Lateral meniscus allograft transplantation: an arthroscopically-assisted single-incision technique using all-inside sutures with a suture hook

Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation

PURPOSE

This study aimed to investigate the graft maturation and safety of single-incision bone bridge lateral meniscus allograft transplantation (LMAT).

METHODS

This study involved 35 patients who underwent LMAT between 2019 and 2020. All patients completed at least 2 years of follow-up (median 34 months; range 24-43) and underwent preoperative magnetic resonance imaging (MRI) to assess the trajectory safety of the leading suture passer and all-inside suture instrument (Fast-Fix). Graft status was evaluated according to the Stoller classification.

RESULTS

Based on preoperative MRI measurements, the expected trajectory of the leading suture passer did not transect the common peroneal nerve (CPN), with the closest distance between the expected trajectory and CPN being 1.4 mm and the average distance being 6.8 ± 3.2 mm. The average distance from the lateral meniscal posterior horn (LMPH) to the popliteal neurovascular bundle (PNVB) was 7.4 ± 2.6 mm and the nearest was 4.8 mm. The expected trajectory of the all-inside suturing instrument did not transect the PNVB when the distance was at least 12 mm, from the most lateral margin of the posterior cruciate ligament (PCL). Grade 3 signal intensity in the posterior third of the allograft on MRI was observed in 6 of 35 (17.1%) patients. Amongst the grade 3 signal intensities in the posterior one-third of the allografts, 3 of the 35 (8.5%) LMATs had a distorted contour.

CONCLUSION

The single-incision bone bridge LMAT technique introduced in this study is a convenient approach that preserves neurovascular safety and provides good results for the distortion of the posterior horn of the allograft and graft maturation. The safety zone for the penetrating devices during the procedure extended from 12 mm laterally to the most lateral margin of the PCL to the medial margin of the popliteal hiatus.

LEVEL OF EVIDENCE

IV.

Graft extrusion after medial and lateral MAT differs according to surgical technique: a meta-analysis

INTRODUCTION

It is unclear whether the incidence and amount of graft extrusion differ between knees undergoing medial and lateral meniscus allograft transplantation (MAT). This meta-analysis, therefore, compared the incidence and amount of transplanted meniscus allograft extrusion following medial and lateral MAT.

MATERIALS AND METHODS

All studies comparing absolute or relative extrusions, or proportion of major extrusions (> 3 mm), on magnetic resonance imaging between medial and lateral MATs were included.

RESULTS

Eight studies were included in the meta-analysis. Using the arthroscopic-assisted technique, medial MAT had significantly greater absolute (0.99 mm, p = 0.002) and relative (19.4%, p = 0.001) extrusions than lateral MAT. Using the complete arthroscopic technique, lateral MAT had 1.45 mm greater absolute extrusion than medial MAT (p < 0.001), but there was no difference in relative extrusion. Using the arthroscopic-assisted technique, the proportion of knees with major extrusion was greater for medial than lateral MAT (OR 5.32, p < 0.001), but, using the complete arthroscopic procedure, there was no difference in proportions of major extrusions between medial and lateral MAT (OR 0.28, p = 0.08).

CONCLUSION

Graft extrusions after medial and lateral MAT differed according to surgical technique. Graft extrusion was greater after medial than lateral MAT using the arthroscopic-assisted technique, but was greater after lateral than medial MAT using the complete arthroscopic procedure.

LEVEL OF EVIDENCE

Meta-analysis (Level II).

Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes

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.