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Pham C, Ebner PJ, Yoshida R, McCullough MC, Brown T, Tanabe K, Kulber DA. Outcomes of Patients Receiving Proximal Row Carpectomy and Meniscus Interposition Allografts for the Treatment of End-Stage Wrist Arthritis: A Comparative Study. Hand (N Y) 2024:15589447241262052. [PMID: 39066490 DOI: 10.1177/15589447241262052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Proximal row carpectomy (PRC) is a mainstay of wrist arthritis treatment; however, it is traditionally contraindicated in patients with an affected capitate. The use of soft tissue interposition grafts to resurface the radiocapitate articulation has been previously described to allow for PRC in these patients. In the current study, we reviewed our outcomes using knee meniscus allograft interposition to resurface the radiocapitate articulation in patients who would have otherwise been contraindicated for PRC. METHODS A retrospective study of patients who underwent PRC with or without meniscus interposition arthroplasty was performed from 2011 to 2022. Patient demographics (age, sex, occupation, hand dominance, etc) were collected. Improvement in pain was the primary outcome. Wrist range of motion and reconstructive failure requiring fusion were the secondary outcomes. RESULTS We identified a total of 83 patients and 43 met the inclusion criteria. Fifteen patients (35%) underwent PRC with meniscus interposition arthroplasty, and 28 patients (65%) underwent PRC alone. Patients with and without meniscus interposition arthroplasty had documented improvement in pain postoperatively (93% vs 95%, P > .05) at a median follow-up time of 11 (range, 3-38 months) and 9 months (range, 3-64 months), respectively. Postoperative wrist range of motion (flexion: +9 vs -4, P > .05, extension: +12 vs -4, P = .10) trended toward increase in patients undergoing meniscus interposition arthroplasty compared with PRC alone. CONCLUSIONS Our short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo PRC and meniscus interposition arthroplasty are comparable with those receiving PRC alone.
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Affiliation(s)
| | | | - Ryu Yoshida
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Kylie Tanabe
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Li W, Luo Y, Zhao X, Wang J. Meniscal Allograft versus Synthetic Graft in Treatment Outcomes of Meniscus Repair: A Mini-review and Meta-analysis. ACS Biomater Sci Eng 2024. [PMID: 39042061 DOI: 10.1021/acsbiomaterials.4c00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Meniscal injuries are highly correlated with osteoarthritis (OA) onset and progression. Although meniscal allograft transplantation (MAT) is a therapeutic option to restore meniscal anatomy, a shortage of donor material and the donor-derived infectious risk may be concerns in clinics. This review summarizes the literature reporting meniscus repair status in preclinical models and clinical practice using allografts or synthetic grafts. The advantages and limitations of biodegradable polymer-based meniscal scaffolds, applied in preclinical studies, are discussed. Then, the long-term treatment outcomes of patients with allografts or commercial synthetic scaffolds are compared. A total of 47 studies are included in our network meta-analysis. Compared with the meniscal allografts, the commercial synthetic products significantly improved clinical treatment outcomes in terms of the Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS) scores, and Lysholm scores. In addition, development strategies for the next generation of novel synthetic scaffolds are proposed through optimization of structural design and fabrication, and selection of cell sources, external stimuli, and active ingredients. This review may inspire researchers and surgeons to design and fabricate clinic-orientated grafts with improved treatment outcomes.
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Affiliation(s)
- Weirong Li
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
- Dongguan Eontec Co., Ltd., Dongguan 523808, P. R. China
| | - Ying Luo
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Xibang Zhao
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Jiali Wang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
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Wang DY, Jiang D, Yu JK. Editorial Commentary: Meniscal Allograft Transplantation Results in Both Pain Relief and Chondroprotection. Arthroscopy 2024; 40:1575-1577. [PMID: 38219097 DOI: 10.1016/j.arthro.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/15/2024]
Abstract
Meniscal allograft transplantation (MAT) effectively alleviates symptoms of the meniscus deficiency. Thus, MAT is a widely accepted and recommended treatment for individuals with unicompartmental pain due to meniscus deficiency. Long-term follow-up studies have indicated that MAT yields favorable clinical outcomes, demonstrating high survivorship and low rates of serious complications. In addition, the ability of MAT to function akin to the native meniscus and shield the knee cartilage from osteoarthritis has been a subject of ongoing investigation, and recent direct magnetic resonance imaging evidence shows long-term chondroprotection following MAT. Cartilage lesions worsen during the meniscus deficiency period. Consequently, delaying MAT until patients become more symptomatic may lead to poor outcomes and low graft survivorship due to concomitant cartilage lesions. These findings prompt a reevaluation of the purpose and timing of MAT decisions for meniscectomy patients, suggesting a more proactive approach to recommending MAT, particularly for patients at high risk of postmeniscectomy syndrome and osteoarthritis progression.
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Affiliation(s)
- Ding-Yu Wang
- Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices
| | - Dong Jiang
- Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices
| | - Jia-Kuo Yu
- Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices; Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Beijing, China
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Li J, Zhang F, Ga X, Gao G, Guo T. Total meniscus replacement with a 3D printing of network hydrogel composite scaffold in a rabbit model. Knee Surg Sports Traumatol Arthrosc 2024; 32:1187-1198. [PMID: 38506124 DOI: 10.1002/ksa.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The aim of this study was to evaluate the role of a novel total meniscal implant in promoting meniscal regeneration and protecting articular cartilage in a rabbit model for 3 and 6 months. METHODS Thirty-six New Zealand rabbits were selected and divided into poly(ɛ-caprolactone) (PG-Pg) scaffold group, meniscectomy group and sham group. In this study, it was investigated whether PG-Pg scaffold can prevent articular cartilage degeneration and promote tissue degeneration, and its mechanical properties at 3 and 6 months after surgery were also explored. RESULT The degree of articular cartilage degeneration was significantly lower in the PG-Pg scaffold group than in the meniscectomy group. The number of chondrocytes increased in the PG-Pg scaffold at 3 and 6 months, while a gradual increase in the mechanical properties of the PG-Pg stent was observed from 6 months. CONCLUSION The PG-Pg scaffold slows down the degeneration of articular cartilage, promotes tissue regeneration and improves biomechanical properties after meniscectomy. This novel meniscus scaffold holds promise for enhancing surgical strategies and delivering superior long-term results for individuals with severe meniscus tears. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Jiaran Li
- Guizhou Provincial People's Hospital, Guiyang, China
- The Third Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | | | - Xisijia Ga
- Guizhou Provincial People's Hospital, Guiyang, China
| | - Gan Gao
- Guizhou Provincial People's Hospital, Guiyang, China
| | - Tao Guo
- Guizhou Provincial People's Hospital, Guiyang, China
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Lee HY, Kim JM, Lee BS, Bin SI, Kim SM, Lee SJ. Lateral Meniscal Allograft Transplantation Shows a Long-Term Chondroprotective Effect on Quantitative Magnetic Resonance Imaging T2 Mapping at 7-Year Minimum Follow-Up. Arthroscopy 2024; 40:1568-1574. [PMID: 37813204 DOI: 10.1016/j.arthro.2023.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To assess the long-term chondroprotective effect of lateral meniscal allograft transplantation (MAT) using quantitative magnetic resonance imaging (MRI) T2 mapping. METHODS In patients who underwent isolated lateral MAT, quantitative MRI T2 mapping was conducted preoperatively and postoperatively with at minimum follow-up of 7 years to assess the articular cartilage status. On the sagittal section image bisecting the lateral femoral condyle, the weight-bearing portions of the femoral and tibial articular cartilage were divided into 3 segments each-6 segments in total-based on the meniscal coverage area. The regions-of-interest analyses were performed on the 6 segments to measure the mean T2 value. Then the whole layer was divided into deep and superficial layers for further zonal analysis. The longitudinal change in T2 values was statistically analyzed using paired t-tests. Clinical outcome was evaluated using the Lysholm score. RESULTS A total of 31 patients were included in the study, with the MRI follow-up period of a minimum of 7 years (mean: 8.9 ± 1.3 years; range: 7.0-11.2 years). The mean T2 value of the whole layer showed significant improvement in all segments of the femoral cartilage and the posterior segment of tibial cartilage. In the zonal analysis, the mean T2 value of the tibial cartilage showed significant improvement in the superficial layer of the mid to posterior portion, while the deep layer remained stable. In contrast, the mean T2 value of the femoral cartilage showed significant improvement in the superficial and deep layers in all segments. The mean Lysholm score significantly improved from 62.6 ± 12.8 to 90.9 ± 10.5 (P < .001). CONCLUSIONS This study suggests that MAT appears to have a long-term chondroprotective effect on the articular cartilage as judged by quantitative T2 mapping. LEVEL OF EVIDENCE Level Ⅳ, case series.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, Eulji Medical Center Daejeon Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea; Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Min Kim
- Department of Orthopaedic Surgery, Wiltse Memorial Hospital, Anyang, Republic of Korea
| | - Seon-Jong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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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.
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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
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Gopinatth V, Warrier AA, Jawanda HS, Mameri ES, Khan ZA, Allahabadi S, Knapik DM, Cole BJ, Chahla J. Correlation between articular cartilage status on outcomes and survivorship following meniscal allograft transplantation: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:623-635. [PMID: 38383989 DOI: 10.1002/ksa.12065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT). METHODS A literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status. RESULTS Sixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full-thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT. CONCLUSIONS Conflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Alec A Warrier
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Harkirat S Jawanda
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S Mameri
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A Khan
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Sachin Allahabadi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Patel A, Pratte T, Wetzler M. Editorial Commentary: Tissue-Engineered Meniscal Scaffolds and Implants Show Promising Short-Term Outcomes While Long-Term Comparison With Meniscal Allograft Transplantation Is Pending. Arthroscopy 2024; 40:996-997. [PMID: 38219115 DOI: 10.1016/j.arthro.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 01/15/2024]
Abstract
Because of the prevalence of meniscal injuries and the difficulty treating irreparable tears and large defects, there has been increasing research and resultant engineering strategies over the past 20 years that have resulted in development of various meniscal scaffolds and meniscal implants. At this time, meniscal allograft transplant may be the "standard" consideration for the nonarthritis, meniscal deficient, stable, and properly aligned painful knee, but challenges include availability, preoperative planning and sizing, costs, and logistics. Newer tissue-engineered implants can minimize these concerns, and recent systematic review shows these may provide short-term improvement in knee pain and function. However, studies demonstrating long-term improvements remain pending, and it is unclear whether these implants will result in outcomes better than meniscal allograft transplant.
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Song JH, Kim JM, Bin SI, Lee BS, Lee J. Risk Factor for Clinical Failure of Medial Meniscal Allograft Transplant: Early vs Late Graft Tear. Am J Sports Med 2024; 52:368-373. [PMID: 38186334 DOI: 10.1177/03635465231214221] [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: 01/09/2024]
Abstract
BACKGROUND Graft tears are common postoperative findings in meniscal allograft transplant (MAT). Graft tear in medial MAT may be different from that of lateral MAT, considering the difference between medial meniscal tears and lateral meniscal tears. Moreover, medial MAT is frequently accompanied by ligament reconstruction, which is associated with graft tear. The effect of graft tear on the long-term survivorship of medial MAT has not been investigated. HYPOTHESIS Graft tear would adversely affect the survivorship of medial MAT and the effect would be different according to the timing of graft tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 55 patients undergoing medial MAT between June 2019 and March 2000 were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) scans were reviewed to identify graft tears, and the timing of their occurrence was investigated. Postoperative MRI was performed routinely during the first postoperative year and every 2 years thereafter. The patients were classified into a no graft tear (NT) group, early graft tear (occurring within 1 year; ET) group, and late graft tear (occurring 1 year after surgery; LT) group. The survival rate of medial MAT was estimated according to graft tear, with a failure being defined as (1) reoperations including arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (>50% of the graft or to the zone of the meniscocapsular junction) or (2) Lysholm score <65. Clinical scores were compared between the groups. RESULTS The mean follow-up duration was 8.6 ± 5.3 years. During that period, clinical failures occurred in 6 (10.9%) patients. The overall survival rate at 5 years was 94.0% (95% CI, 90.6%-97.4%). Graft tears were seen in 18 patients: 6 patients in the ET group and 12 patients in the LT group. The median time when the graft tear was noted on MRI scans was 5.5 months (range, 1-11 months) postoperatively in the ET group and 99.5 months (range, 19-264 months) postoperatively in the LT group. Five patients in the ET group had root tears, whereas 9 patients in the LT group had complex or horizontal tears. The 5-year survival rate of the ET group was 62.5% (95% CI, 41.2%-83.8%), which was significantly lower than that of the NT group (96.8%; 95% CI, 93.6%-99.9%) and the LT group (85.7%; 95% CI, 72.5%-98.9%; P = .002). The mean postoperative Lysholm scores were 85.6 ± 17.9 in the NT group, 93.0 ± 2.8 in the ET group, and 79.3 ± 11.6 in the LT group, showing no significant difference between the groups (Kruskal-Wallis test, P = .058). CONCLUSION Clinical relevance of graft tear that occurred after medial MAT was dependent upon its timing. ET was a risk factor for clinical failure, whereas LT did not adversely affect graft survivorship. Lysholm scores did not differ according to graft tear.
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Affiliation(s)
- Ju-Ho Song
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongjin Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Morales-Avalos R, Masferrer-Pino Á, Padilla-Medina JR, Amestoy-Ramos J, Ibáñez M, Perelli S, Ariztegui-Andrade C, Espregueira-Mendes J, Monllau JC. Mid-Term Clinical and Radiological Outcomes of Lateral Meniscal Allograft Transplantation with Suture-Only Fixation Plus Capsulodesis. J Knee Surg 2024; 37:26-36. [PMID: 36122692 DOI: 10.1055/a-1946-7079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meniscal allograft transplantation (MAT) is an effective reconstructive procedure for treating a symptomatic postmeniscectomy syndrome. It consists of replacing the lost meniscal tissue aiming to improve the clinical outcomes and prevent progressive deterioration of the joint. The aim of this study was to evaluate meniscal graft survivorship and report on the radiographic (in terms of graft extrusion and joint space width and alignment) and the functional results through a midterm follow-up of lateral MAT performed with a soft tissue fixation technique after capsulodesis. In total, 23 patients who underwent lateral MAT as a single procedure were included. The Knee injury and Osteoarthritis Outcome Score, Lysholm, Tegner, and visual analog scale scales were used for patient assessment. Magnetic resonance imaging and a complete radiographic protocol were conducted to determine the degree of meniscal extrusion and the changes in the degree of osteoarthritis and coronal alignment. Assessments were performed after 2 and 7 years of follow-up. A significant improvement in all the scores, relative to preoperative values, was found after 7 years of follow-up. This improvement remained consistent throughout the first and second follow-up periods. A mean absolute extrusion of 2.2 mm ± 1.6 and an extrusion percentage of 28.0% ± 11.43 were found, with no significant differences throughout the follow-up periods. There was no statistically significant difference in terms of the frontal mechanical axis and joint space narrowing between the preoperative value and at the first and second follow-up periods. A survival rate of 85.7% was found after 7 years of follow-up. Capsulodesis results in a low degree of meniscal extrusion in isolated lateral MAT fixed with a suture-only technique, which is maintained after 7 years of follow-up, with a high graft survival index (>85%) and satisfactory results on the functional scales.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (U.A.B.), Barcelona, Catalunya, Spain
- Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
- Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - Ángel Masferrer-Pino
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (U.A.B.), Barcelona, Catalunya, Spain
| | - José Ramón Padilla-Medina
- Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - Jorge Amestoy-Ramos
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (U.A.B.), Barcelona, Catalunya, Spain
| | - Maximiliano Ibáñez
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (U.A.B.), Barcelona, Catalunya, Spain
| | - Simone Perelli
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (U.A.B.), Barcelona, Catalunya, Spain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Catalunya, Spain
| | | | - João Espregueira-Mendes
- FIFA Medical Centre of Excellence, Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal
- School of Medicine, Minho University, Braga, Portugal
| | - Joan Carles Monllau
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (U.A.B.), Barcelona, Catalunya, Spain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Catalunya, Spain
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11
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Pawelczyk J, Fanourgiakis I, Feil S, Siebold R. Significant improvements in clinical outcome measures and patient satisfaction after combined all-arthroscopic meniscal allograft transplantation and autologous chondrocyte implantation: A single-centre longitudinal study. Knee Surg Sports Traumatol Arthrosc 2024; 32:78-88. [PMID: 38226734 DOI: 10.1002/ksa.12023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The optimal treatment approach for the complex pathology of meniscal insufficiency and coexisting full-thickness cartilage defects remains unclear. The purpose of this study was to evaluate the viability, safety, and efficacy of this combined surgical approach at medium-term follow-up. METHODS This is a single-centre longitudinal study with blinded outcome assessment. All consecutive patients treated with combined all-arthroscopic meniscal allograft transplantation (MAT) with bone bridge fixation and ACI using chondrospheres at our institution between 2001 and 2021 were eligible for inclusion. Twenty patients with an average follow-up of 72.6 ± 34.4 months were included in the statistical analysis. Clinical outcomes were assessed pre- and postoperatively using the IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and Visual Analog Scale (VAS) for patient satisfaction. Failure and reoperation rates were assessed, and cartilage regeneration tissue was evaluated on postoperative MRI. RESULTS IKDC scores significantly improved from 52.1 ± 16.9 to 68.5 ± 16.3 (p = 0.003). Lysholm scores improved from 61.5 ± 21.7 to 78.5 ± 12.9 (p = 0.004). Tegner scores improved from 3.5 (1-4) to 4.0 (2-6) (p = 0.014). KOOS scores improved significantly across all subcategories, except 'symptoms', where improvements did not reach statistical significance. VAS for overall patient satisfaction showed improvements but did not reach statistical significance. The combined procedure was successful in 17 patients (85%). Eight patients had to undergo reoperation (40%), comprising mostly small, arthroscopic procedures. Seven reoperations were directly attributable to meniscal allograft transplantation (46.7%). Postoperative Magnetic Resonance Observation of Cartilage Repair Tissue scores were 68.9 ± 16.8 (n = 14). CONCLUSION Combined arthroscopic MAT and autologous chondrocyte implantation (ACI) is a viable, safe, and effective treatment approach for younger patients with meniscal insufficiency and coexisting full-thickness cartilage damage, where alternative treatment options are limited. The combined surgical procedure achieved significant improvements in clinical outcome measures and patient satisfaction with acceptable failure and high arthroscopic reoperation rates. MAT is the limiting part of this combined procedure, with most failures and reoperations being attributable to MAT, as opposed to ACI. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Sven Feil
- International Center for Orthopedics, ATOS Clinic, Heidelberg, Germany
| | - Rainer Siebold
- International Center for Orthopedics, ATOS Clinic, Heidelberg, Germany
- Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany
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12
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Lee J, Lee DW, Kyeong TH, Lee JW, Kim JG. Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation. Knee Surg Sports Traumatol Arthrosc 2023; 31:5864-5872. [PMID: 37964127 DOI: 10.1007/s00167-023-07641-3] [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] [Received: 05/03/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023]
Abstract
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.
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Affiliation(s)
- JiHwan Lee
- Department of Orthopedic Surgery, Myongji Hospital, 55, Hwasu-Ro 14Beon-Gil, Deogyang-Gu, Goyang-Si, Gyeonggi-Do, 10475, South Korea
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Tae Hyun Kyeong
- Department of Orthopedic Surgery, Myongji Hospital, 55, Hwasu-Ro 14Beon-Gil, Deogyang-Gu, Goyang-Si, Gyeonggi-Do, 10475, South Korea
| | - Jung Wook Lee
- Department of Orthopedic Surgery, Myongji Hospital, 55, Hwasu-Ro 14Beon-Gil, Deogyang-Gu, Goyang-Si, Gyeonggi-Do, 10475, South Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Myongji Hospital, 55, Hwasu-Ro 14Beon-Gil, Deogyang-Gu, Goyang-Si, Gyeonggi-Do, 10475, South Korea.
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13
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Song JH, Kim JM, Bin SI, Lee BS, Lee J. Early Graft Tear As a Major Risk Factor for the Clinical Failure of Lateral Meniscal Allograft Transplantation. Am J Sports Med 2023; 51:3701-3705. [PMID: 37975518 DOI: 10.1177/03635465231208714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Graft tears are often observed on magnetic resonance imaging after lateral meniscal allograft transplantation (MAT). Their characteristics, such as the location and configuration, are likely to be different depending on the timing of the injury. However, the clinical relevance of early and late graft tears has not been investigated. HYPOTHESIS (1) Both early and late graft tears would be associated with the clinical failure of lateral MAT, and (2) an early graft tear (ET) would lead to worse outcomes than a late graft tear (LT) or an intact graft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 261 patients who had undergone lateral MAT between March 2000 and June 2019 were retrospectively reviewed. The graft tear was investigated using magnetic resonance imaging, which was performed routinely during the first postoperative year and every 2 years thereafter. The patients were classified according to the timing of the graft tear: no graft tear (NT) group, ET (≤1 year after surgery) group, and LT (>1 year after surgery) group. Clinical failure was defined as (1) reoperations including arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (>50% of the graft or to the zone of the meniscocapsular junction) or (2) a Lysholm score of <65. Risk factors for a low survival rate were investigated using Cox regression analysis. A comparison of the Lysholm scores for each group was also performed. RESULTS There were 24 (9.2%) patients who had clinical failure at a mean follow-up of 7.5 ± 4.3 years. The overall survival rate at 5 years was 92.8% (95% CI, 91.1%-94.5%). A graft tear was noted in 80 patients: 23 patients in the ET group and 57 patients in the LT group. The most common tear pattern was a meniscocapsular tear in the ET group and a complex tear in the LT group. The hazard ratios for clinical failure in the ET and LT groups were 30.7 (95% CI, 9.4-76.4; P < .001) and 4.0 (95% CI, 1.3-12.9; P = .013), respectively. The Lysholm score of the ET group (82.7 ± 14.8) was significantly lower than that of the other 2 groups (NT: 87.6 ± 11.7; LT: 90.7 ± 9.0; P = .024). CONCLUSION An ET was a major risk factor for the clinical failure of lateral MAT. An LT was associated with a lower survival rate. An ET was also associated with worse clinical outcomes.
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Affiliation(s)
- Ju-Ho Song
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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14
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Lee SJ, Bin SI, Kim JM, Lee BS, Kim SM, Lee HY. Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 2023; 31:4485-4491. [PMID: 37596367 DOI: 10.1007/s00167-023-07506-9] [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] [Received: 11/20/2022] [Accepted: 07/05/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE To investigate the characteristics of anatomically failed grafts within 1 year after meniscal allograft transplantation (MAT) and compare the differences between lateral and medial MATs. METHODS The records of consecutive patients with anatomically failed grafts within 1 year after primary MAT between 2005 and 2018 were reviewed. Anatomical failure was defined as a tear covering > 50% of the allograft or an unstable peripheral rim. The pattern and location of the graft tears were analyzed using magnetic resonance imaging or arthroscopy. RESULTS A total of 21 patients were included. All 21 patients had anatomical failure with tears involving > 50% of the allograft, whereas 15 had an unstable peripheral rim of the allograft. The mean failure time was 6.6 ± 3.6 months in all patients (lateral MAT, n = 15; medial MAT, n = 6). In the lateral MAT group, meniscocapsular separation was the most common pattern (n = 10, 66.7%), followed by complex (n = 3, 20.0%), radial (n = 1, 6.7%), and longitudinal (n = 1, 6.7%) tear. In the medial MAT group, a root tear was the most common pattern (n = 5, 83.3%), followed by a complex tear (n = 1, 16.7%). Meanwhile, in the lateral MAT, the midbody was the most frequently affected location (n = 9, 60.0%), followed by the posterior (n = 5, 33.3%) and anterior (n = 1, 6.7%) areas; in the medial MAT group, the posterior (n = 5, 83.3%) was the most frequently affected location, followed by the anterior area (n = 1, 16.7%). Significant differences in the pattern (P = 0.002) and location (P = 0.043) of the graft tears were found between lateral and medial MATs. CONCLUSION In patients with early failure after MAT, meniscocapsular separation in the midbody of the lateral compartment and root tears in the posterior area of the medial compartment were the most common. Thus, surgeons are encouraged to pay extra attention to these vulnerable areas during the early period after MAT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seon-Jong Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 Gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 Gil, Songpa-gu, 05505, Seoul, Republic of Korea.
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 Gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 Gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Seung-Min Kim
- Department of Orthopaedic Surgery, Wiltse memorial hospital, Anyang, Republic of Korea
| | - Hyo Yeol Lee
- Daejeon Eulji University Hospital, Daejeon, Republic of Korea
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15
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Bhattacharyya R, Krishnan H, Bausch N, Pilarski A, McGoldrick N, Thompson P, Metcalfe A, Spalding T. Bone bridge technique for lateral meniscal allograft transplantation: no difference in clinical outcome compared to the soft tissue technique. Knee Surg Sports Traumatol Arthrosc 2023; 31:4162-4170. [PMID: 37154910 DOI: 10.1007/s00167-023-07443-7] [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] [Received: 09/20/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE There is considerable debate regarding the optimal method of fixation for lateral meniscus allograft transplantation (MAT), with bone bridge techniques technically harder but allowing maintenance of root attachments, while soft tissue techniques are potentially more challenging for healing. The aim of this study was to compare the clinical results of the bone bridge and soft tissue techniques for lateral MAT in terms of failure, re-operation rate, complications and patient reported outcomes. METHODS Retrospective analysis of prospectively collected data for patients undergoing primary lateral MAT with a minimum of 12-month follow-up. Patients following surgery utilising the bone bridge technique (BB) were compared with historical control patients who underwent MAT with the soft tissue technique (ST). Outcome was assessed by failure rate, defined as removal or revision of the meniscus transplant, survivorship by Kaplan-Meir analysis, re-operation rates, and other adverse event. Patient-reported outcome measures (PROMs) were compared using data at the 2-year point or 1 year if not reached 2 years. RESULTS One-hundred and twelve patients following lateral meniscal transplants were included, 31 in the BB group and 81 in the ST historical control group, with no differences in demographics between both groups. Median follow-up for the BB group was 18 (12-43) months compared to 46 (15-62) months for the ST group. There were 3 failures (9.6%) in the BB group v 2 (2.4%) in the ST group (n.s.) with a mean time to failure of 9 months in both groups. 9 patients (29%) required a re-operation (all cause) in the BB group v 24 patients (29.6%) in the ST group (n.s). There was no difference in complications between both groups. There was significant improvement (p < 0.0001) in all PROMs (Tegner, IKDC, KOOS and Lysholm) between baseline and 2-year follow-up for both groups but no between-group differences. CONCLUSION Lateral MAT has a high success rate for symptomatic meniscal deficiency with significant benefits irrespective of the fixation technique. There is no advantage in performing the more technically demanding BB technique over ST fixation. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Rahul Bhattacharyya
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK.
| | | | - Nicole Bausch
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
| | - Adam Pilarski
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
| | | | - Peter Thompson
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
| | - Andrew Metcalfe
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
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16
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Kaarre J, Herman ZJ, Zsidai B, Grassi A, Zaffagnini S, Samuelsson K, Musahl V. Meniscus allograft transplantation for biologic knee preservation: gold standard or dilemma? Knee Surg Sports Traumatol Arthrosc 2023; 31:3579-3581. [PMID: 36205759 DOI: 10.1007/s00167-022-07187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 02/14/2023]
Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburg, Pittsburgh, USA.
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburg, Pittsburgh, USA
| | - Bálint Zsidai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburg, Pittsburgh, USA
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17
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Wang DY, Meng XY, Gong X, Yu JK, Jiang D. Meniscal allograft transplantation in discoid meniscus patients achieves good clinical outcomes and superior chondroprotection compared to meniscectomy in the long term. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07263-1. [PMID: 36454294 DOI: 10.1007/s00167-022-07263-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To compare the long-term clinical and radiological results of meniscal allograft transplantation (MAT) for discoid lateral meniscus (DLM) patients with MAT for non-discoid lateral meniscus patients and meniscectomy (ME) for DLM patients and, thus, to determine whether DLM patients are suitable candidates for MAT. METHODS Eight MAT cases in DLM patients were identified (discoid MAT group), six MAT cases in non-discoid lateral meniscus patients (non-discoid MAT group) and ten total meniscectomy cases in DLM patients (discoid ME group) were matched as controls. Subjective evaluations, postoperative radiography and magnetic resonance imaging (MRI) were conducted at 5 years and 10-14 years, respectively. Joint degeneration was evaluated by the Kellgren-Lawrance (KL) grade and joint space width (JSW). MRI with T2 mapping sequences was used to quantitatively evaluate degeneration of the joint cartilage and shrinkage of the allografts. Student's t test was used to compare quantitative variables and the Mann‒Whitney U test was used to compare categorical variables. RESULTS There was no difference in Lysholm, IKDC, Tegner or VAS scores amongst the discoid MAT, non-discoid MAT and discoid ME groups at the final follow-up. No revision surgery was performed in any MAT patient. The JSW narrowing in the discoid MAT group was better than that in the discoid ME group (0.8 ± 0.4 mm vs. 2.1 ± 1.3 mm, p = 0.012) and worse than that in the non-discoid MAT group (0.1 ± 0.1 mm, p = 0.003). The KL progression of the discoid MAT group was less than that of the discoid ME group (1.3 ± 0.7 vs. 2.3 ± 0.9, p = 0.034). The discoid ME group had worse cartilage lesion progression than the discoid MAT and non-discoid MAT groups. The allograft width of the DLM patients shrank more than that of the non-discoid patients at the meniscus midbody (3.6 ± 0.9 mm vs. 6.2 ± 1.9 mm, p = 0.015). CONCLUSION Compared to meniscectomy, MAT achieved similar long-term symptom relief and superior chondroprotection in discoid meniscus patients. Despite more graft shrinkage, the outcomes of MAT in discoid meniscus patients were comparable to those in non-discoid meniscus patients. Therefore, DLM patients may be suitable candidates for MAT procedures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ding-Yu Wang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Xiang-Yu Meng
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Xi Gong
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Jia-Kuo Yu
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China. .,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China.
| | - Dong Jiang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China. .,Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China.
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