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Richards JA, Williamson JT, Woodard DR, Caborn DN. All-Soft-Tissue Meniscus Allograft Transplantation With Circumferential Suture Tape Augmentation to Mitigate Hoop Stress and Promote Centralization. Arthrosc Tech 2024; 13:102954. [PMID: 38835470 PMCID: PMC11144943 DOI: 10.1016/j.eats.2024.102954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/14/2024] [Indexed: 06/06/2024] Open
Abstract
Meniscus allograft transplantation (MAT) is a technically challenging procedure. Bone plugs, slot techniques, and all-soft-tissue fixation techniques have been described in the past. Each technique comes with advantages and disadvantages. Native menisci have circumferential collagen fibers to help resist hoop stress during loading cycles. Although hoop stress resistance is a known function of the menisci, its recreation in MAT has only been targeted indirectly through anatomic root placement. The authors describe the use of a high-tensile suture tape (i.e. InternalBrace) to promote centralization by directly mitigating hoop stresses through recreation of peripheral meniscus tensioning in MAT.
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Affiliation(s)
- Jarod A. Richards
- Department of Orthopaedic Surgery, University of Louisville (UofL), Louisville, Kentucky, U.S.A
- UofL Health Sports Medicine, Louisville, Kentucky, U.S.A
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, U.S.A
| | - Jacob T. Williamson
- Department of Orthopaedic Surgery, University of Louisville (UofL), Louisville, Kentucky, U.S.A
| | - David R. Woodard
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, U.S.A
| | - David N.M. Caborn
- Department of Orthopaedic Surgery, University of Louisville (UofL), Louisville, Kentucky, U.S.A
- UofL Health Sports Medicine, Louisville, Kentucky, U.S.A
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Husen M, Poudel K, Wang A, Saul D, Stuart MJ, Levy BA, Saris DBF, Krych AJ. Survivorship of 157 Arthroscopic Meniscal Allograft Transplants Using Bone Fixation at a Mean of 7 Years and Prognostic Factors Analysis. Am J Sports Med 2024; 52:96-108. [PMID: 38164687 DOI: 10.1177/03635465231212667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) is an accepted and effective treatment option in the context of unsalvageable menisci, particularly in young and active patients. It has been shown to reduce pain and improve knee function in previously symptomatic patients. However, there is still limited knowledge about the long-term survival rates of allografts, the durability of clinical results, and the influence of patient-specific parameters, such as leg alignment, tibial slope, and preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade. PURPOSE To determine (1) the long-term clinical success rate after MAT with bony fixation in a large, single-center cohort of consecutive patients, and (2) if patient-specific and procedural variables influence the clinical, anatomic, and subjective outcomes and risk of failure. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data on 185 consecutive knees undergoing MAT in a single institution were prospectively collected and screened for inclusion in this study. The minimum follow-up time was 2 years. Radiographic variables (ICRS grade and Kellgren-Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (PROMs) (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale [VAS] score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery due to graft failure or conversion to total knee arthroplasty. Anatomic failure was considered a tear covering >20% of the allograft, any peripheral tear, and unstable peripheral fixation leading to dislocation of the graft. Subjective failure was defined as Lysholm score ≤65. Preoperative tibial slope and leg alignment were assessed. Survival analyses were performed using the Kaplan-Meier estimate. Univariate and multivariate analyses were performed to determine risk factors for clinical and anatomic failure. RESULTS A total of 157 knees met inclusion criteria. After a mean follow-up time of 7 ± 3.5 years, 127 (80.9%) knees were free of clinical, anatomic, and subjective failure. Fourteen (8.9%) knees experienced clinical failure, 26 (16.6%) knees were identified as having experienced anatomic failure, and 13 (8.3%) patients experienced subjective failure with a reported Lysholm score of ≤65 at a mean follow-up of 7 years. Concurrent osteochondral allograft transplantation was identified as a predictor of both clinical (hazard ratio [HR], 4.55; 95% CI, 1.46-14.17; P = .009) and anatomic (HR, 3.05; 95% CI, 1.34-6.92; P = .008) failure. Cartilage damage of ICRS grade 3 or 4 of the index compartment conveyed an increased risk for clinical (HR, 3.41; 95% CI, 1.05-11.01; P = .04) and anatomic (HR, 3.04; 95% CI, 1.31-7.11; P = .01) failure. High-grade cartilage damage preoperatively (HR, 10.67; 95% CI, 1.037-109.768; P = .046), patient age >25 years (HR, 5.44; 95% CI, 0.120-246.070; P = .384), and a body mass index >30 (HR, 2.24; 95% CI, 0.748-6.705; P = .149) were associated with subjective failure. PROMs including KOOS and IKDC were significantly improved at final follow-up compared with preoperative scores across all measurements (P < .005). CONCLUSION MAT showed good to excellent clinical results at a mean follow-up of 7 years. Low ICRS lesion grade was associated with a higher clinical and anatomic survival rate. Patients with concurrent OCA transplantation are at a higher risk of clinical and anatomic failure, but still report significantly improved PROMs. These results suggest that MAT has a lasting beneficial effect both in isolation and in complex cases with ≥1 concurrent procedures.
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Affiliation(s)
- Martin Husen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Keshav Poudel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dominik Saul
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniël B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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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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Kelly SR, Stannard JT, Reddy J, Cook JL, Stannard JP, Nuelle CW. Meniscus Allograft Transplantation With Bone Plugs Using Knotless All-Suture Anchors and Cortical Button Suspensory Fixation. Arthrosc Tech 2023; 12:e1707-e1714. [PMID: 37942117 PMCID: PMC10627850 DOI: 10.1016/j.eats.2023.05.020] [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: 03/24/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Meniscus allograft transplantation can be successful for treatment of meniscal deficiency using a number of transplant techniques. In this Technical Note, we describe a double bone plug medial meniscus allograft transplantation technique that uses knotless all-suture anchors with cortical-button suspensory fixation. This technique maintains the reported advantages for bone-plug fixation while mitigating the risk for meniscal root damage, facilitating easier bone plug insertion and seating, expanding tensioning capabilities, and preventing soft-tissue irritation from suture knot stacks.
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Affiliation(s)
- Shayne R. Kelly
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - James T. Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Jahnu Reddy
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - James L. Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - James P. Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
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5
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Lichtig A, Bedi A, Koh J, Amirouche F. A Transplant or a Patch? A Review of the Biologic Integration of Meniscus Allograft Transplantation. JBJS Rev 2023; 11:01874474-202309000-00003. [PMID: 37678287 DOI: 10.2106/jbjs.rvw.23.00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
» After transplantation revascularization does occur although data are only available for animal models.» The time zero biomechanics, that is, the biomechanical properties at the time of transplant, of a meniscus allograft transplantation appear to appropriately mimic the original so long as the graft is sized correctly within 10% of the original and bone plug fixation is used.» Allograft type, that is, fresh vs. frozen, does not appear to affect the integration of the allograft.
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Affiliation(s)
| | - Asheesh Bedi
- NorthShore University Health System, Evanston, Illinois
| | - Jason Koh
- NorthShore University Health System, Evanston, Illinois
| | - Farid Amirouche
- University of Illinois Chicago, Chicago, Illinois
- NorthShore University Health System, Evanston, Illinois
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Leite CBG, Merkely G, Zgoda M, Farina EM, Görtz S, Howard J, Lattermann C. Systematic Review of Clinical Results After Medial Meniscus Allograft Transplantation Reveals Improved Patient Reported Outcomes at Greater Than 5 Years Follow-Up. Arthroscopy 2023; 39:802-811. [PMID: 36543661 DOI: 10.1016/j.arthro.2022.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To systematically summarize the medial meniscus allograft transplantation (MAT) reported outcomes and evaluate whether the surgical technique is associated with allograft extrusion and knee function. METHODS Systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were English-language clinical studies involving arthroscopically assisted medial MAT that reported the surgical technique and the presence of graft extrusion or functional outcomes after surgery. Studies in which outcomes for medial MAT could not be separated from lateral MAT were excluded. Surgical technique, allograft-related characteristics, and clinical outcomes were extracted. RESULTS Twenty-four studies with 328 medial MAT were included, 58.3% studies qualified as level 4 of evidence, 29.2% as level 3, and 12.5% as level 2. Allograft fixation techniques were bone plug (235/328 [71.6%]), bone bridge/trough (55/328 [16.8%]), and soft-tissue suture fixation only (38/328 [11.6%]). Relative percentage of extrusion after surgery ranged from 24.8% to 53.7%. Major extrusion (>3 mm) ranged from zero to 78%. Overall, functional scores improved after medial MAT. None of surgical techniques were associated with poor functional outcomes or extruded meniscus; however, nonanatomical placement of the anterior and posterior horns appeared to increase meniscus extrusion. CONCLUSION Medial MAT provides favorable outcomes, with acceptable rates of complication and failure regardless of surgical technique. Although allograft extrusion appears equivalent for both bone plug and soft-tissue fixation techniques, positioning allograft horns at the native meniscal footprint may be critical for preventing extrusion. However, the heterogeneity and low level of evidence of the studies included in this review prevent decisive conclusions regarding optimal MAT fixation techniques, clinical significance of allograft extrusion, or comparative clinical outcomes after medial MAT. LEVEL OF EVIDENCE Level IV - systematic review of Level II to IV studies.
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Affiliation(s)
- Chilan Bou Ghosson Leite
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Gergo Merkely
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Molly Zgoda
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evan M Farina
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon Görtz
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Howard
- Department of Rehabilitation Sciences, Beaver College of Health Sciences, Appalachian State University, Boone, North Carolina, U.S.A
| | - Christian Lattermann
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ow ZGW, Cheong CK, Hai HH, Ng CH, Wang D, Krych AJ, Saris DBF, Wong KL, Lin HA. Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis. Am J Sports Med 2022; 50:4008-4018. [PMID: 34633225 DOI: 10.1177/03635465211042014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal allograft transplant (MAT) is an important treatment option for young patients with deficient menisci; however, there is a lack of consensus on the optimal method of allograft fixation. HYPOTHESIS The various methods of MAT fixation have measurable and significant differences in outcomes. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A single-arm meta-analysis of studies reporting graft failure, reoperations, and other clinical outcomes after MAT was performed. Studies were stratified by suture-only, bone plug, and bone bridge fixation methods. Proportionate rates of failure and reoperation for each fixation technique were pooled with a mixed-effects model, after which reconstruction of relative risks with confidence intervals was performed using the Katz logarithmic method. RESULTS A total of 2604 patients underwent MAT. Weighted mean follow-up was 4.3 years (95% CI, 3.2-5.6 years). During this follow-up period, graft failure rates were 6.2% (95% CI, 3.2%-11.6%) for bone plug fixation, 6.9% (95% CI, 4.5%-10.3%) for suture-only fixation, and 9.3% (95% CI, 6.2%-13.9%) for bone bridge fixation. Transplanted menisci secured using bone plugs displayed a lower risk of failure compared with menisci secured via bone bridges (RR = 0.97; 95% CI, 0.94-0.99; P = .02). Risks of failure were not significantly different when comparing suture fixation to bone bridge (RR = 1.02; 95% CI, 0.99-1.06; P = .12) and bone plugs (RR = 0.99; 95% CI, 0.96-1.02; P = .64). Allografts secured using bone plugs were at a lower risk of requiring reoperations compared with those secured using sutures (RR = 0.91; 95% CI, 0.87-0.95; P < .001), whereas allografts secured using bone bridges had a higher risk of reoperation when compared with those secured using either sutures (RR = 1.28; 95% CI, 1.19-1.38; P < .001) or bone plugs (RR = 1.41; 95% CI, 1.32-1.51; P < .001). Improvements in Lysholm and International Knee Documentation Committee scores were comparable among the different groups. CONCLUSION This meta-analysis demonstrates that bone plug fixation of transplanted meniscal allografts carries a lower risk of failure than the bone bridge method and has a lower risk of requiring subsequent operations than both suture-only and bone bridge methods of fixation. This suggests that the technique used in the fixation of a transplanted meniscal allograft is an important factor in the clinical outcomes of patients receiving MATs.
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Affiliation(s)
| | - Chin Kai Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hao Han Hai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dean Wang
- Department of Orthopedic Surgery, University of California, Irvine, Orange County, California, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keng Lin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Orthopedic Surgery, Sengkang General Hospital, Singapore, Singapore.,Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Heng An Lin
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
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Brzezinski A, Imbergamo C, Pfaff W, Tarapore R, Nasra M, Simon M, Gatt C. Biomechanical Comparison of Meniscal Allograft Root Fixation Techniques: Anterograde Interference Bone Plug Fixation Yields Favorable Results Compared to Transosseous Suture Fixation Alone. Arthrosc Sports Med Rehabil 2022; 4:e907-e914. [PMID: 35747667 PMCID: PMC9210386 DOI: 10.1016/j.asmr.2022.01.001] [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: 10/06/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare the biomechanical properties of 2 different fixation techniques (interference bone plug fixation vs transosseous suture fixation) of the posterior horn of the medial meniscus using a porcine model. Methods Twenty-six matched pairs of fresh-frozen juvenile domestic porcine knees were used in this study. Specimens were randomly distributed among 3 groups: (1) native meniscus groups, (2) interference fixation, and (3) transosseous suture fixation. In each group, the posterior segments of the tested medial menisci were gripped with the freeze clamps and fixed to the tensile testing machine. Samples were preconditioned, followed by cyclic tension-relaxation for 1000 cycles between 10 and 30 N at 0.5 Hz and finally pulled to failure at a rate of 0.55 mm/s. The cyclic elongation, stiffness to failure, mode, and ultimate load to failure were recorded. Results There was no significant difference in ultimate load to failure between the interference fixation (169.71 ± 71.98 N) and transosseous suture fixation (222.73 ± 72.40 N) groups (P = .118), both were significantly less than that of the native meniscus (405.46 ± 95.62) (P < .001). Interference fixation displayed cyclic elongation (1.04 ± 0.71 mm) and stiffness (69.10 ± 25.8 N/mm) that were not significantly different from the native meniscus tissue (0.78 ± 0.53 mm and 83.1 ±26.28 N/mm) (P = .359 and P = .224), in comparison to transosseous suture fixation, which did show increased cyclic elongation (1.85 ± 1.44 mm) (P = .047) and decreased stiffness (34.72 ± 10.2 N/mm) (P < .001). Conclusion Interference fixation of the posterior horn of the medial meniscus has superior cyclic elongation and stiffness when compared to transosseous suture fixation. Interference fixation and the native meniscus model have a similar stiffness and cyclic elongation. Clinical Relevance The significance of our study is that using interference fixation for meniscal allograft transplantation has the potential to reduce short term surgical failures as well as long term complication rates.
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Affiliation(s)
- Andrzej Brzezinski
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | | | - William Pfaff
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Rae Tarapore
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
- Address correspondence to Rae Tarapore, B.A., 125 Paterson St New Brunwsick, NJ, 08901.
| | - Matthew Nasra
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Michael Simon
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Charles Gatt
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
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9
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Kohno Y, Koga H, Ozeki N, Matsuda J, Mizuno M, Katano H, Sekiya I. Biomechanical analysis of a centralization procedure for extruded lateral meniscus after meniscectomy in porcine knee joints. J Orthop Res 2022; 40:1097-1103. [PMID: 34314533 PMCID: PMC9292650 DOI: 10.1002/jor.25146] [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] [Received: 12/27/2020] [Revised: 06/02/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
The recently developed arthroscopic centralization for lateral meniscal extrusion has obtained satisfactory short-term clinical and radiological results and improves the meniscus biomechanical properties. However, the effectiveness of treatment for meniscus extrusion after partial meniscectomy still requires elucidation. This study investigated the effect of centralization with modifications from a mechanical viewpoint. Porcine knee joints (N = 6) were set in a universal tester under the following conditions: (1) Intact; (2) Meniscectomy: Inner half of the posterior half meniscus was removed; (3) Extrusion: Posterior meniscus was dislocated laterally by transecting the posterior root and the meniscotibial ligament; (4) Centralization-1: Centralization procedure using one anchor; (5) Centralization-2: Centralization procedure using two anchors; and (6) Centralization-ad: Centralization with capsular advancement using two anchors. Load distributions and contact pressure in the meniscus and tibial cartilage were evaluated with an axial compressive force of 200 N. After meniscectomy, the tibial cartilage load increased and that of the medial margin of the posterior part of the meniscus decreased. When the meniscus was extruded, the load was concentrated only on the tibial cartilage. Centralization-1 increased the load on the meniscus, while Centralization-2 further increased the meniscus load but decreased the tibial cartilage load. Centralization-ad further decreased the load on the tibial plateau. The average contact pressure of the tibial cartilage was significantly higher in the Extrusion group than in the Intact group or the Centralization-ad group. From a biomechanical viewpoint, centralization with capsular advancement was the most effective of the tested procedures for treatment for an extruded meniscus after partial meniscectomy.
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Affiliation(s)
- Yuji Kohno
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Nobutake Ozeki
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Junpei Matsuda
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Mitsuru Mizuno
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hisako Katano
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Ichiro Sekiya
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
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10
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Teo SJ, Tan MWP, Koh DTS, Lee KH. Medial Meniscal Allograft Transplantation With Bone Plugs Using a 3-Tunnel Technique. Arthrosc Tech 2022; 11:e217-e222. [PMID: 35155116 PMCID: PMC8821312 DOI: 10.1016/j.eats.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/17/2021] [Indexed: 02/03/2023] Open
Abstract
Meniscal allograft transplantation is an area of active research, given that the importance of the meniscus in native knee joint longevity has been increasingly recognized. This article describes a modified meniscal allograft transplantation technique using 3 bone tunnels with allograft fixation through the use of bone plugs. The addition of a third tunnel increases the strength of fixation, avoiding meniscal extrusion and improving load distribution.
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Affiliation(s)
- Shao Jin Teo
- Address correspondence to Shao Jin Teo, M.B.B.S., Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road Academia, Level 4, Singapore 169865, Singapore.
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11
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Wang D, Gonzalez-Leon E, Rodeo SA, Athanasiou KA. Clinical Replacement Strategies for Meniscus Tissue Deficiency. Cartilage 2021; 13:262S-270S. [PMID: 34802295 PMCID: PMC8808868 DOI: 10.1177/19476035211060512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022] Open
Abstract
Meniscus tissue deficiency resulting from primary meniscectomy or meniscectomy after failed repair is a clinical challenge because the meniscus has little to no capacity for regeneration. Loss of meniscus tissue has been associated with early-onset knee osteoarthritis due to an increase in joint contact pressures in meniscectomized knees. Clinically available replacement strategies range from allograft transplantation to synthetic implants, including the collagen meniscus implant, ACTIfit, and NUSurface. Although short-term efficacy has been demonstrated with some of these treatments, factors such as long-term durability, chondroprotective efficacy, and return to sport activities in young patients remain unpredictable. Investigations of cell-based and tissue-engineered strategies to treat meniscus tissue deficiency are ongoing.
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Affiliation(s)
- Dean Wang
- Department of Orthopedic Surgery,
University of California, Irvine, Orange, CA, USA
| | - Erik Gonzalez-Leon
- Department of Biomedical Engineering,
University of California, Irvine, Irvine, CA, USA
| | - Scott A. Rodeo
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
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12
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Winkler PW, Wagala NN, Hughes JD, Irrgang JJ, Fu FH, Musahl V. Association Between Meniscal Allograft Tears and Early Surgical Meniscal Allograft Failure. Am J Sports Med 2021; 49:3302-3311. [PMID: 34399055 DOI: 10.1177/03635465211032970] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 transplantation (MAT) has become a viable treatment option for patients with symptomatic meniscal deficiency. Some patients experience early surgical meniscal allograft failure attributed to causes that have not yet been sufficiently clarified. PURPOSE To evaluate the prevalence, types, and distribution of arthroscopically confirmed meniscal allograft tears and the associated effect on surgical meniscal allograft survival. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing MAT with a minimum 2-year follow-up were retrospectively reviewed. Descriptive and surgical data were collected. Type and location of arthroscopically confirmed meniscal allograft tears were recorded and compared between medial and lateral allografts and suture-only and bone block fixation. A survival analysis was conducted to evaluate the effect of meniscal allograft tears on surgical meniscal allograft survival. RESULTS This study included 142 patients (54% male; mean ± SD age, 29.6 ± 10.4 years) with a mean follow-up of 10.3 ± 7.5 years. The prevalence of meniscal allograft tears was 32%, observed at a median of 1.2 years (interquartile range, 2.8 years) after MAT. The posterior horns were most frequently affected, followed by the posterior roots, midbodies, anterior horns, and anterior roots. The most frequently observed tear types were root tears (43%), followed by longitudinal, horizontal, radial, complex, bucket-handle, and meniscocapsular separation tears. A statistically significant association was found between meniscal allograft tear types and fixation techniques (P = .027), with root tears predominant after suture-only as compared with bone block fixation (57% vs 22%). Patients with meniscal allograft root tears were a mean of 5.4 years (95% CI, 1.6-9.2 years; P = .007) younger than were patients without root tears. The 1-year surgical meniscal allograft survival rate was significantly lower for torn versus intact meniscal allografts (75% vs 99%; P < .001). CONCLUSION Meniscal allograft root tears were predominant, associated with younger patient age, and more often observed when using the suture-only fixation technique versus the bone block fixation technique. Torn meniscal allografts were associated with early surgical graft failure when compared with intact meniscal allografts, resulting in a significantly lower 1-year survival rate.
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Affiliation(s)
- Philipp W Winkler
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department for Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nyaluma N Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [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] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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14
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Hollier-Larousse B, Kim SH, Pujol N. Does intermeniscal ligament tenodesis affect meniscal allograft extrusion? Retrospective comparative study at a minimum follow-up of 2 years. Orthop Traumatol Surg Res 2021; 107:102815. [PMID: 33484905 DOI: 10.1016/j.otsr.2021.102815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/25/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Meniscal allograft transplantation (MAT) is indicated for the treatment of post-meniscectomy syndrome in young patients who do not have severe cartilage loss. While its clinical effectiveness is well established in the short- and mid-term, it does not appear to stop the progression of osteoarthritis. Meniscal extrusion often occurs early on and is irreversible. The aim of this study was to evaluate results of arthroscopic MAT combined with reconstruction of the intermeniscal ligament (IML). HYPOTHESIS Concurrent reconstruction of the IML decreases the incidence of early allograft extrusion when compared to conventional soft-tissue techniques. MATERIALS AND METHODS This was a retrospective single-centre comparative study of 55 patients operated between 2011 and 2018. The 34 patients who met the inclusion criteria were divided into two subgroups: the IML group (MAT with IML repair, n=14) and the non-IML group (MAT without IML repair, n=20). Clinical outcomes consisted of the KOOS at the last follow-up visit and the surgical revision rate. MRI was performed at a minimum of 12 months (mean 34±25 months) to determine absolute and relative meniscal extrusion, sagittal anterior and posterior extrusion, and cartilage coverage in the frontal and sagittal planes. RESULTS The KOOS score was not significantly different between the two groups. There were no reoperations in the IML group, but there were four in the non-IML group (13%) (p=0.13). Meniscal extrusion of the allograft occurred in 43% of patients (6/14) in the IML group versus 85% (17/20) in the non-IML group (p<0.03). Absolute meniscal extrusion was 2.9mm ([2.2-3.6] SD=1.2) in the ILM group versus 5.4 mm ([4.1-6.7] SD=2.9) (p=0.004) in the non-ILM group. DISCUSSION Adding ILM tenodesis or reconstruction can significantly limit early extrusion of the meniscal allograft. Clinical outcomes at a mean of 34 months are not different when compared to standard procedure. These patients should be re-evaluated in the long term to determine whether the incidence of osteoarthritis is lower with ILM tenodesis. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Bernard Hollier-Larousse
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Seong Hwan Kim
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France; Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Nicolas Pujol
- Service de chirurgie orthopédique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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15
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Schreiner AJ, Stannard JP, Cook CR, Bozynski CC, Kuroki K, Stoker AM, Smith PA, Cook JL. Comparison of meniscal allograft transplantation techniques using a preclinical canine model. J Orthop Res 2021; 39:154-164. [PMID: 32198782 DOI: 10.1002/jor.24668] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 02/04/2023]
Abstract
Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with menisco-capsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibial-osteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with menisco-tibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.
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Affiliation(s)
- Anna J Schreiner
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Traumatology and Reconstructive Surgery, BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Cristi R Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Division of Sports Medicine, Columbia Orthopaedic Group, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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16
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Sochacki KR, Varshneya K, Safran MR, Abrams GD, Donahue J, Wang T, Sherman SL. Reoperation Rates Following Meniscus Transplantation Using the Truven Database. Arthroscopy 2020; 36:2731-2735. [PMID: 32645340 DOI: 10.1016/j.arthro.2020.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the (1) reoperation rate and (2) 30-day complication rate in a large insurance database. METHODS The Truven Database was queried for subjects that underwent meniscus allograft transplantation (Current Procedural Terminology code 29868) in the outpatient setting with minimal 2-year follow-up. Patients without confirmed laterality and patients that underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using International Classification of Diseases, 9th Revision, Clinical Modification codes. RESULTS A total of 284 patients (mean age of 26.2 ± 10.4 years; 49.6% females) were included in this study with mean follow up of 43.2 ± 19.2 months. One hundred and sixty-seven subjects (58.8%) undergoing meniscus allograft transplantation underwent reoperation at an average of 11.9 ± 12.2 months postoperatively. There was a low number of subjects that required ipsilateral unicompartmental knee arthroplasty and total knee arthroplasty postoperatively (0.7% and 1.1%, respectively). The overall 30-day complication rate following meniscus allograft transplantation was 1.4%. CONCLUSIONS Patients undergoing meniscus allograft transplantation have a 58.8% reoperation rate at final follow up with low (1.4%) 30-day complication rates in a large insurance database. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kyle R Sochacki
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A..
| | - Kunal Varshneya
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Joseph Donahue
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Tim Wang
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, U.S.A
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17
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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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18
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Kubota R, Koga H, Ozeki N, Matsuda J, Kohno Y, Mizuno M, Katano H, Sekiya I. The effect of a centralization procedure for extruded lateral meniscus on load distribution in porcine knee joints at different flexion angles. BMC Musculoskelet Disord 2020; 21:205. [PMID: 32245447 PMCID: PMC7126455 DOI: 10.1186/s12891-020-03197-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Meniscal extrusion results in loss of the ability to resist hoop strain and biomechanical overload on the joint articular surface. A centralization technique has been developed to overcome these problems. In this study, we analyzed the biomechanics of the extruded and centralized lateral meniscus (LM) in porcine knee joints at different flexion angles. Methods Porcine knee joints (n = 8) were set in the universal tester and each knee was tested under the following states: 1) intact; 2) extrusion—meniscal extrusion was created by resecting the posterior root of the LM and posterior synovial capsule; and 3) centralization—centralization was performed by two anchors inserted in the lateral tibial plateau. Deviation distance of the meniscus, contact pressure, and contact area in the anterior LM, middle LM, posterior LM, and the contact pressure of the tibial cartilage were evaluated with an axial compressive force of 200 N at knee flexion angles of 30°, 45°, 60°, and 90°. Results The deviation distance of LM significantly increased in extrusion but was restored to the intact status after centralization at all angles. Both the contact pressure and area significantly decreased in extrusion and were restored after centralization close to the intact status in the anterior and middle LM; in the posterior LM, however, decreased contact pressure and area were not restored after centralization. The contact pressure of the tibial cartilage increased significantly in extrusion but decreased close to the intact status after centralization. Conclusions This centralization procedure could reduce extrusion of the LM and restore the load-distributing function of the anterior-middle LM. However, the procedure itself could not restore hoop function in cases where the defect lies in the posterior LM.
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Affiliation(s)
- Rei Kubota
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Junpei Matsuda
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yuji Kohno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Beeler S, Jud L, von Atzigen M, Sutter R, Fürnstahl P, Fucentese SF, Vlachopoulos L. Three-dimensional meniscus allograft sizing-a study of 280 healthy menisci. J Orthop Surg Res 2020; 15:74. [PMID: 32093711 PMCID: PMC7041285 DOI: 10.1186/s13018-020-01591-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background Inaccurate meniscus allograft size is still an important problem of the currently used sizing methods. The purpose of this study was to evaluate a new three-dimensional (3D) meniscus-sizing method to increase the accuracy of the selected allografts. Methods 3D triangular surface models were generated from 280 menisci based on 50 bilateral and 40 unilateral knee joint magnetic resonance imaging (MRI) scans. These models served as an imaginary meniscus allograft tissue bank. Meniscus sizing and allograft selection was simulated for all 50 bilateral knee joints by (1) the closest mean surface distance (MeSD) (3D-MRI sizing with contralateral meniscus), (2) the smallest meniscal width/length difference in MRI (2D-MRI sizing with contralateral meniscus), and (3) conventional radiography as proposed by Pollard (2D-radiograph (RX) sizing with ipsilateral tibia plateau). 3D shape and meniscal width, length, and height were compared between the original meniscus and the selected meniscus using the three sizing methods. Results Allograft selection by MeSD (3D MRI) was superior for all measurement parameters. In particular, the 3D shape was significantly improved (p < 0.001), while the mean differences in meniscal width, length, and height were only slightly better than the allograft selected by the other methods. Outliers were reduced by up to 55% (vs. 2D MRI) and 83% (vs. 2D RX) for the medial meniscus and 39% (vs. 2D MRI) and 56% (vs. 2D RX) for the lateral meniscus. Conclusion 3D-MRI sizing by MeSD using the contralateral meniscus as a reconstruction template can significantly improve meniscus allograft selection. Sizing using conventional radiography should probably not be recommended. Trial registration Kantonale Ethikkommission Zürich had given the approval for the study (BASEC-No. 2018-00856).
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Affiliation(s)
- Silvan Beeler
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Lukas Jud
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Marco von Atzigen
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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20
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Kim SH, Lipinski L, Pujol N. Meniscal Allograft Transplantation With Soft-Tissue Fixation Including the Anterior Intermeniscal Ligament. Arthrosc Tech 2019; 9:e137-e142. [PMID: 32021787 PMCID: PMC6993485 DOI: 10.1016/j.eats.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023] Open
Abstract
Meniscal allograft transplantation has been introduced as a treatment for symptomatic meniscus-deficient patients to improve clinical outcomes. We describe an arthroscopic technique for meniscal allograft with soft-tissue fixation including the anterior intermeniscal ligament (AIML): arthroscopic double soft-tissue fixation technique. The AIML and anterior and posterior roots are detached and sutured using running locked Krackow stitches. After preparation of the meniscal bed, the meniscus is passed into the knee and the posterior meniscal horn is fixed with sutures through bone tunnels. The body of the meniscus is fixed with all-inside sutures. Then, the anterior meniscal suture is fixed on the anatomic point of the anterior root with an anchor. The AIML suture is fixed with an anchor to the bare area of the proximal tibia, anterior to the anterior cruciate ligament insertion. This reliable and reproducible technique is less complex than bone plug methods; it is less invasive but still provides stable and secure graft fixation. It will help surgeons to improve clinical results and to limit early secondary extrusion of the graft.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Lukasz Lipinski
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Seoul, Republic of Korea
- Orthopedics and Pediatric Orthopedics Clinic, Medical University of Lodz, Lodz, Poland
| | - Nicolas Pujol
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
- Address correspondence to Nicolas Pujol, M.D., Department of Orthopedic Surgery, Centre Hospitalier de Versailles, 177 Rue de Versailles, Le Chesnay, France.
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