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Grassi A, Lucidi GA, Di Paolo S, Altovino E, Agostinone P, Dal Fabbro G, Romandini I, Filardo G, Zaffagnini S. Clinical Outcomes of Medial Meniscal Allograft Transplantation With or Without High Tibial Osteotomy: A Case-Control Study Up to 8 Years of Follow-up. Am J Sports Med 2024; 52:1813-1819. [PMID: 38767945 PMCID: PMC11143754 DOI: 10.1177/03635465241248822] [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: 09/17/2023] [Accepted: 02/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Satisfactory clinical results of meniscal allograft transplantation (MAT) have been reported in recent years. However, it remains unclear whether the clinical outcomes of MAT when combined with an osteotomy are inferior to those of isolated MAT. PURPOSE To compare the survival rates and clinical outcomes of patients who received isolated medial MAT with those of patients undergoing medial MAT combined with high tibial osteotomy (HTO). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 55 patients underwent arthroscopic medial MAT using the soft tissue technique and HTO (mean age, 41.3 ± 10.4 years; 9 female); after fuzzy case-control matching on demographics, 55 controls who underwent isolated medial MAT were also included. Survival analyses were performed using the Kaplan-Meier method with surgical failure, clinical failure (Lysholm score, <65), and reoperation as endpoints. Subjective clinical scores were collected preoperatively and at the final follow-up. RESULTS The mean follow-up time was 5.4 years, up to 8 years. All outcomes significantly improved at the last follow-up (P < .001). No differences were identified between MAT and MAT + HTO groups preoperatively and at the last follow-up (P > .05). At the final follow-up, 8 of 55 (14.5%) of the MAT + HTO patients and 9 of 55 (16.4%) of the MAT patients had a Lysholm score <65 (P = .885). Overall, 90% of the patients declared they would repeat the surgery regardless of the combined procedure. Surgical failure was identified in 6 of 110 (5.5%) patients: 5 of 55 (9.1%) in the MAT + HTO group and 1 of 55 (1.8%) in the MAT group (P = .093). Clinical failure was identified in 19 of 110 (17.3%) patients: 11 of 55 (20%) in the MAT + HTO group and 8 of 55 (14.5%) in the MAT group (P = .447). A significantly lower survivorship from surgical failure was identified in the MAT + HTO group (hazard ratio, 5.1; P = .049), while no differences in survivorship from reoperation and clinical failure were identified (P > .05). CONCLUSION Patients undergoing medial MAT + HTO showed similar clinical results to patients undergoing isolated medial MAT at midterm follow-up, and thus a surgically addressed malalignment does not represent a contraindication for medial MAT. However, the need for a concomitant HTO is associated with a slightly higher failure rate over time.
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Affiliation(s)
- Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuele Altovino
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Surgical Department, Aspetar Hospital, Qatar, Doha
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Iacopo Romandini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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Solaro L, Andriolo L, Di Martino A, Grassi A, Zaffagnini S, Filardo G. Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769777 DOI: 10.1002/ksa.12268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The aim of this study was to prospectively evaluate the long-term clinical results and failure rate of patients treated with complex salvage procedures using a combined mechanical and biological approach to address unicompartmental knee osteoarthritis (OA) and postpone the need for joint replacement. METHODS Thirty-nine patients (40.3 ± 10.9 years old) affected by unicompartmental OA (Kellgren-Lawrence 3) in stable joints underwent a personalized surgical treatment depending on the specific requirements of the affected compartment, including high tibial osteotomy, osteochondral scaffold, meniscal scaffold and meniscal allograft transplantation. Patients were evaluated with the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS) and Tegner scores before surgery, at 3 years and a minimum of 10 years of follow-up. RESULTS A significant improvement was observed over time in all scores but worsened at the final follow-up. The IKDC subjective score improved from 46.9 ± 16.2 to 79.8 ± 16.4 at 3 years (p < 0.0005) and then decreased to 64.5 ± 21.4 (p = 0.001) at 12 years. A similar trend was confirmed for VAS and Tegner scores. Only two patients subsequently underwent knee arthroplasty, and nine more patients were considered clinical failure, for a cumulative surgical and clinical failure rate of 28.2% at the final follow-up. CONCLUSION A personalized, joint-preserving, combined mechanical and biological approach, addressing alignment as well as meniscal and cartilage lesions, is safe and effective, providing a clinical benefit and delaying the need for arthroplasty in young patients affected by unicompartmental knee OA. At the final evaluation, the clinical improvement decreased, but more than two-thirds of the patients still benefited from this treatment at a long-term follow-up. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Luca Solaro
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Surgery, EOC, Service of Orthopaedics and Traumatology, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
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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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Wagner KR, Kaiser JT, Quigley RA, Hevesi M, Damodar D, Meeker ZD, Cotter EJ, Yanke AB, Cole BJ. Revision and Conversion to Arthroplasty Are Low Among Adolescents Undergoing Meniscal Allograft Transplantation Using the Bridge-In-Slot Technique at Midterm Follow-Up. Arthroscopy 2024; 40:1186-1194.e1. [PMID: 37597703 DOI: 10.1016/j.arthro.2023.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To report midterm outcomes after primary medial and lateral meniscal allograft transplantation (MAT) with fresh-frozen allografts implanted with the bridge-in-slot technique in the adolescent patient population. METHODS Adolescent patients less than 18 years old at the time of primary MAT from 1999 to 2016 were retrospectively identified. International Knee Documentation Committee (IKDC) subjective form, Lysholm, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales scores were collected before surgery and at 1-year, 2-year, and a minimum 5-year follow-up. Thresholds for achieving clinically significant outcomes were calculated, and the proportion of patients achieving minimal clinically important difference (MCID), patient-acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) was determined. Meniscus reoperation (partial, subtotal, or total meniscectomy, repair, or failure) and failure (revision MAT or conversion to arthroplasty) rates were determined. RESULTS Forty-four (female n = 33; male n = 11) of 62 identified patients met inclusion criteria and were followed for a mean of 9.5 ± 3.8 years (range, 5.0-17.7). Lateral MAT was performed in most patients (n = 35/44 [80%]). Isolated MAT was performed in 27 (61%) patients. Common concomitant procedures included osteochondral allograft transplantation (32%), autologous chondrocyte implantation (18%), and anterior cruciate ligament reconstruction (14%). MCID, PASS, and SCB were achieved by patients at a minimum 5-year follow-up for IKDC (62%; 76%; 31%), Lysholm (62%; 79%; 23%), and KOOS questionnaires (Pain [65%; 81%; 41%], Symptoms [58%; 81%; 47%], Activities of Daily Living [53%; 77%; 35%], Sport [86%; 75%; 50%], and Quality of Life [59%; 81%; 59%]), respectively. Fourteen patients (32%) underwent reoperation at an average of 5.0 ± 4.3 years (range, 0.8-14.0) after MAT. Three (7%) patients met criteria for failure, requiring revision MAT an average of 3.8 ± 1.1 years (range, 2.8-4.9) after transplantation. No patients underwent arthroplasty. Overall survival free from failure at 1, 2, 5, and 10 years was 100%, 100%, 93%, and 93%, respectively. At the time of final follow-up, 80% of patients reported satisfaction with their current physical status. CONCLUSIONS Primary MAT in adolescent patients resulted in significant and durable functional improvements at mid- to long-term follow-up. At an average of 9.5 years after surgery, meniscal reoperation rate was 32% whereas graft survival free of revision MAT was 93%. Adolescents undergoing MAT demonstrated similar functional outcomes and graft survivability when compared to available adult MAT literature. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan A Quigley
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Eric J Cotter
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
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5
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Vanbiesbroeck F, Vandenrijt J, Van Glabbeek F, Verdonk P, Heusdens CH. A Case Report of a National Judo Champion: Is Return to High-Level Contact Sports Possible After Meniscus Allograft Transplantation? Cureus 2024; 16:e56764. [PMID: 38650767 PMCID: PMC11034290 DOI: 10.7759/cureus.56764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Meniscus allograft transplantation (MAT) is a surgical procedure reserved for (relatively) younger individuals who remain symptomatic after the resection of a voluminous part of the meniscus. Return to sports and certainly the level of sport post-MAT are highly variable. We present a unique case of a national judo champion who was able to compete at the highest level following MAT. Considerations regarding the rehabilitation and follow-up of this patient are provided, and the risk of rerupture is discussed. Although returning to high-level contact sports post-MAT is possible, the risk of rerupture should be considered.
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Affiliation(s)
| | | | | | - Peter Verdonk
- Orthopaedics, AZ (Algemeen Ziekenhuis) Monica, Antwerp, BEL
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Struijk C, Lydon KL, Husen M, Verdonk P, Michielsen J, van Wijnen AJ, Krych AJ, Saris DBF. Cellular Enhancement of Frozen Meniscus Allograft Combining Native Meniscus and Mesenchymal Stromal Cell Injections. Cartilage 2024:19476035231224802. [PMID: 38321966 DOI: 10.1177/19476035231224802] [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: 02/08/2024] Open
Abstract
OBJECTIVE This proof-of-concept study investigated an improved cell-based injection therapy combining mesenchymal stem cells (MSCs) and meniscus cells (MCs) to support superior meniscus allograft repopulation and early revival compared to injecting MSCs alone. DESIGN In this controlled laboratory study, frozen meniscus allograft samples were injected vertically with a cell suspension containing different ratios of MSCs and MCs or control (lactated ringers) and cultured for 28 days. Samples were analyzed weekly for cell viability, migration, and metabolism using histological and biochemical assays. Tissue medium was analyzed for matrix metalloproteinase (MMP) expression using zymography. RESULTS Cellular repopulation of frozen allografts injected with different cell suspensions was validated by immunohistochemistry. Significant higher DNA content was evidenced in grafts treated with suspensions of MCs or MC:MSC (1:4 ratio). Cell metabolic activity was significantly different between all treated groups and control group after 1 week. Allografts injected with MCs showed significantly more cell proliferation than injections with MSCs. MMP2 activity was detected in medium of all grafts cellularized with MCs with or without MSCs. Scanning electron microscopy (SEM) analysis showed resolution of the needle puncture, but not in the control group. Cell labeling of MCs upon injection of mixed MC:MSC suspensions revealed a gradual increase in the cell ratio. CONCLUSIONS The findings of this study establish that injection of MCs with or without MSCs enhances the cellularity of meniscus allograft to support early graft revival and remodeling.
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Affiliation(s)
- Caroline Struijk
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, University of Antwerp, Antwerp, Belgium
| | | | - Martin Husen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopaedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Verdonk
- Department of Orthopedic Surgery, University of Antwerp, Antwerp, Belgium
- Orthoca, Antwerp, Belgium
| | - Jozef Michielsen
- Department of Orthopedic Surgery, University of Antwerp, Antwerp, Belgium
| | - Andre J van Wijnen
- Department of Biochemistry, The University of Vermont, Burlington, VT, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Lydon KL, Struijk C, Michielsen J, Prokop L, Krych AJ, Saris D, Verdonk P. Fresh Versus Frozen Meniscal Allograft Transplant: Revisit or Redundant? A Systematic Review. Am J Sports Med 2024:3635465231200236. [PMID: 38282584 DOI: 10.1177/03635465231200236] [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: 01/30/2024]
Abstract
BACKGROUND Fresh-frozen allografts are the current standard in meniscal allograft transplant (MAT) surgery, due to their availability, ease of preservation, and affordability. However, fresh-frozen grafts are associated with several clinical challenges such as graft shrinkage and extrusion, among many others. PURPOSE To present the current knowledge on the use of fresh meniscal allografts, presenting whether benefits associated with fresh grafts provide sufficient evidence to support their use in clinical practice. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A comprehensive search was conducted with keywords listed below. After an initial screening on title and abstract, full-text articles were assessed with the inclusion criteria. RESULTS A total of 78 studies matched the inclusion criteria. Literature and preclinical studies indicated that fresh meniscal allografts are beneficial for maintaining mechanical properties, graft ultrastructure, and matrix metabolism due to the presence of viable cells. Therefore, fresh allografts may address common complications associated with fresh-frozen MAT. To overcome challenges associated with both fresh-frozen and fresh allografts, a group has studied treating fresh-frozen allografts with a cell-based injection therapy. CONCLUSION Fresh meniscal allografts pose several challenges including limited availability, demanding preservation procedures, and high costs. Although the role of viable cells within meniscal allografts remains controversial, these cells may be vital for maintaining tissue properties.
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Affiliation(s)
- Katherine L Lydon
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Struijk
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
| | - Jozef Michielsen
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
| | - Larry Prokop
- Library Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Saris
- Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, University Medical Centre, Utrecht, the Netherlands
| | - Peter Verdonk
- Department of Orthopedic Surgery, Antwerp University, Antwerp, Belgium
- ORTHOCA, Antwerp, Belgium
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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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9
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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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10
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Agarwal AR, Kreulen RT, Mathur A, Mikula J, Doerre T, Thakkar SC, Best MJ. Trends in utilization of meniscal allograft transplantation between 2010 and 2019. PHYSICIAN SPORTSMED 2023. [PMID: 38054215 DOI: 10.1080/00913847.2023.2292038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/04/2023] [Indexed: 12/07/2023]
Affiliation(s)
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abhay Mathur
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jacob Mikula
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Doerre
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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11
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Di Paolo S, Lucidi GA, Grassi A, Macchiarola L, Ambrosini L, Agostinone P, Dal Fabbro G, Zaffagnini S. Isolated meniscus allograft transplantation with soft-tissue technique effectively reduces knee laxity in the presence of previous meniscectomy: In-vivo navigation of 18 consecutive cases. J ISAKOS 2023; 8:430-435. [PMID: 37739345 DOI: 10.1016/j.jisako.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Although meniscal allograft transplantation (MAT) is a well-established procedure with satisfactory clinical results, limited in vivo kinematic information exists on the effect of medial and lateral MAT performed in the clinical setting. The purpose of the present study was to evaluate the biomechanical effect of arthroscopic isolated medial and lateral MAT with a soft-tissue fixation on pre- and post-operative knee laxity using a surgical navigation system. METHODS 18 consecutive patients undergoing MAT (8 medial, 10 lateral) were enrolled. A surgical navigation system was used to quantify the anterior-posterior displacement at 30 and 90 degrees of knee flexion (AP30 and AP90), the varus-valgus rotation at 0 and 30 degrees of knee flexion (VV0 and VV30) and the dynamic laxity on the pivot-shift test (PS), which was determined through the anterior displacement of the lateral tibial compartment (APlat) and posterior acceleration of the lateral tibial compartment during tibial reduction (ACC). Data from laxity before and after MAT were compared through paired t-test (p < 0.05). RESULTS After medial MAT, there was a significant decrease in tibial translation of 3.1 mm (31%; p = 0.001) for AP30 and 2.3 mm (27%; p = 0.020) for AP90, a significant difference of 2.5° (50%; p = 0.002) for VV0 and 1.7° (27%; p = 0.012) for VV30. However, medial MAT did not determine any reduction in the PS kinematic data. Lateral MAT determined a significant decrease in the tibial translation of 2.5 mm (38%; p < 0.001) for AP30 and 1.9 mm (34%; p = 0.004) for AP90 as well as a significant difference of 3.4° (59%; p < 0.001) for VV0 and of 1.7° (23%; p = 0.011) for VV30. There was also a significant reduction of the PS of 4.4 mm (22%; p = 0.028) for APlat and 384.8 mm/s2 (51%; p = 0.005) for ACC. CONCLUSION MAT with soft-tissue fixation results in a significant laxity reduction in an in-vivo setting. Medial MAT improved knee kinematics by determining a significant reduction with particular emphasis on AP translation and VV manoeuvre. Conversely, Lateral MAT determined a massive reduction of the PS and a mild decrease of the AP translation and VV manoeuvre. STUDY DESIGN Controlled laboratory study.
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Affiliation(s)
- Stefano Di Paolo
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, 40100, Italy
| | - Gian Andrea Lucidi
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, 40100, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Luca Ambrosini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy.
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12
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Uchio Y, Takuwa H, Wakatsuki T, Kuwata S. Meniscal Allograft Transplantation Concomitant With Cartilage Repair for Symptomatic Lateral Meniscus-Deficient Knees With Over Two Years of Follow-up. Cureus 2023; 15:e48774. [PMID: 38024091 PMCID: PMC10644150 DOI: 10.7759/cureus.48774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective The treatment for symptomatic meniscus-deficient knees with cartilage defects remains challenging on account of insufficient meniscal substitutes. One solution for this might involve combining meniscal allograft transplantation (MAT) and cartilage repair. In this study, we aimed to analyze the effectiveness and safety of MAT concomitant with cartilage repair for symptomatic lateral meniscus-deficient knees in a setting with limited availability of meniscal transplants in Japan. Methods Nine patients who underwent MAT concomitant with osteochondral transplantation (five) and/or autologous chondrocyte implantations (seven) were followed up for at least two years (mean: 51.2 months, range: 24-84 months). Their demographic data and other characteristics were as follows - mean age: 51.7 years, range: 36-67 years; men/women: 4/5; cause: trauma/discoid meniscus: 8/1; cartilage defect size: mean: 6.7 cm2/knee, range: 1.0-11.3. The effectiveness and safety were evaluated clinically by using the Lysholm Knee Scoring Scale (LKSS) and Japanese Orthopaedic Association (JOA) knee score, physical examination, X-rays, and MRI preoperatively and at one, 12, and 24 months after the implantation. Differences between the variables were analyzed using the Friedman test and Scheffe's multiple comparisons. Results The median LKSS and JOA scores significantly improved from 70 points (range: 21-80) and 35 (25-45) preoperatively to 86.5 (65-98) and 87.5 (80-95) at 24 months after surgery, respectively (p<0.001, p=0.0013). The range of motion (ROM), femorotibial angle, and the lateral joint space showed no significant changes. However, lateral meniscal extrusions (LMEs) increased by 3.0 mm (range: 0-6.3 mm) at one month postoperatively and remained unchanged until two years postoperatively. Treatment failure occurred in one case, which was revised by total knee arthroplasty (TKA) at 18 months postoperatively. Additional surgeries were needed in some cases: lateral meniscal tear (three cases), contracture (two cases), and patellar instability (one case). However, neither infection nor allergic reaction was observed in the blood exams. Conclusions Although MAT concomitant with cartilage repair showed good clinical outcomes, half of the cases needed additional surgeries. Based on our findings, this technique should be adopted only in select cases and performed by a handful of highly experienced surgeons.
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Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Hiroshi Takuwa
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Takuya Wakatsuki
- Department of Orthopaedic Surgery, Shimane University, Izumo, JPN
| | - Suguru Kuwata
- Department of Orthopaedic Surgery, National Hospital Organization Hamada Medical Center, Hamada, JPN
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13
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Jérôme V, Jacques H, Esfandiar C, Xavier C, Dorothée F, Harold J, René V. Could a three-dimensional contralateral meniscus segmentation for allograft or scaffold sizing be possible? A prospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2457-2465. [PMID: 37552318 DOI: 10.1007/s00264-023-05923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Meniscal allografts and biodegradable meniscal implants are attractive surgical options for painful subtotal or total meniscectomies. In order to get the best results, these should be as similar as possible to the original meniscus in terms of shape, structure, and volume. Three-dimensional meniscus sizing could be an approach to improve the accuracy of meniscus matching. Therefore, the aims of this study were to perform a comparative morphological and volumetric analysis of the healthy meniscus based on manual tri-planar segmentation and to demonstrate that the menisci from the contralateral knee could be used as a reference in the sizing of a meniscal graft or a scaffold. METHODS Three-dimensional meniscal models were created based on 120 MRIs in 60 healthy subjects (bilateral knees). The differences between the pairs of menisci concerning the widths, thicknesses, lateromedial distances, anteroposterior distances, angles of coverage, and meniscal volumes were evaluated. T-Student tests were used to compare the quantitative numerical variables of the different groups. Pearson's linear regression was used to determine if correlations existed between demographic variables (age, gender, height, weight) and anatomical parameters. Statistical significance was set at p < 0.05. RESULTS Comparing the 120 pairs of menisci of each subject, there was no statistically significant difference for all parameters studied for both the medial and lateral meniscus. When the measurements were stratified by gender, statistically significant differences were observed for all parameters except meniscal coverage angles. We observed that anteroposterior and lateromedial distances were positively correlated with height and body mass index both at the level of the medial meniscus (r = 0.68; r = 0.66; r = 0.65; and r = 0.63) and lateral (r = 0.68; r = 0.69; r = 0.61; and r = 0.60). CONCLUSION Our study demonstrated that the intra-individual 3D shapes of the left and right menisci are very similar. Therefore, the contralateral side could be used as a template for the 3D sizing of meniscal allografts or meniscal implants.
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Affiliation(s)
- Valcarenghi Jérôme
- Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire d'Ambroise Paré, Hainaut, Belgium.
| | - Hernigou Jacques
- Department of Orthopaedics and Traumatology, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Chahidi Esfandiar
- Department of Orthopaedics and Traumatology, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Collard Xavier
- Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire d'Ambroise Paré, Hainaut, Belgium
| | - Francotte Dorothée
- Department of Radiology, Centre Hospitalier Universitaire de Tivoli, Hainaut, Belgium
| | - Jennart Harold
- Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire de Tivoli, Hainaut, Belgium
| | - Verdonk René
- Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Hainaut, Belgium
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14
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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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15
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Wagner KR, Kaiser JT, Hevesi M, Cotter EJ, Gilat R, Meeker ZD, Frazier LP, Yanke AB, Cole BJ. Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation With Fresh-Frozen Allografts Using the Bridge-in-Slot Technique. Am J Sports Med 2023; 51:2954-2963. [PMID: 37594374 DOI: 10.1177/03635465231188657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) has been shown to provide clinical benefits in patients with symptomatic meniscal deficiency in the short term and midterm. There is, however, a paucity of data regarding long-term outcomes after MAT using fresh-frozen allografts and the bridge-in-slot technique. PURPOSE To report clinical outcomes and revision rates after primary MAT with fresh-frozen allografts and the bridge-in-slot technique in a large case series of patients at a 10-year minimum follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of prospectively collected data was performed on patients undergoing primary MAT between 2001 and 2012. Lysholm, International Knee Documentation Committee subjective form, and Knee injury and Osteoarthritis Outcome Score subscales were collected preoperatively and at 1-, 2-, 5-, and minimum 10-year follow-ups. Cox proportional hazards modeling was used to identify variables associated with reoperation and failure, defined as revision MAT or conversion to arthroplasty. Reoperation was defined as a subsequent surgical intervention on the transplanted meniscus, including partial or total meniscectomy, meniscal repair, or failure as defined in the previous sentence. RESULTS A total of 174 patients undergoing MAT met the inclusion criteria and were followed for a mean of 12.7 ± 2.7 years (range, 10.0-21.0 years). The mean age at surgery was 28.3 ± 10.1 years. The patients were predominantly female (n = 92; 53%), and medial MAT was the most commonly performed procedure (n = 91; 52%). Concomitant procedures were performed in 115 patients (66%), with the most common procedure being osteochondral allograft transplantation (n = 59; 34%). Patients demonstrated statistically significant postoperative improvements at all time points for all patient-reported outcome measures (P≤ .0001). A total of 65 patients (37%) underwent a meniscal reoperation at a mean time of 6.6 ± 5.5 years (range, 0.3-16.7 years) postoperatively. A total of 40 patients (23%) met the criteria for failure at a mean time of 7.3 ± 5.0 years (range, 1.0-17.4 years) after MAT, with 22 of these patients having undergone a previous meniscal reoperation. At the final follow-up, 13 patients (7%) had undergone revision MAT and 27 (15%) had converted to arthroplasty. The MAT survival rates free of meniscal reoperation and failure were 73% and 85% at 10 years and 60% and 72% at 15 years, respectively. At the time of the final follow-up, 86% of patients reported that they were satisfied with their overall postoperative condition. CONCLUSION Primary MAT demonstrates efficacy and durability with high rates of patient satisfaction at a minimum 10-year follow-up. Patients should be counseled that although reoperation rates may approach 40% at 15 years, rates of overall revision MAT and conversion to arthroplasty remain low at long-term follow-up.
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Affiliation(s)
- Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Cotter
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Landon P Frazier
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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16
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Lee S, Brown JR, Bartolomei C, Turnbull T, Miles JW, Dornan GJ, Frank RM, Vidal AF. Effects of Lateral Opening-Wedge Distal Femoral Osteotomy on Meniscal Allograft Transplantation: A Biomechanical Evaluation. Orthop J Sports Med 2023; 11:23259671231156639. [PMID: 37347021 PMCID: PMC10280523 DOI: 10.1177/23259671231156639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/08/2022] [Indexed: 06/23/2023] Open
Abstract
Background Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically. Purpose/Hypothesis The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus. Study Design Controlled laboratory study. Methods Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation. Results Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (-41%) (all P < .05 vs intact), while LMAT restored all outcome measures (all P > .05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (-0.0479 N/mm2), 5.9% (-0.154 N/mm2), and 1.4% (-6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively. Conclusion Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile. Clinical Relevance Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient.
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Affiliation(s)
- Simon Lee
- Steadman Philippon Research Institute,
Vail, Colorado, USA
| | | | | | | | - Jon W. Miles
- Steadman Philippon Research Institute,
Vail, Colorado, USA
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17
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Aubret S, Ngbilo C, Winkler M, Neyret B, Choudja Ouabo E. Combined Medial Meniscus Allograft Transplantation and Open-Wedge High Tibial Osteotomy Using a Patient-Specific Instrumentation Guide. Arthrosc Tech 2022; 11:e2279-e2288. [PMID: 36632381 PMCID: PMC9827122 DOI: 10.1016/j.eats.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
Despite technical advances in meniscus allograft transplantation, there remains a need to improve postoperative outcomes.1 , 2 The bone plugs technique using osseous fixation of the anterior and posterior roots has demonstrated increased stability and long-term survival. Recently, the importance of limb alignment has been demonstrated for this procedure. In case of malalignment, osteotomy is essential to improve the long-term viability of both meniscus allograft and cartilage. The recent introduction of patient-specific instrumentation has raised the possibility of making instrumentation specific to each patient achieving an optimal correction in a safe and reliable manner. This Technical Note describes the use of a combined medial meniscus allograft transplantation and open wedge high tibial osteotomy using a patient-specific instrumentation guide.
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Affiliation(s)
- Sylvain Aubret
- Orthopaedics Department, Hôpital Privé la Châtaigneraie, Clermont-Ferrand, France,Address correspondence to Sylvain Aubret, M.D., Hôpital Privé la Châtaigneraie, Clermont-Ferrand, France.
| | - Cédric Ngbilo
- Clinique Bois-Cerf, Hirslanden, Lausanne, Switzerland
| | | | | | - Eric Choudja Ouabo
- Clinique Bois-Cerf, Hirslanden, Lausanne, Switzerland,Eric Choudja Ouabo, M.D., Clinique Bois-Cerf, Hirslanden, Avenue d'Ouchy 31, 1006 Lausanne, Suisse.
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18
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Wang DY, Lee CA, Zhang B, Li YZ, Meng XY, Jiang D, Yu JK. The immediate meniscal allograft transplantation achieved better chondroprotection and less meniscus degeneration than the conventional delayed transplantation in the long-term. Knee Surg Sports Traumatol Arthrosc 2022; 30:3708-3717. [PMID: 35484433 DOI: 10.1007/s00167-022-06982-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to compare the long-term clinical and radiological outcomes between the immediate and delayed meniscus allograft transplantation (MAT). METHODS Nine menisci were transplanted immediately after total meniscectomy (immediate group, IM), and 10 menisci were delayed transplanted in patients with the median of 35 months (range 9-92 months) after total meniscectomy (delayed group, DE). Patient's subjective clinical outcomes including VAS, IKDC, Lysholm and Tegner scores as well as muscle strength measures were compared. Joint degeneration was evaluated by both radiographs to assess joint space width narrowing, Kellegren-Lawrence (KL) grade and MRI with T2 mapping sequences to quantitatively analyze both cartilage and meniscal allograft degeneration. RESULTS The median follow-up time was 10.8 years (range 10-14 years). The IKDC (IM vs DE, 89.8 vs 80.9, n.s.) and Lysholm scores (IM vs DE, 87.7 vs 78.0, n.s.) were close in two groups, while the IM group showed slightly lower VAS (IM vs DE, 0.2 vs 1.5, p = 0.031), higher Tegner score (IM vs DE, 7 vs 3.5 p = 0.021) and better quadriceps muscle strength. The IM group had less joint space narrowing (IM vs DE, 0.35 mm vs 0.71 mm, n.s.), less KL grade progression (IM vs DE, 0.6 vs 1.7, p = 0.041) on radiographs and less chondral lesions development on MRIs (Cartilage Degeneration Index, IM vs DE, 252 vs 2038, p = 0.025). All meniscal grafts exhibited degeneration by showing grade 3 signal on MRI, and 4 (4/9) in the IM group and 8 (8/10) cases in the DE group. The T2 value of cartilage and meniscal allograft in the IM group was close to that of the healthy control and was significantly lower than that of the DE group. CONCLUSION Compared to the conventional delayed MAT, the immediate MAT achieved better cartilage and meniscus protection in the long-term, while its superiority in patient-reported outcomes was limited. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ding-Yu Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China
| | - Cassandra A Lee
- Department of Orthopedic Surgery, Sports Medicine and Arthroscopy, University of California at Davis, Sacramento, CA, 95816, USA
| | - Bo Zhang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China
| | - Yan-Zhang Li
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China
| | - Xiang-Yu Meng
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.,Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China
| | - Dong Jiang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China. .,Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China.
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China. .,Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China.
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19
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Lucidi GA, Grassi A, Agostinone P, Di Paolo S, Dal Fabbro G, D’Alberton C, Pizza N, Zaffagnini S. Risk Factors Affecting the Survival Rate of Collagen Meniscal Implant for Partial Meniscal Deficiency: An Analysis of 156 Consecutive Cases at a Mean 10 Years of Follow-up. Am J Sports Med 2022; 50:2900-2908. [PMID: 35924871 PMCID: PMC9442777 DOI: 10.1177/03635465221112635] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Collagen meniscal implant (CMI) is a biologic scaffold that can be used to replace meniscus host tissue after partial meniscectomy. The short-term results of this procedure have already been described; however, little is known about risk factors for failure. PURPOSE To determine the factors that predict failure of meniscal scaffold implantation in a large series of patients treated at a single institution and to better define the indications for surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The analysis included 186 consecutive patients with a minimum 5-year follow-up who underwent CMI scaffold implantation or combined procedures. Patients' characteristics and details of the surgery were obtained via chart review. Patients with a Lysholm score <65 were considered to have experienced clinical failure. Surgical failure was defined as partial or total scaffold removal. RESULTS The final analysis included 156 patients (84%) at a mean follow-up of 10.9 ± 4.3 years. The patients' mean age at surgery was 42.0 ± 11.1 years, and the survival rate was 87.8%. Subgroup analysis identified Outerbridge grade 3-4 (Hazard ratio [HR], 3.8; P = .004) and a lateral meniscal implant (HR, 3.2; P = .048) as risk factors for failure. The survival rate was 90.4% for medial implants and 77.4% for lateral implants. An Outerbridge grade 3-4 (HR, 2.8; P < .001) and time from meniscectomy to scaffold >10 years (HR, 2.8; P = .020) were predictive of surgical or clinical failure. CONCLUSION CMI for partial meniscal deficiency provided good long-term results, with 87.8% of the implants still in situ at a mean 10.9 years of follow-up. Outerbridge grade 3-4, lateral meniscal implants, and longer time from the meniscectomy to implantation of the CMI were identified as risk factors for clinical and surgical failure.
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Affiliation(s)
- Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Piero Agostinone, IRCCS
Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna (BO),
Italy ()
| | | | - Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara D’Alberton
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Pizza
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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20
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Long sports career and satisfactory clinical outcomes after Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous sports. Knee Surg Sports Traumatol Arthrosc 2022; 30:2314-2319. [PMID: 34812916 DOI: 10.1007/s00167-021-06779-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the return to sport rate of young professional athletes, to analyze their careers in terms of matches played and league participation over a minimum period of 6 years after Meniscal Allograft Transplantation (MAT), as well as to assess the long-term clinical subjective outcomes and satisfaction. METHODS Thirteen professional athletes (ten soccer and one basketball players, one fencer and one wrestler) with a mean age at surgery of 23.4 ± 4.0 underwent MAT (six medial, seven lateral). The time required to return to sport, post-operative performance level and the number of reoperations were evaluated. At an average follow-up of 9.0 ± 2.8 years, Lysholm, KOOS and Cincinnati scores were administered and collected. RESULTS Thirteen patients (100%) returned to sports practice after an average period of 11.8 ± 3.8 months. Nine athletes (69%) returned to sports at the same pre-injury level. Overall, 93%, 85%, 62% and 55% were active until the 3rd, the 5th, the 7th and the 9th season after MAT, respectively. Seven patients (54%) underwent a reoperation after MAT, where only two of them (15%) were related to graft problems (one meniscectomy and one graft suture). Of the ten athletes that completed subjective evaluation, the mean Lysholm score was 72 ± 15 (0% "Excellent", 10% "Good", 60% "Fair", 30% "Poor"). Of the athletes with lower scores, one suffered from patellar tendon rupture, one from post-operative infection and one from a previous femoral fracture. The mean Cincinnati knee score was 77 ± 18, while the average KOOS values were 60 ± 34 for sports. CONCLUSION Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous activities allowed all patients to return to pre-injury sport and in nearly 70% of cases at their pre-injury level. After five seasons following MAT, 85% of patients were still active or playing more than 20-30 matches per season. On the other hand, nearly 50% underwent at least one reoperation and only 70% of patients were rated as "Good", or "Fair" using the Lysholm score. LEVEL OF EVIDENCE IV.
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21
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Palumbo NE, Matava MJ. Editorial Commentary: Knee Meniscal Allograft Transplantation Results in Significantly Improved Outcomes in the Majority Patients, but There Is Wide Variability in the Rate at Which Athletes Return to Sports. Arthroscopy 2022; 38:1362-1365. [PMID: 35369929 DOI: 10.1016/j.arthro.2021.12.033] [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: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023]
Abstract
Meniscal allograft transplantation (MAT) is the reconstructive procedure of choice following a total or near-total meniscectomy for the symptomatic patient with a stable, well-aligned knee prior to the onset of degenerative arthritis. Historically, the goals were to eliminate symptoms with activities of daily living and improve longevity of the articular cartilage. However, athletically active individuals are rarely satisfied unless they return to their prior level of function, which is dependent on patient-specific, knee-specific, and sports-specific factors. Despite the fact that subjective patient-reported outcomes are significantly improved in the majority of MAT patients, there is wide variability in the rate at which athletic patients are able to return to sports, when they return, and their ultimate level of performance. We advise active individuals who undergo a MAT to pursue "low-impact" activities based on 10-year survivorship of 70% to 80%. Risk of a recurrent meniscal tear is the most common complication, and the ability of MAT to prevent osteoarthritis is unproven.
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22
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Struijk C, Van Genechten W, Verdonk P, Krych AJ, Dietz AB, van Wijnen AJ, Saris DBF. Human meniscus allograft augmentation by allogeneic mesenchymal stromal/stem cell injections. J Orthop Res 2022; 40:712-726. [PMID: 33969529 PMCID: PMC8578587 DOI: 10.1002/jor.25074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Meniscus allograft transplantations (MATs) represent established surgical procedures with proven outcomes. Yet, storage as frozen specimens and limited cellular repopulation may impair graft viability. This proof-of-concept study tests the feasibility of injecting allogeneic mesenchymal stromal/stem cells (MSCs) in meniscus allograft tissue. We investigated the injectable cell quantity, survival rate, migration, and proliferation ability of MSCs up to 28 days of incubation. In this controlled laboratory study, seven fresh-frozen human allografts were injected with human allogeneic MSCs. Cells were labeled and histological characteristics were microscopically imaged up to 28 days. Mock-injected menisci were included as negative controls in each experiment. Toluidine blue staining demonstrated that a 100-µl volume can be injected while retracting and rotating the inserted needle. Immediately after injection, labeled MSCs were distributed throughout the injection channel and eventually migrated into the surrounding tissues. Histological assessment revealed that MSCs cluster in disc-like shapes, parallel to the intrinsic lamination of the meniscus and around the vascular network. Quantification showed that more than 60% of cells were present in horizontally injected grafts and more than 30% were observed in vertically injected samples. On Day 14, cells adopted a spindle-shaped morphology and exhibited proliferative and migratory behaviors. On Day 28, live/dead ratio assessment revealed an approximately 80% cell survival. The study demonstrated the feasibility of injecting doses of MSCs (>0.1 million) in meniscus allograft tissue with active cell proliferation, migration, and robust cell survival.
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Affiliation(s)
- Caroline Struijk
- Orthopedics and Sports MedicineMayo ClinicRochesterMinnesotaUSA,Department of Orthopedic SurgeryAntwerp UniversityAntwerpBelgium
| | - Wouter Van Genechten
- Orthopedics and Sports MedicineMayo ClinicRochesterMinnesotaUSA,Department of Orthopedic SurgeryAntwerp UniversityAntwerpBelgium
| | - Peter Verdonk
- Department of Orthopedic SurgeryAntwerp UniversityAntwerpBelgium,ORTHOCAAntwerpBelgium
| | - Aaron J. Krych
- Orthopedics and Sports MedicineMayo ClinicRochesterMinnesotaUSA
| | - Allan B. Dietz
- Department of Laboratory Medicine and PathologyIMPACT; Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | | | - Daniel B. F. Saris
- Orthopedics and Sports MedicineMayo ClinicRochesterMinnesotaUSA,Orthopaedic SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands,Reconstructive MedicineUniversity of TwenteEnschedeThe Netherlands
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23
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Wagner KR, Kaiser JT, DeFroda SF, Meeker ZD, Cole BJ. Rehabilitation, Restrictions, and Return to Sport After Cartilage Procedures. Arthrosc Sports Med Rehabil 2022; 4:e115-e124. [PMID: 35141543 PMCID: PMC8811518 DOI: 10.1016/j.asmr.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 11/21/2022] Open
Abstract
The ability to return to sport (RTS) after articular cartilage injury is of vital importance to athletes. Discussing the likelihood of returning to sport with patients is necessary, yet patients should be informed of the heterogeneous nature of the variables associated with successful RTS and the methodologic limitations behind current RTS rate estimates. Patient-specific factors affecting RTS are numerous and, in most cases, their isolated effect on RTS rates have yet to be examined and will remain difficult to do so. The purpose of this review is to discuss current RTS rates, explore factors leading to successful RTS, and examine the variability in physical therapy protocols after cartilage procedures, including microfracture, osteochondral allograft transplantation (OCA), autologous chondrocyte implantation (ACI), and meniscal allograft transplantation (MAT). The senior author’s postoperative protocols will also be presented, as with a discussion on using RTS as a metric of patient and procedural success. Overall, there is significant variation in reported RTS rates among procedures examined, and providers must continue managing patient expectations when discussing treatment options.
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Affiliation(s)
| | | | | | | | - Brian J. Cole
- Address correspondence to Brian J. Cole, M.D., M.B.A., 1611 W Harrison St, Chicago, IL 60612.
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24
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Autologous semitendinosus tendon graft could function as a meniscal transplant. Knee Surg Sports Traumatol Arthrosc 2022; 30:1520-1526. [PMID: 34100999 PMCID: PMC9033706 DOI: 10.1007/s00167-021-06606-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Meniscectomy results in poor knee function and increased risk for osteoarthritis. Meniscal allograft transplantation is not widely used due to costs and availability. The semitendinosus tendon (ST) has the potential to remodel and revascularize in an intraarticular environment, such as ACL reconstruction. The objective for this pilot study was to investigate whether the ST graft could function as a meniscal transplant. METHODS The ST was doubled and sutured with running sutures and pull-out sutures in each end. Bone tunnels were used for root anchorage and the graft was sutured with allinside, inside-out and outside-in technique. The pull-out sutures were fixed over a button. Partial weight bearing was allowed with limited range of motion in a brace for the first 6 weeks. Evaluation was assessed using clinical examination, radiology and patient reported outcome. RESULTS A total of seven patients have been included between January 2018 and June 2020. Six medial transplants and one lateral transplant were performed. Mean age was 29 years. Four patients had completed the 12-month follow-up. Improvements were noted for IKDC Global Score, KOOS pain subscale and Lysholm. MRI indicated that the transplant become more wedge-like with visible roots and minor protrusion. CONCLUSIONS Even though this is primarily a technical report the follow-up data indicate that the transplant survives and adapts in shape and capabilities to an original meniscus. There were no adverse events and the patients seem to improve in terms of pain and quality of life.
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25
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Kani KK, Porrino JA, Chew FS. Meniscal Allograft Transplantation: A Pictorial Review. Curr Probl Diagn Radiol 2021; 51:779-786. [PMID: 34836722 DOI: 10.1067/j.cpradiol.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/29/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
Meniscal allograft transplantation may be indicated in a subset of patients with high-grade meniscectomy or irreparable meniscal injury and persistent knee pain that is resistant to conservative management. Meniscal allograft transplantation has demonstrated good to excellent results in short-term to midterm follow-up studies and satisfactory outcomes in long-term studies. The goals of this article are to review the indications, preoperative imaging assessment, surgical techniques, and postoperative assessment of uncomplicated and complicated meniscal allograft transplants.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Jack A Porrino
- Yale School of Medicine, Radiology and Biomedical Imaging, New Haven, CT
| | - Felix S Chew
- Department of Radiology, University of Washington, Seattle, WA
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26
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Abstract
The menisci are fibrocartilaginous semilunar structures in the knee that provide load support. Injury to the meniscus alters its load sharing and biomechanical profile. Knee arthroscopy with meniscus débridement is the most common orthopaedic surgical procedure done in the United States. The current goals of meniscal surgery are to preserve native meniscal tissue and maintain structural integrity. Meniscal preservation is critical to maintain the normal mechanics and homeostasis of the knee; however, it is not always feasible because of the structure's poor blood supply and often requires removal of irreparable tissue with meniscectomy. Efforts have increasingly focused on the promotion of meniscal healing and the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. The purpose of this article was to review current and future meniscal salvage treatments such as meniscus transplant, synthetic arthroplasty, and possible bioprinted meniscus to allow patients to maintain quality of life, limit pain, and delay osteoarthritis.
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27
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Wang DY, Lee CA, Li YZ, Zhang B, Li N, Jiang D, Yu JK. Prognostic Factors to Determine Survivorship of Meniscal Allograft Transplant: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211007215. [PMID: 34159210 PMCID: PMC8182187 DOI: 10.1177/23259671211007215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background: There is much room for improvement and optimization of meniscal allograft
survivorship. Purpose: To understand prognostic factors for survivorship using evidence-based
selection criteria in order to identify patients who would best benefit from
meniscal allograft transplant (MAT). Study Design: Systematic review; Level of evidence, 4. Methods: We conducted this systematic review to analyze prognostic factors for
survivorship of MAT. The Cochrane Central Register, PubMed publisher,
Embase.com, and Web of Science databases were searched
through August 8, 2019. Included studies entailed patients of any age who
received MAT with a reported association between prognostic factors and
survivorship of the allograft. Two reviewers independently screened all
titles and abstracts for eligibility, extracted the data, assessed the risk
of bias using the Newcastle-Ottawa Scale, and performed a best-evidence
synthesis. Results: The review included 18 studies with a total of 1920 patients. The mean
follow-up time was 6.0 years (range, 2.1-11.2 years). A total of 20
prognostic factors were identified and shown to be associated with
survivorship of MAT. Strong evidence was found that severe cartilage damage
was associated with poor survivorship. Strong evidence was also found
showing that sex, knee compartment, surgical side, concomitant anterior
cruciate ligament (ACL) reconstruction, and concomitant osteotomy for
malalignment had no effect on survivorship. Moderate evidence was found that
body mass index (<36), tobacco use, and arthroscopic versus open
procedure had no influence on survivorship. Conflicting evidence was found
that older age and kissing cartilage lesions (lesions on both the femur and
tibia vs on a single side) decreased survivorship. Conclusion: Severe cartilage damage decreases the survivorship of MAT. Concomitant ACL
reconstruction and osteotomy showed no relationship to survivorship. Many
determinants showed conflicting and limited evidence. Older age may be of
interest and should be further studied.
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Affiliation(s)
- Ding-Yu Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Cassandra A Lee
- Department of Orthopedic Surgery, Sports Medicine and Arthroscopy, University of California, Davis, Sacramento, California, USA
| | - Yan-Zhang Li
- Peking University First Hospital, Beijing, China
| | - Bo Zhang
- Peking University First Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Dong Jiang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
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28
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Wagala NN, Tisherman RT, Lucidi GA, Eads R, Musahl V. Meniscal problems in the ACL deficient knee: What every ACL surgeon must be able to do! OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150832] [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]
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29
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Grassi A, Lucidi GA, Filardo G, Agostinone P, Macchiarola L, Bulgheroni P, Bulgheroni E, Zaffagnini S. Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study. Orthop J Sports Med 2021; 9:2325967121994919. [PMID: 34104658 PMCID: PMC8155770 DOI: 10.1177/2325967121994919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing
partial meniscal defects. The long-term results of lateral meniscal
replacement have never been investigated. Purpose: To document the clinical outcomes and failures of lateral CMI implantation
for partial lateral meniscal defect at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4, Methods: This study included 24 consecutive patients who underwent lateral CMI
implantation for partial lateral meniscal defects between April 2006 and
September 2009 and who were part of a previous study with a 2-year
follow-up. Outcome measures at the latest follow-up included the Lysholm
score, Knee injury and Osteoarthritis Outcome Score, visual analog scale
(VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data
regarding complications and failures were collected, and patients were asked
about their satisfaction with the procedure. Results: Included in the final analysis were 19 patients (16 male, 3 female) with a
mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5
years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal
because of implant breakage and 4 joint replacements (2 unicompartmental
knee arthroplasties and 2 total knee arthroplasties). The implant survival
rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years,
and 64% at 14 years. Lysholm scores at the final follow-up were rated as
“excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and
“fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19
patients) reporting that they were pain-free; the median Tegner score was 3
(interquartile range, 2-5). All clinical scores decreased from the 2-year
follow-up; however, with the exception of the Tegner score, they remained
significantly higher compared with the preoperative status. Overall, 79% of
patients were willing to undergo the same procedure. Conclusion: Lateral CMI implantation for partial lateral meniscal defects provided good
long-term results, with a 10-year survival rate of 85% and a 14-year
survival rate of 64%. At the final follow-up, 58% of the patients had “good”
or “excellent” Lysholm scores. However, there was a general decrease in
outcome scores between the short- and the long-term follow-up.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Bulgheroni
- Reparto di Ortopedia e Traumatologia, Ospedale Santa Chiara, Trento, Italy
| | - Erica Bulgheroni
- Reparto di Ortopedia e Traumatologia, Policlinico Di Monza, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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30
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Acetabular labral reconstruction with medial meniscal allograft: preliminary results of a new surgical technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:515-521. [PMID: 34028622 DOI: 10.1007/s00590-021-02986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Reconstruction of the acetabular labrum during femoroacetabular impingement (FAI) surgery is accepted when the labrum is deficient and irreparable. Here we describe a novel technique using fresh-frozen medial meniscal allograft for labral reconstruction during surgical hip dislocation for correction of pincer FAI due to acetabular overcoverage. METHODS The results from seven hips (six patients) that underwent this procedure with 1 year minimum follow-up, and radiographs are presented. RESULTS Six of the seven hips had improvements in pain, hip flexion, hip abduction, and Merle d'Aubigné-Postel scores. Only one patient with pre-existing osteoarthritis underwent reoperation with conversion to total hip arthroplasty. All digastric trochanteric osteotomies healed, and there were no cases of femoral head osteonecrosis or progression of Tönnis grades. CONCLUSIONS The medial meniscus is a morphologically and clinically suitable option for labral reconstruction and effectively restores the hip fluid seal.
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31
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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.
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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
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32
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Dianat S, Small KM, Shah N, Lattermann C, Mandell JC. Imaging of meniscal allograft transplantation: what the radiologist needs to know. Skeletal Radiol 2021; 50:615-627. [PMID: 33011872 DOI: 10.1007/s00256-020-03631-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
Meniscal allograft transplantation is an emerging surgical option for younger patients with symptomatic meniscal deficiency, which aims to restore anatomic biomechanics and load distribution in the knee joint, and by so doing to potentially delay accelerated osteoarthritis. In this review article, we summarize the structure and biomechanics of the native meniscus, describe indications and procedure technique for meniscal allograft transplantation, and demonstrate the spectrum of expected postoperative imaging and role of imaging to identify potential complications.
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Affiliation(s)
- Saeed Dianat
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Division of Musculoskeletal Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kirstin M Small
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nehal Shah
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Lattermann
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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33
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Park JG, Bin SI, Kim JM, Lee BS, Lee SM. Trends in Meniscal Allograft Transplant in the Republic of Korea, 2010-2018: An Analysis Based on the Korean National Health Insurance Claims Database. Orthop J Sports Med 2021; 9:2325967121996395. [PMID: 35146024 PMCID: PMC8822109 DOI: 10.1177/2325967121996395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Analyzing the current trends in meniscal allograft transplant (MAT) is important. However, no recent descriptive epidemiological study based on a national registry database has been reported. Purpose: To assess serial trends in the incidence of MAT in the Republic of Korea between 2010 and 2018, stratified by age and sex. Study Design: Descriptive epidemiology study. Methods: The number of MAT procedures between 2010 and 2018 was assessed using the Korean National Health Insurance claims database. We used code N0825 for isolated MAT and code N0820 for MAT combined with other procedures, such as ligament reconstruction, realignment surgery, and cartilage procedures. The incidence of MAT was calculated using the general population data of the Republic of Korea, and Poisson log-linear regression analysis was used to assess statistical serial trends. Results: A total of 369 patients underwent MAT in 2010 and 774 in 2018, with an increase of 47.6%. The incidence of MAT per 100,000 person-years in the Republic of Korea increased significantly during the period studied, from 0.75 in 2010 to 1.50 in 2018 (annual relative risk = 1.09; 95% CI, 1.08-1.10; P < .001), whereas the rate of MAT combined with other procedures increased from 5.1% in 2014 to 16.0% in 2018. MAT was mostly performed in men in their early 20s. Most MAT procedures were performed in the summer and winter, with distinct seasonal variances. Conclusion: In the Republic of Korea, the incidence of MAT in 2018 was 1.50 per 100,000 person-years, with an average annual increase of 10% since 2010. MAT was mostly performed in men in their early 20s, and the rate of MAT combined with other procedures has increased since 2014.
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Affiliation(s)
- Jun-Gu Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University 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
| | - 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
| | - Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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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]
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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]
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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.
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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
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Carter T. Editorial Commentary: Medial and Lateral Meniscus Allografts Using Bone Plug Fixation in Patients Without Advanced Arthritis Have 80% Positive Outcomes at 10 Years. Arthroscopy 2020; 36:3069-3071. [PMID: 33276893 DOI: 10.1016/j.arthro.2020.09.050] [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: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
Meniscal allograft transplantation (MAT) for symptomatic knees after meniscectomy decreases pain and often improves function, but it does not replicate a normal meniscus. The ability of MAT to delay arthritic changes is an ongoing area of study, and it is known that outcomes and graft survivorship deteriorate with longer follow-up. Recommended indications are symptomatic patients after meniscectomy with mild (or at most moderate) degenerative changes and absence of (or surgically corrected) associated malalignment or ligament deficiency. When these indications are followed, 80% of patients improve, with survivorship of 83% at 10 years and 56.2% at 20 years. Medial or lateral MAT shows no difference with respect to graft survivorship or patient-reported outcome measures. Meniscus allografts fixed with bone have less graft extrusion than soft tissue fixation alone. While MAT can be beneficial in an arthritic knee in the short term, the survivorship in knees with advanced arthritis is much smaller, with an extensive rehabilitation requirement, and there is a limited supply of meniscal allograft tissue.
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Ambra LF, Kaleka CC, Debieux P, Almeida JC, Shah N, Cohen M, Gomoll A. Radiographic Methods Are as Accurate as Magnetic Resonance Imaging for Graft Sizing Before Lateral Meniscal Transplantation. Am J Sports Med 2020; 48:3534-3540. [PMID: 33108216 DOI: 10.1177/0363546520963095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accurate allograft matching is deemed critical for meniscal transplantation; thus, precise measurements are essential to correctly calculate meniscal size. Several methods for meniscal sizing have been described, but there remains a discussion on which is the most accurate for the lateral meniscus. PURPOSE To compare the accuracy of radiographic, anthropometric, and magnetic resonance imaging (MRI) methods of determining width and length of the lateral meniscus with actual dimensions after anatomic dissection. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen human cadaveric knees without any evidence of meniscal or ligamentous injury were primarily imaged using radiography and MRI and subsequently underwent dissection to assess the anatomic size of each meniscus. Four methods were used to predict the size of the lateral menisci: anthropometric, radiographic (Pollard and Yoon), and MRI. Absolute differences in length and width between actual and predicted sizes were determined. RESULTS The anatomic lateral meniscal width and length were 33.01 ± 4.25 mm (mean ± SD; range, 24.84-40.18 mm) and 31.41 ± 5.06 mm (range, 25.2-40.05 mm), respectively. Regarding width, the anthropometric method demonstrated an absolute difference from anatomic measurement significantly greater when compared with the Pollard technique and MRI (P = .002). Regarding length, the Pollard method presented an absolute difference significantly greater than all other techniques (P = .003). In terms of the ability to measure width and length, MRI accurately predicted meniscal size within 10% of the anatomic size in 65% of measurements, the Yoon method in 54%, and the Pollard method in 20% (P = .01). Radiographs tended to overestimate the true size of the lateral meniscus, while the anthropometric technique overestimated width in all specimens. CONCLUSION This study demonstrated that MRI and the Yoon radiographic method are comparable in terms of accuracy for graft sizing before lateral meniscal transplantation. While MRI is useful, a contralateral MRI is required, which makes the Yoon radiographic method recommended given the ease and cost advantage. The original Pollard technique and the anthropometric method are not recommended. CLINICAL RELEVANCE Over- and undersizing of meniscal transplants has been implicated in graft failure. Therefore, increasing the reliability of preoperative meniscal measurements is deemed important for the success of meniscal allograft transplantation.
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Affiliation(s)
- Luiz Felipe Ambra
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | | | - Pedro Debieux
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Nehal Shah
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andreas Gomoll
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
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Meniscal allograft transplantation: a review of indications, techniques, and outcomes. Knee Surg Sports Traumatol Arthrosc 2020; 28:3539-3550. [PMID: 32415360 DOI: 10.1007/s00167-020-06058-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 01/25/2023]
Abstract
When compared to meniscectomy, meniscus allograft transplantation (MAT) may provide superior long-term benefits to young, active patient populations who have lost meniscal function because of irreparable damage, such as, an avascular tear, previous repair failure, and unsalvageable tear types. Positive outcomes are most likely to be achieved when meniscus allograft transplantation is performed in appropriately selected patients. Indications include patients younger than 50 years of age, with a history of subtotal or total meniscectomy without concomitant articular cartilage defects, uncorrectable joint malalignment, and/or knee instability. Outcomes for meniscal allograft transplantation are promising with studies reporting long-term graft survivorship as high as 89% at 10 years and significant improvements in multiple patient reported outcome measures. LEVEL OF EVIDENCE: Level V.
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Pache S, Del Castillo J, Moatshe G, LaPrade RF. Anterior cruciate ligament reconstruction failure and revision surgery: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Grassi A, Zaffagnini S. Editorial Commentary: It Takes Two to Tango: The Shared Decision of Return to Sport After Meniscal Transplantation. Arthroscopy 2020; 36:2464-2465. [PMID: 32891247 PMCID: PMC7463272 DOI: 10.1016/j.arthro.2020.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 02/02/2023]
Abstract
Despite its overall good results, meniscal allograft transplantation is considered a salvage procedure, and abstention from sport practice is considered a valid solution to preserve the transplanted meniscus as long as possible. However, many patients want to return to sport, and this is often beneficial for them. Therefore, we should know how meniscal allograft transplantation performs in terms of return to sport to better counsel our patients. It is thus of primary importance to discuss general and sport-related expectations with each patient, whom should be informed of the potential short- and long-term risks of strenuous or light sport activities. In particular, the high risk of reoperation, the long recovery time, and the potentially deleterious effect of sporting activity on graft survival should be quite clear to both surgeons and patients because, when it comes to return-to-sport decisions, "It takes two to tango"!
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Noyes FR. Editorial Commentary: Long-Term Survivorship of Knee Meniscal Transplant Surgery-The Importance of Patient-Reported Outcomes With Magnetic Resonance Imaging Demonstration of Retained Meniscal Transplant Function. Arthroscopy 2020; 36:2275-2278. [PMID: 32747067 DOI: 10.1016/j.arthro.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/02/2023]
Abstract
The altered knee joint function and symptomatic state in younger patients after meniscectomy and progressive tibiofemoral arthritis remain an important unsolved treatment dilemma. Meniscal allograft transplantation has evolved as an acceptable treatment because there are few (if any) other options. The procedure is effective in most patients, who experience a decrease in tibiofemoral pain and improved knee function, even allowing a return to light recreational activities. However, biological remodeling of the implant occurs over time, with replacement of the complex circumferential and radial fibers with disorganized collagen tissues and altered cellular and proteoglycan components that affects load bearing and negates chondroprotective function. Positive patient outcomes may still be reported even with the loss of meniscal transplant function on magnetic resonance imaging giving a false-positive survivorship analysis. Repeated surgical procedures are frequent by 10 years. Patients are advised that meniscal allograft transplant surgery, although beneficial in the short term to buy time, is not curative.
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Carter TR, Brown MJ. Meniscal Allograft Survivorship and Outcomes 20 Years After Implantation. Arthroscopy 2020; 36:2268-2274. [PMID: 32622785 DOI: 10.1016/j.arthro.2020.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate meniscal allograft survivorship and outcomes 20 years after implantation. METHODS Fifty-six meniscal allograft patients at a minimum 20 years following implantation comprised the study group. Forty-eight (85.7%) were able to be contacted regarding the function of their knee and if any additional surgeries were performed. RESULTS Of the 48 patients, 21 required surgical treatment of the graft. Thirteen patients had isolated partial meniscectomy. Eight patients had knee arthroplasty with 1 having prior partial graft removal and one also had a high tibial osteotomy. The average time to arthroplasty was 12.7 years. The graft survivorship was 56.2%. The activity levels at follow-up varied widely, but in general did not deteriorate compared to those preoperatively. Only 1 patient stated they would not have undergone the procedure. CONCLUSIONS Meniscal allografts were able to provide subjective improvement at 20 years after surgery and while not as durable as the native meniscus, the overall graft survivorship was 56.2% after implantation. LEVEL OF EVIDENCE Retrospective case series, Level of evidence IV.
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Affiliation(s)
| | - Matthew J Brown
- Banner Thunderbird Medical Center, Glendale, Arizona, U.S.A..
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Grassi A, Macchiarola L, Lucidi GA, Coco V, Romandini I, Filardo G, Neri MP, Marcacci M, Zaffagnini S. Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study. Am J Sports Med 2020; 48:2360-2369. [PMID: 32628513 DOI: 10.1177/0363546520932923] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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 considered an effective procedure for reducing pain and improving knee function. Nevertheless, the current knowledge regarding the results of MAT is limited to short- to mid-term follow-up studies, especially for arthroscopic techniques. PURPOSE To evaluate the long-term clinical outcomes, reoperations, and failures with a minimum follow-up of 10 years after fresh-frozen MAT performed arthroscopically with soft tissue fixation. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 46 patients (age, 36.6 ± 10.6 years; 36 male, 10 female) who underwent medial MAT (n = 27) or lateral MAT (n = 19) with a minimum 10-year follow-up were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, and Tegner score. Surgical failure was defined as the need for partial or total graft removal (meniscectomy or knee replacement), and clinical failure was defined as the need for partial or total graft removal in addition to a poor Lysholm score (<65 points) at final follow-up. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS) for MAT. RESULTS 10-year survival and clinical data were available for 38 patients. Because 6 meniscectomies were required, the rate of survival free from surgical failure was 91% at 5 years and 86% at 10 years. Lower survival was reported in lateral MAT (73%) compared with medial MAT (96%). Because a further 4 patients had poor Lysholm scores, the rate of survival free from surgical and clinical failure was 87% at 5 years and 70% at 10 years. The average Lysholm score at final follow-up was 82 ± 20, and 60% to 82% of patients achieved PASS of the various KOOS subscales. The Tegner score and the KOOS Sport score significantly decreased from mid-term to long-term evaluation (P < .001 and P < .05, respectively). Other KOOS subscales and the Lysholm score remained stable at long-term evaluation. No significant differences were found between isolated MAT or combined MAT regarding subjective scores, surgical failures, or clinical failures. CONCLUSION Up to 10 years after surgery, 86% of fresh-frozen MATs with soft tissue fixation were still in situ, and satisfactory clinical results were present for about 70% of patients. Decline of clinical outcomes from midterm to long term was noted only in sports-related scores. A higher number of overall reoperations was noted in female patients, whereas a higher risk of failure was present in the patients with lateral MAT.
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Affiliation(s)
- Alberto Grassi
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
| | - Luca Macchiarola
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
| | - Gian Andrea Lucidi
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
| | - Vito Coco
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
| | - Iacopo Romandini
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
| | - Giuseppe Filardo
- IRCCS Istituto Ortopedico Rizzoli, Centro di Ricerca Applicata e Traslazionale, Bologna, Italy
| | - Maria Pia Neri
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
| | - Maurilio Marcacci
- Humanitas University, Humanitas Clinical and Research Center, Milano, Italy
| | - Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
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Ren S, Zhang X, Yu X, Zhou R, Xu L, Lin Z, Zhang W. Correlation analysis of potential factors influencing graft maturity based on MRI after lateral meniscal allograft transplantation. Sci Rep 2020; 10:11250. [PMID: 32647114 PMCID: PMC7347933 DOI: 10.1038/s41598-020-68153-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this respective study was to assess the graft signal/noise quotient (SNQ) value and associated factors based on magnetic resonance imaging (MRI) after lateral meniscal allograft transplantation (LMAT). Patients with LMAT were included. The SNQ, width of the anterior horn (WAH), width of the midbody (WMB), width of the posterior horn (WPH) of each lateral meniscus, coronal graft extrusion (CGE), the anterior cartilage meniscus distance (ACMD) and the posterior cartilage meniscus distance (PCMD) were measured using MRI and tested by multivariate stepwise regression analysis. The relative percentage of extrusion (PRE) was calculated. Seventy-one male patients were examined, and 7 patients were lost to follow-up. The SNQ of the meniscus increased from immediately after surgery to 6 months postoperatively, decreased from 6 to 12 months, increased from 12 to 24 months, and increased from 24 to 36 months. The mean SNQ had a significant negative association with the WPH and CGE at 6 months (p < 0.05), the WPH at 1 year (p < 0.05), the PRE of CGE (CPRE) at 2 years (p < 0.05), and the PCMD, CPRE, and PRE of the PCMD (PPRE) at 3 years (p < 0.01) postoperatively. Multivariate stepwise regression analysis showed that the WPH at 6 months, WPH at 1 year, WMD and PCMD at 2 years, and WMD, ACMD and CGE at 3 years were significant independent factors correlated with the mean SNQ of grafts in different periods. Maturation of meniscal grafts fluctuated with time. The maturation process occupied the main role before 1 year postoperatively, but after the maturation process, tearing of the meniscal allograft played the leading role. Changes in an allograft’s location had an obvious association with the SNQ. The WPH influenced the graft SNQ value at 6 months and 1 year postoperatively, but after the maturation process, the WMB and graft extrusion played the same roles.
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Affiliation(s)
- Shiyou Ren
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Xintao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Xiurong Yu
- Anesthesia Operation Center, Hainan Hospital of PLA General Hospital, Sanya, 572013, Hainan, China
| | - Ri Zhou
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Lu Xu
- Radiology Department, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Zhenglong Lin
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China
| | - Wentao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, 1120 Lianhua Road, Futian District, Shenzhen, 518036, Guangdong, China.
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Victor JMK. CORR Insights®: Likelihood of Return to Duty Is Low After Meniscal Allograft Transplantation in an Active-duty Military Population. Clin Orthop Relat Res 2020; 478:731-733. [PMID: 32229742 PMCID: PMC7282583 DOI: 10.1097/corr.0000000000000968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/03/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Jan M K Victor
- J. M. K. Victor, Orthopaedic Surgeon, University Hospital Ghent, Department of Orthopaedics, Gent, Belgium
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Antosh IJ, Cameron KL, Marsh NA, Posner MA, DeBerardino TM, Svoboda SJ, Owens BD. Likelihood of Return to Duty Is Low After Meniscal Allograft Transplantation in an Active-duty Military Population. Clin Orthop Relat Res 2020; 478:722-730. [PMID: 32229741 PMCID: PMC7282605 DOI: 10.1097/corr.0000000000000915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) is considered a viable surgical treatment option in the symptomatic, postmeniscectomy knee and as a concomitant procedure with ACL revision and articular cartilage repair. Although promising outcomes have recently been reported in active and athletic populations, MAT has not been well-studied in the high-demand military population. QUESTIONS/PURPOSES (1) What proportion of active-duty military patients who underwent MAT returned to full, unrestricted duty? (2) What demographic and surgical variables, if any, correlated with return to full, unrestricted duty? METHODS Between 2005 and 2015, three fellowship-trained sports surgeons (TMD, SJS, BDO) performed 110 MAT procedures in active-duty military patients, of which 95% (104 patients) were available for follow-up at a minimum 2 years (mean 2.8 ± SD 1.1 year). During the study period, indications for MAT generally included unicompartmental pain and swelling in a postmeniscectomized knee and as a concomitant procedure when a meniscal-deficient compartment was associated with either an ACL revision reconstruction or cartilage repair. Demographic and surgical variables were collected and analyzed. The primary endpoints were the decision for permanent profile activity restrictions and military duty termination by a medical board. The term "medical board" implies termination of military service because of medical reasons. We elected to set statistical significance at p < 0.001 to reduce the potential for spurious statistical findings in the setting of a relatively small sample size. RESULTS Forty-six percent (48 of 104) of eligible patients had permanent profile activity restrictions and 50% (52 of 104) eventually had their military duty terminated by a military board. Only 20% (21 of 104) had neither permanent profile activity restrictions nor medical-board termination and were subsequently able to return to full duty, and only 13% (13 of 104) continued unrestricted military service beyond 2 years after surgery. Age, gender, tobacco use, and BMI did not correlate with return to full duty. Combat arms soldiers were less likely to have permanent profile activity restrictions (odds ratio 4.76 [95% confidence interval 1.93 to 11.8]; p = 0.001) and were more likely to return to full duty than soldiers in support roles (OR 0.24 [95% CI 0.09 to 0.65]; p = 0.005), although these findings did not reach statistical significance. Officers were more likely to return to full duty than enlisted soldiers at more than 2 years after surgery (OR 17.44 [95% CI 4.56 to 66.65]; p < 0.001). No surgical variables correlated with return-to-duty endpoints. CONCLUSIONS Surgeons should be aware of the low likelihood of return to military duty at more than 2 years after MAT and counsel patients accordingly. Based on this study, MAT does not appear to be compatible with continued unrestricted military duty for most patients. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Ivan J Antosh
- I. J. Antosh, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905 USA
| | - Kenneth L Cameron
- K. L. Cameron, M. A. Posner, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA
| | - Nathan A Marsh
- N. Marsh, Department of Orthopaedic Surgery, Womack Army Medical Center, Ft. Bragg, NC, USA
| | - Matthew A Posner
- K. L. Cameron, M. A. Posner, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA
| | - Thomas M DeBerardino
- T. M. DeBerardino, Combined Baylor School of Medicine & San Antonio, Texas Sports Medicine Fellowship, Burkhart Research Institute of Orthopaedics, The San Antonio Orthopaedic Group, San Antonio, TX, USA
| | - Steven J Svoboda
- S. J. Svoboda, MedStar Orthopaedic Institute, Georgetown University Hospital, Washington, DC, USA
| | - Brett D Owens
- B. D. Owens, Department of Orthopaedic Surgery, Brown Alpert Medical School, Providence, RI, USA
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Gilat R, Cole BJ. Meniscal Allograft Transplantation: Indications, Techniques, Outcomes. Arthroscopy 2020; 36:938-939. [PMID: 32006568 DOI: 10.1016/j.arthro.2020.01.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
Meniscal allograft transplantation (MAT) has become an acceptable surgical treatment for select symptomatic and relatively young (<50 years of age) patients with a meniscal deficiency. MAT may also be considered in meniscal-deficient patients undergoing anterior cruciate ligament reconstruction and/or articular cartilage repair procedure in the ipsilateral compartment. Contraindications to MAT include asymptomatic patients, severe osteoarthritis, uncorrectable malalignment or instability, irreparable chondral damage, active infection, or inflammatory arthropathy. Most institutions prefer the use of fresh-frozen allografts, whereas the use of fresh-viable grafts is limited by their availability, and the use of cryopreserved and lyophilized grafts has gone out of favor. Donor allografts are size-matched to the recipient using x-rays or magnetic resonance imaging measurements. To date, no particular surgical technique has demonstrated superiority. Therefore, there are several used approaches (mini-open or arthroscopic), horns-fixation techniques (soft-tissue, bone-plugs, or bone-bridge), and peripheral suture techniques (inside-out or all-inside). Ipsilateral malalignment, instability, and/or chondral defects should be corrected or repaired if MAT is being performed. MAT survival rates are estimated at 73.5% at 10 years and 60.3% at 15 years. Mean time-to-failure is ∼8.2 and ∼7.6 years for a medial and lateral meniscus transplant, respectively. Significant improvement in patient-reported outcomes is expected following MAT, and 90% of patients will attest they will undergo the procedure again. Reoperation rates are estimated at 32%, with the most common complication being a tear of the meniscal allograft. Many studies reporting on outcomes of MAT are flawed because of low-quality, the use of non-fresh-frozen preservation techniques, and heterogeneity of patients and concomitant procedures. As our knowledge regarding patient selection, graft preparation, and techniques continue to develop, we expect MAT outcomes to improve much further.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL; Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL.
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Puzzitiello RN, Liu JN, Garcia GH, Redondo ML, Christian DR, Yanke AB, Cole BJ. Return to Sport and Outcomes After Concomitant Lateral Meniscal Allograft Transplant and Distal Femoral Varus Osteotomy. Arthroscopy 2020; 36:253-260. [PMID: 31864586 DOI: 10.1016/j.arthro.2019.07.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the time and rate of return to sport (RTS), as well as outcomes, in young and active patients receiving concomitant lateral meniscal allograft transplantation (MAT) and distal femoral varus osteotomy (DFVO) for lateral meniscal deficiency and valgus malalignment. METHODS This was a retrospective study of consecutive patients who underwent concomitant MAT and DFVO by a single surgeon. The exclusion criteria were any concomitant procedures other than cartilage restoration procedures for focal full-thickness cartilage defects of the lateral femoral condyle and less than 2 years of follow-up. At final follow-up, patients were asked to complete a subjective sports questionnaire, the Marx Activity Rating Scale, a visual analog scale (VAS), the Single Assessment Numeric Evaluation, and a satisfaction questionnaire. Changes in patient-reported outcome measures were assessed using nonparametric statistical testing. RESULTS A total of 21 patients met the inclusion criteria, of whom 17 were included for analysis at an average follow-up of 7.5 years (range, 2.2-13.3 years). The average age at the time of surgery was 23.3 years (range, 16.9-36.2 years), and 76.5% of patients were female patients. The average VAS score decreased from 5.7 preoperatively to 2.6 postoperatively (P = .02). Of the 15 patients who participated in sports within 3 years prior to their surgical procedure, 14 (82.4%) returned to 1 or more sports at an average of 16.9 months (range, 6-36 months); however, only 46.7% were able to return to their preinjury level of participation or higher. Furthermore, 88.2% of patients reported being satisfied with their sport-related outcomes. Direct rates of sport-specific return were as follows: weightlifting, 100%; skiing, 100%; running, 66.7%; and basketball, 50%. CONCLUSIONS In our study population, concomitant MAT and DFVO afforded a high rate of RTS at an average of 16.9 months postoperatively, as well as a significant decrease in VAS pain scores. These findings are essential to note when counseling patients receiving these procedures who wish to resume sports and physical activities so that they may expect an extensive recovery process before they can RTS. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Grant H Garcia
- Orthopedic Specialists of Seattle, Seattle, California, U.S.A
| | | | | | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, U.S.A..
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