTS A total of 9 studies (including 287 knees undergoing surgery using medial MAT and 407 with lateral MAT) met the inclusion criteria and were analyzed in detail. The proportion of knees in which midterm (5-10 years) survival rates (medial, 97/113; lateral, 108/121; odds ratio [OR] 0.71; 95% CI, 0.31-1.64; P = .42) and long-term (>10 years) survival rates (medial, 303/576; lateral, 456/805; OR 0.78; 95% CI, 0.52-1.17; P = .22) were evaluated did not differ significantly between medial and lateral MAT. In addition, both groups had substantial proportions of knees exhibiting midterm survivorship (85.8% for medial MAT and 89.2% for lateral MAT) but much lower proportions of knees exhibiting long-term survivorship (52.6% for medial MAT and 56.6% for lateral MAT). In contrast, overall pain score (medial, 65.6 points; lateral, 71.3 points; 95% CI, -3.95 to -0.87; P = .002) and Lysholm score (medial, 67.5 points; lateral, 72.0 points; 95% CI, -10.17 to -3.94; P < .00001) were significantly higher for lateral MAT compared with medial MAT. CONCLUSION Meta-analysis indicated that 85.8% of medial and 89.2% of lateral meniscal allograft transplants survive at midterm (5-10 years) while 52.6% of medial and 56.6% of lateral meniscal allograft transplants survive long term (>10 years). Patients undergoing lateral meniscal allograft transplantation demonstrated greater pain relief and functional improvement than patients undergoing medial meniscal allograft transplantations.
Collapse
Affiliation(s)
- Seong-Il Bin
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyung-Wook Nha
- Department of Orthopedic Surgery, Ilsanpaik Hospital, Inje University College of Medicine, Goyangsi, Republic of Korea
| | - Ji-Young Cheong
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| |
Collapse
|
30
|
Smith NA, Parsons N, Wright D, Hutchinson C, Metcalfe A, Thompson P, Costa ML, Spalding T. A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. Bone Joint J 2018; 100-B:56-63. [PMID: 29305451 DOI: 10.1302/0301-620x.100b1.bjj-2017-0918.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months. PATIENTS AND METHODS A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions. RESULTS A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups. CONCLUSION This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Cite this article: Bone Joint J 2018;100-B:56-63.
Collapse
Affiliation(s)
- N A Smith
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - N Parsons
- University of Warwick, Coventry, CV7 4AL, UK
| | - D Wright
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - C Hutchinson
- Warwick Medical School, University of Warwick, Coventry CV7 4AL, UK
| | - A Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV7 4AL, UK
| | - P Thompson
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M L Costa
- NDORMS, Windmill Road, Oxford OX3 7LD, UK
| | - T Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| |
Collapse
|
31
|
Zacchilli MA, Dai AZ, Strauss EJ, Jazrawi LM, Meislin RJ. Bone Trough Lateral Meniscal Allograft Transplantation: The Tapered Teardrop Technique. Arthrosc Tech 2017; 6:e2301-e2312. [PMID: 29552463 PMCID: PMC5852289 DOI: 10.1016/j.eats.2017.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/14/2017] [Indexed: 02/03/2023] Open
Abstract
The meniscus plays a vital role in knee biomechanics, and its physical absence or functional incompetence (e.g., irreparable root or radial tear) leads to unacceptably high rates of joint degeneration in affected populations. Meniscal allograft transplantation has been used successfully to treat patients with postmeniscectomy syndrome, and there is early laboratory and radiographic evidence hinting at a potential prophylactic role in preventing joint degeneration. We present a technique for lateral meniscal allograft transplantation using the CONMED Meniscal Allograft Transplantation system.
Collapse
Affiliation(s)
| | - Amos Z. Dai
- Address correspondence to Amos Z. Dai, B.S., NYU Hospital for Joint Diseases, 301 E 17th Street, Suite 1500, New York, NY 10003, U.S.A.NYU Hospital for Joint Diseases301 E 17th StreetSuite 1500New YorkNY10003U.S.A.
| | | | | | | |
Collapse
|
32
|
Woodmass JM, Johnson NR, Levy BA, Stuart MJ, Krych AJ. Lateral Meniscus Allograft Transplantation: The Bone Plug Technique. Arthrosc Tech 2017; 6:e1215-e1220. [PMID: 29354420 PMCID: PMC5622462 DOI: 10.1016/j.eats.2017.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/25/2017] [Indexed: 02/03/2023] Open
Abstract
Lateral meniscus tears are commonly encountered by orthopaedic surgeons. Despite efforts to repair and preserve the meniscus, meniscectomy is occasionally required to treat irreparable tears. The resulting lateral meniscus deficiency leads to increased tibiofemoral contact pressures and ultimately early osteoarthritic changes in the knee. Lateral meniscal allograft transplant (LMAT) has been proposed as a way to restore the lateral meniscus-deficient knee to its native form. Although several techniques for LMAT have been proposed, osseous fixation has demonstrated increased stability, improved outcomes, and improved long-term survival. This article presents a technique for LMAT using bone plugs and standard arthroscopic portals.
Collapse
Affiliation(s)
| | | | | | | | - Aaron J. Krych
- Address correspondence to Aaron J. Krych, M.D., Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A.Mayo Clinic200 First Street SWRochesterMN55905U.S.A.
| |
Collapse
|
33
|
Meniskustransplantation mit Spendermeniskus. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T, Amis A, Bin SI, Bugbee W, Caborn D, Carter T, Chan KM, Cohen C, Cohen M, Condello V, DeBerardino T, Dirisamer F, Engebretsen L, Farr J, Gomoll A, Harner C, Heard M, Hiemstra L, Kim JG, Kim J, Kim JM, Kon E, Laggae K, Lee BS, Litchfield R, Marcacci M, McCormack R, McDermott I, Monlau JC, Myers P, Noyes F, Patsch C, Robinson J, Rodeo S, Seo SS, Sherman S, Siebold R, Snow M, Stone K, Tashman S, Thompson P, van Arkel E, van der Merwe W, Verdonk R, Williams A, Zaffagnini S. International Meniscus Reconstruction Experts Forum (IMREF) 2015 Consensus Statement on the Practice of Meniscal Allograft Transplantation. Am J Sports Med 2017; 45:1195-1205. [PMID: 27562342 DOI: 10.1177/0363546516660064] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes.
Collapse
Affiliation(s)
- Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario, Canada
| | | | - Peter Verdonk
- Antwerp Orthopedic Center, Monica Hospitals, Antwerp, Belgium
| | - Wayne Gersoff
- Advanced Orthopedic and Sports Medicine Specialists, Denver, Colorado, USA
| | - Brian Cole
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Kim JM, Bin SI, Lee BS, Kim NK, Song JH, Choi JW, Lee CR. Long-term Survival Analysis of Meniscus Allograft Transplantation With Bone Fixation. Arthroscopy 2017; 33:387-393. [PMID: 27692556 DOI: 10.1016/j.arthro.2016.07.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the long-term clinical results and clinical survival rate of meniscus allograft transplantation (MAT) with bone fixation. METHODS The inclusion criteria of this study were previous MAT with bone fixation technique in our institution and minimum follow-up duration of 8 years. Potential subjects were identified using the medical records and database that was prospectively collected from December 1996 to December 2005. The exclusion criteria were diffuse International Cartilage Repair Society grade IV articular cartilage degeneration that was not treated with a concomitant or staged cartilage repair procedure. Surgical indication for MAT was previous total or subtotal meniscectomy followed by persistent swelling and pain in involved compartment. Recommendations to return to contact sports or strenuous activities were not made. Clinical outcomes were evaluated using the modified Lysholm score, and comparison between preoperative and final Lysholm score was done using Student t-test. During the follow-up period, failure was defined as (1) subtotal resection of the allograft, (2) conversion to total knee arthroplasty, or (3) a modified Lysholm score less than 65 or that of the preoperative status. Survival analysis was performed using the Kaplan-Meier method. RESULTS During the study period, 52 knees underwent MAT in our institution and 49 knees were eligible for this study. Three knees were excluded because they had diffuse grade IV cartilage degeneration in the respective compartment. Among the 49 knees enrolled, 34 underwent lateral and 15 underwent medial MAT. Two patients had bilateral lateral MAT. Of those 47 patients, 37 were male and 10 were female. Mean patient age at the time of the MAT was 30.4 ± 8.6 years. The median follow-up period was 11.5 years (8 to 17 years). The preoperative mean modified Lysholm score was 73.2 ± 10.6, which significantly increased to 89.4 ± 13.2 at the time of the final follow-up (P < .001). There were 2 failures noted at 6 months and 11.3 years, respectively, after MAT. All of the other allografts were surviving at the time of the latest follow-up. The 10-year survival rate was 98.0% (95% confidence interval [CI], 94.1%-100%), and the 15-year survival rate was 93.3% (95% CI, 83.7%-100%) according to the Kaplan-Meier analysis. CONCLUSIONS MAT using the bone fixation techniques demonstrated a high clinical survival rate according to the long-term observation. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Jong-Min Kim
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Nam-Ki Kim
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ju-Ho Song
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jun-Weon Choi
- Department of Orthropaedic Surgery, Namyangju Hanyang General Hospital, Seoul, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| |
Collapse
|
36
|
McCulloch PC, Dolce D, Jones HL, Gale A, Hogen MG, Alder J, Palmer JE, Noble PC. Comparison of Kinematics and Tibiofemoral Contact Pressures for Native and Transplanted Lateral Menisci. Orthop J Sports Med 2016; 4:2325967116674441. [PMID: 28203586 PMCID: PMC5298409 DOI: 10.1177/2325967116674441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lateral meniscus transplantation is a proven treatment option for the meniscus-deficient knee, yet little is known about meniscal kinematics, strain, and tibiofemoral contact pressure changes after transplantation or the effect of altered root position in lateral meniscus transplantation. PURPOSE To compare the native lateral meniscal kinematics, strain, and tibiofemoral contact pressures to a best-case scenario meniscus transplant with perfectly matched size and position and to determine how sensitive these factors are to subtle changes in shape and position by using a nonanatomic meniscus transplant position. STUDY DESIGN Controlled laboratory study. METHODS The lateral menisci of 8 cadaveric knees were circumferentially implanted with radiopaque spherical markers. They were mounted to a testing apparatus applying muscle and ground-reaction forces. The meniscus was evaluated at 0°, 30°, 90°, and 115° of knee flexion using Roentgen stereophotogrammetric analysis (RSA), with a pressure sensor affixed to the lateral tibial plateau. Measurements were recorded for 3 states: the native lateral meniscus, an anatomic autograft transplant, and a nonanatomic autograft transplant with an anteriorized posterior root position. RESULTS After transplantation, there was less posterior displacement in both the anatomic and nonanatomic transplant states compared with the native meniscus, but this was not significant. The largest lateral translation in the native state was 2.38 ± 1.58 mm at the anterolateral region from 0° to 90°, which was increased to 3.28 ± 1.39 mm (P = .25) and 3.12 ± 1.18 mm (P = .30) in the anatomic and nonanatomic transplant states, respectively. Internal deformations of the transplant states were more constrained, suggesting less compliance. The native meniscus distributed load over 223 mm2, while both the anatomic (160 mm2) and nonanatomic (102 mm2) states concentrated pressure anteriorly to the tibial plateau centroid. CONCLUSION This study is the first to characterize kinematics in the native lateral meniscus compared with a transplanted state utilizing RSA. Results demonstrate increased meniscal constraint and pressure concentrations even after an ideal size and position matched transplantation, which further increased with a nonanatomic posterior root position. CLINICAL RELEVANCE The results show that kinematics are similar in both transplanted states when compared with the native meniscus at various flexion angles. Because both transplanted states were more constrained with less deformation compared with the native state, this should allow for relatively safe postoperative range of motion. However, in the transplanted states, peak pressures were distributed over a smaller area and shifted anteriorly. This pattern was exacerbated in the nonanatomic state compared with anatomic. This could have detrimental effects with regard to articular cartilage degeneration, and ultimately result in a failed transplantation.
Collapse
Affiliation(s)
- Patrick C McCulloch
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Donald Dolce
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Hugh L Jones
- Institute of Orthopedic Research & Education, Houston, Texas, USA
| | - Andrea Gale
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael G Hogen
- Institute of Orthopedic Research & Education, Houston, Texas, USA
| | - Jason Alder
- Institute of Orthopedic Research & Education, Houston, Texas, USA
| | - Jeremiah E Palmer
- Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Philip C Noble
- Institute of Orthopedic Research & Education, Houston, Texas, USA
| |
Collapse
|
37
|
Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T. Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 2016; 24:2923-2935. [PMID: 25786823 DOI: 10.1007/s00167-015-3573-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/05/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE The primary aim of this systematic review was to examine the hypothesis that meniscal allograft transplantation is chondroprotective by identifying and appraising studies that have assessed the progression of osteoarthritis following meniscal allograft transplantation. The secondary aim was to identify and appraise radiological measures of meniscal allograft integrity following surgery. METHODS Clinical studies on human participants undergoing meniscal allograft transplantation with a minimum follow-up of 6 months were included. The primary outcome measure was any radiological osteoarthritis progression measure. Secondary outcomes included magnetic resonance measures of meniscal integrity including meniscal size, shape, healing, extrusion and signal intensity. RESULTS Thirty-eight studies with 1056 allografts were included. The weighted mean joint space loss was 0.032 mm at 4.5 years across 11 studies. Other radiological classification systems were reported in small numbers and with variable progression rates. Meniscal extrusion was present in nearly all cases, but was not associated with clinical or other radiological outcomes. Meniscal healing rates were high, although the size, shape and signal intensity were commonly altered from that of the native meniscus. The quality of the included studies was low, with a high risk of bias. CONCLUSION There is some evidence to support the hypothesis that meniscal allograft transplantation reduces the progression of osteoarthritis, although it is unlikely to be as effective as the native meniscus. If this is proven, there may be a role for prophylactic meniscal allograft transplantation in selected patients. Well-designed randomised controlled trials are needed to further test this hypothesis. LEVEL OF EVIDENCE Systematic review of studies, Level IV.
Collapse
Affiliation(s)
- Nick A Smith
- University of Warwick, Clinical Sciences Research Laboratories, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
| | - Benjamin Parkinson
- University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Charles E Hutchinson
- University of Warwick, Clinical Sciences Research Laboratories, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Matthew L Costa
- University of Warwick, Clinical Sciences Research Laboratories, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, CV2 2DX, UK
| |
Collapse
|
38
|
Gonzalez-Lomas G, Dold AP, Kaplan DJ, Fralinger DJ, Jazrawi L. Osteochondral Proximal Tibial and Lateral Meniscal Allograft Transplant. Arthrosc Tech 2016; 5:e953-e958. [PMID: 27909660 PMCID: PMC5123987 DOI: 10.1016/j.eats.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/25/2016] [Indexed: 02/03/2023] Open
Abstract
Knee pain in young, active patients with meniscus-deficient knees and articular cartilage damage can present a challenge to treatment. Meniscal allograft transplantation (MAT) has shown good clinical results as treatment for meniscus deficiency; however, worse outcomes have been observed in patients with significant chondral damage. The development of chondral restorative techniques such as osteochondral allograft transplantation (OCA) has expanded the population of patients who may benefit from MAT. We present a case of proximal tibial osteochondral and lateral meniscal allograft transplant. This review includes a sample of patient examinations and imaging, followed by a detailed technical description of the case. The technique article concludes with a discussion on the niche combined MAT-OCA procedures occupy in the patient treatment realm.
Collapse
Affiliation(s)
| | | | - Daniel J. Kaplan
- Address correspondence to Daniel J. Kaplan, B.A., NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY 10016, U.S.A.NYU Hospital for Joint Diseases333 East 38th Street4th FloorNew YorkNY10016U.S.A.
| | | | | |
Collapse
|
39
|
Kim NK, Bin SI, Kim JM, Lee CR. Does Lateral Meniscal Allograft Transplantation Using the Keyhole Technique Restore the Anatomic Location of the Native Lateral Meniscus? Am J Sports Med 2016; 44:1744-52. [PMID: 27159296 DOI: 10.1177/0363546516639937] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is important to restore the normal anatomy of the native meniscus in meniscal allograft transplantation (MAT) for successful surgical results. PURPOSE/HYPOTHESIS The purpose of this study was to compare the anatomic positions of the anterior horn (AH) and posterior horn (PH) between the preoperative lateral meniscus and postoperative meniscal allograft after lateral MAT using the keyhole technique. We hypothesized that the keyhole technique could restore the preoperative anatomy of the native lateral meniscus. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between December 2012 and December 2014, a total of 70 patients underwent lateral MAT using the keyhole technique. The anatomic positions of both horns of the native lateral meniscus and the meniscal allograft were measured on magnetic resonance imaging (MRI). Preoperative MRI was performed 1 day before lateral MAT, while postoperative MRI was performed 2 days after lateral MAT. A percentage reference method was used to measure the location of both horns. RESULTS For the AH, the mean delta value of the absolute position was 0.7 ± 1.8 mm (95% CI, 0.3-1.1 mm) in the coronal plane and 0.5 ± 1.6 mm (95% CI, 0.2-0.9 mm) in the sagittal plane, and the mean delta value of the relative position was 1.0% ± 2.3% (95% CI, 0.5%-1.6%) in the coronal plane and 1.1% ± 3.3% (95% CI, 0.2%-1.8%) in the sagittal plane. For the PH, the mean delta value of the absolute position was 2.4 ± 2.6 mm (95% CI, 1.8 to 3.1 mm) in the coronal plane and -0.1 ± 2.1 mm (95% CI, -0.6 to 0.4 mm) in the sagittal plane, and the mean delta value of the relative position was 3.3% ± 3.5% (95% CI, 2.5% to 4.2%) in the coronal plane and -0.3% ± 4.4% (95% CI, -1.3% to 0.8%) in the sagittal plane. Therefore, the AH moved by a mean of 0.7 mm laterally and 0.5 mm anteriorly (absolute values) and 1.0% laterally and 1.1% anteriorly (relative values) compared with the preoperative position. The PH moved by a mean of 2.4 mm laterally and 0.1 mm posteriorly (absolute values) and 3.3% laterally and 0.3% posteriorly (relative values) compared with the preoperative position. For the AH, the proportion of patients with an absolute delta value of ≥5 mm was 4.3% in the coronal plane and 2.9% in the sagittal plane. For the PH, the proportion of patients with an absolute delta value of ≥5 mm was 18.6% in the coronal plane and 4.3% in the sagittal plane. CONCLUSION When comparing the position of the horns preoperatively and postoperatively, both horns showed mean relative postoperative positional changes of <5% of relative values and <5 mm of absolute values in both the coronal and sagittal planes. The keyhole technique in lateral MAT can reconstruct the lateral meniscus close to its native anatomic position by avoiding displacement of >5 mm in both the coronal and sagittal planes.
Collapse
Affiliation(s)
- Nam-Ki Kim
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, College of Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| |
Collapse
|
40
|
Load distribution in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1815-25. [PMID: 27085358 DOI: 10.1007/s00167-016-4123-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/29/2016] [Indexed: 01/30/2023]
Abstract
Total knee replacement is an accepted standard of care for the treatment of advanced knee osteoarthritis with good results in the vast majority of older patients. The use in younger and more active populations, however, remains controversial due to concerns over activity restrictions, implant survival, and patient satisfaction with the procedure. It is in these younger patient populations that alternatives to arthroplasty are increasingly being explored. Historically, osteotomy was utilized to address unicompartmental pain from degeneration and overload, for example, after meniscectomy. Utilization rates of osteotomy have fallen in recent years due to the increasing popularity of partial and total knee arthroplasty. This article explores the indications and outcomes of traditional unloading osteotomy, as well as newer options that are less invasive and offer faster return to function.
Collapse
|
41
|
|
42
|
Spalding T, Getgood A. Defining outcome after meniscal allograft transplantation: Is buying time a valid measure of success? Knee Surg Sports Traumatol Arthrosc 2016; 24:1424-6. [PMID: 27106921 DOI: 10.1007/s00167-016-4128-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tim Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada
| |
Collapse
|
43
|
Perez-Blanca A, Espejo-Baena A, Amat Trujillo D, Prado Nóvoa M, Espejo-Reina A, Quintero López C, Ezquerro Juanco F. Comparative Biomechanical Study on Contact Alterations After Lateral Meniscus Posterior Root Avulsion, Transosseous Reinsertion, and Total Meniscectomy. Arthroscopy 2016; 32:624-33. [PMID: 26545307 DOI: 10.1016/j.arthro.2015.08.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 08/03/2015] [Accepted: 08/28/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effects of lateral meniscus posterior root avulsion left in situ, its repair, and meniscectomy on contact pressure distribution in both tibiofemoral compartments at different flexion angles. METHODS Eight cadaveric knees were tested under compressive 1000 N load for 4 lateral meniscus conditions (intact, posterior root avulsion, transosseous root repair, and total meniscectomy) at flexion angles 0°, 30°, 60°, and 90°. Contact area and pressure distribution were registered using K-scan pressure sensors inserted between menisci and tibial plateau. RESULTS In the lateral compartment, root detachment decreased contact area (P = .017, 0° and 30°; P = .012, 60° and 90°) and increased mean (P = .012, all angles) and maximum (P = .025, 0° and 30°; P = .017, 60°; P = .012, 90°) pressures relative to intact condition. Repair restored all measured parameters close to intact at 0°, but effectiveness decreased with flexion angle, yielding no significant effect at 90°. Meniscectomy produced higher decreases than root avulsion in contact area (P = .012, 0° and 90°; P = .05, 30° and 60°) and increases in mean (P = .017, 0° and 30°; P = .018, 90°) and maximum pressure (P = .012, 0°; P = .036, 30°). In the medial compartment, lesion changed the contact area at high flexion angles only, while meniscectomy induced greater changes at all angles. CONCLUSIONS Lateral meniscus posterior root avulsion generates significant alterations in contact area and pressures at lateral knee compartment for flexion angles between full extension and 90°. Meniscectomy causes greater disorders than the avulsion left in situ. Transosseous repair with a single suture restores these alterations to conditions close to intact at 0° and 30° but not at 60° and 90°. CLINICAL RELEVANCE Altered contact mechanics after lateral meniscus posterior root avulsion might have degenerative consequences. Transosseous repair with one suture should be revised to effectively restore contact mechanics at high flexion angles.
Collapse
Affiliation(s)
- Ana Perez-Blanca
- Biomechanics Laboratory, Department of Mechanical Engineering, University of Malaga, Malaga, Spain.
| | - Alejandro Espejo-Baena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Daniel Amat Trujillo
- Department of Anatomy and Forensic Medicine, University of Malaga, Malaga, Spain
| | - María Prado Nóvoa
- Biomechanics Laboratory, Department of Mechanical Engineering, University of Malaga, Malaga, Spain
| | | | - Clara Quintero López
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | |
Collapse
|
44
|
Krych AJ, Gobbi A, Lattermann C, Nakamura N. Articular cartilage solutions for the knee: present challenges and future direction. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
45
|
Spalding T, Parkinson B, Smith NA, Verdonk P. Arthroscopic Meniscal Allograft Transplantation With Soft-Tissue Fixation Through Bone Tunnels. Arthrosc Tech 2015; 4:e559-63. [PMID: 26900554 PMCID: PMC4722248 DOI: 10.1016/j.eats.2015.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/02/2015] [Indexed: 02/03/2023] Open
Abstract
Meniscal allograft transplantation improves clinical outcomes for patients with symptomatic meniscus-deficient knees. We describe an established arthroscopic technique for meniscal allograft transplantation without the need for bone fixation of the meniscal horns. After preparation of the meniscal bed, the meniscus is parachuted into the knee through a silicone cannula and the meniscal horns are fixed with sutures through bone tunnels. The body of the meniscus is then fixed with a combination of all-inside and inside-out sutures. This technique is reliable and reproducible and has clinical outcomes comparable with those of bone plug fixation techniques.
Collapse
Affiliation(s)
- Tim Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England
| | - Ben Parkinson
- Reef Orthopaedic Clinic, Cairns, Queensland, Australia
| | | | | |
Collapse
|
46
|
Abstract
The anatomy and microstructure of the menisci allow the effective distribution of load across the knee. Meniscectomy alters the biomechanical environment and is a potent risk factor for osteoarthritis. Despite a trend towards meniscus-preserving surgery, many tears are irreparable, and many repairs fail. Meniscal allograft transplantation has principally been carried out for pain in patients who have had a meniscectomy. Numerous case series have reported a significant improvement in patient-reported outcomes after surgery, but randomised controlled trials have not been undertaken. It is scientifically plausible that meniscal allograft transplantation is protective of cartilage, but this has not been established clinically to date. Cite this article: Bone Joint J 2015; 97-B:590–4.
Collapse
Affiliation(s)
- N. A. Smith
- Clinical Sciences Research Laboratories, Clifford
Bridge Road, Coventry CV2 2DX, UK
| | - M. L. Costa
- University of Warwick, Gibbet Hill
Road, Coventry CV4 7AL, UK
| | - T. Spalding
- UHCW Hospital, 5th
Floor Orthopaedic Offices, Clifford Bridge
Road, Coventry, CV2 2DX, UK
| |
Collapse
|
47
|
Wang H, Chen T, Gee AO, Hutchinson ID, Stoner K, Warren RF, Rodeo SA, Maher SA. Altered regional loading patterns on articular cartilage following meniscectomy are not fully restored by autograft meniscal transplantation. Osteoarthritis Cartilage 2015; 23:462-8. [PMID: 25498591 PMCID: PMC4339622 DOI: 10.1016/j.joca.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the changes in regional dynamic loading patterns on tibial articular cartilage during simulated walking following medial meniscectomy and meniscal transplantation. METHODS Seven fresh frozen human cadaveric knees were tested under multidirectional loads mimicking the activity of walking, while the contact stresses on the tibial plateau were synchronously recorded using an electronic sensor. Each knee was tested for three conditions: intact meniscus, medial meniscectomy, and meniscal transplantation. The loading profiles at different locations were assessed and common loading patterns were identified at different sites of the tibial plateau using an established numerical algorithm. RESULTS Three regional patterns were found on the tibial plateau of intact knees. Following medial meniscectomy, the area of the first pattern which was located at the posterior aspect of the medial plateau was significantly reduced, while the magnitude of peak load was significantly increased by 120%. The second pattern which was located at the central-posterior aspects of the lateral plateau shifted anteriorly and laterally without changing its magnitude. The third pattern in the cartilage-to-cartilage contact region of the medial plateau was absent following meniscectomy. Meniscal transplantation largely restored the first pattern, but it did not restore the other two patterns. CONCLUSION There are site-dependent changes in regional loading patterns on both the medial and lateral tibial plateau following medial meniscectomy. Even when a meniscal autograft is used where the geometry and material properties are kept constant, the only region in which the loading pattern is restored is at posterior aspect of the medial plateau.
Collapse
Affiliation(s)
- Hongsheng Wang
- Department of Biomechanics, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021
| | - Tony Chen
- Department of Biomechanics, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021
| | - Albert O Gee
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021,Orthopaedics and Sports Medicine, University of Washington School of Medicine, 535 E 70 St., New York, NY 10021
| | - Ian D Hutchinson
- Department of Biomechanics, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021,Orthopaedic Surgery, Wake Forest School of Medicine, 535 E 70 St., New York, NY 10021
| | - Kirsten Stoner
- Department of Biomechanics, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021,Department of Biomedical Engineering, University of Iowa, 535 E 70 St., New York, NY 10021
| | - Russell F Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021
| | - Suzanne A Maher
- Department of Biomechanics, Hospital for Special Surgery, 535 E 70 St., New York, NY 10021
| |
Collapse
|
48
|
Dirisamer F, Patsch C. Allogene Meniskustransplantation. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-014-0838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
49
|
Meniscal allograft transplantation. Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2015; 23:323-33. [PMID: 25266230 DOI: 10.1007/s00167-014-3344-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/17/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE To provide a systematic review of the literature regarding five topics in meniscal allograft transplantation (MAT): optimal timing for transplantation, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. METHODS A systematic literature search was conducted using the PubMed (MEDLINE), ScienceDirect, and EBSCO-CINAHL databases. Articles were classified only in one topic, but information contained could be reported into other topics. Information was classified according to type of study (animal, in vitro human, and in vivo human) and level of evidence (for in vivo human studies). Specific inclusion criteria were determined for the outcomes and prevention of osteoarthritis topics. RESULTS Twenty-four studies were finally included: two optimal timing, seven outcomes, three return to competitive sport, 16 MAT and associated procedures, and 5 MAT and prevention of osteoarthritis (some studies were categorized in more than one topic). These studies corresponded to 2 animal studies and 31 in vivo human studies (1 level II, 1 level III, and 29 level IV). CONCLUSIONS The principal conclusions were as follows: (a) there is no evidence to support that MAT has to be performed at the same time or immediately after meniscectomy to prevent development of postmeniscectomy syndrome; (b) MAT successfully improves symptoms, function, and quality of life at 7-to-14 years of follow-up (level IV evidence); (c) the overall failure rate (need for knee arthroplasty) is 10-29% at long-term follow-up; (d) MAT allows return to same level of competition in 75-85% of patients at short- to mid-term follow-up (only three studies level IV evidence with small sample size); (e) associated cartilage procedures or anterior cruciate ligament reconstruction to MAT does not worsen the results; (f) MAT may prevent progression of cartilage damaged at long-term follow-up, but may not prevent degeneration in previously healthy cartilage. LEVEL OF EVIDENCE Systematic review of level II-IV studies, Level IV.
Collapse
|
50
|
Jang KM, Wang JH. Lateral meniscus allograft transplantation using a single-incision technique. Knee Surg Sports Traumatol Arthrosc 2015; 23:258-63. [PMID: 23455419 DOI: 10.1007/s00167-013-2464-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 02/20/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this work is to introduce and evaluate a novel arthroscopically assisted meniscus allograft transplantation (MAT) technique that requires only one small anterior incision for an arthrotomy. METHODS In the novel technique, the posterior horn of the allograft meniscus was repaired using the modified all-inside suture technique instead of the conventional inside-out technique. By doing this, an additional posterior incision could be avoided. Thirteen consecutive patients with total or subtotal meniscectomy of the lateral meniscus underwent lateral MAT using the novel technique from August 2010 to October 2011. The clinical outcomes were evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity level scales. RESULTS The median follow-up period was 21.0 months (range 13-28 months). The post-operative median Lysholm score improved to 85.0 (range 77-95, P < 0.05). The median IKDC subjective score was 80.0 (range 63-99, P < 0.05) at last follow-up. The median Tegner activity level of 6.0 (range 4-7) was improved compared with the median preoperative level (P < 0.05). None of the patients presented with symptoms requiring a secondary surgical procedure at the time of final follow-up. CONCLUSION The novel method requires only one small arthrotomy incision except for arthroscopic portals. In addition to the minimal number of incisions, this technique has several advantages over previous techniques. This single-incision technique could be effective and satisfactory option for lateral MAT. LEVEL OF EVIDENCE Case series with no comparison group, Level IV.
Collapse
Affiliation(s)
- Ki-Mo Jang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Gu, Seoul, 135-710, South Korea
| | | |
Collapse
|