Predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction

Superior pain relief and quality of life with autografts using semitendinosus or patellar ligament compared to allografts in meniscal reconstruction: A 2-year prospective comparative study

PURPOSE

This study aims to compare the 2-year clinical outcomes of meniscal reconstructions using allograft versus autograft tissue, with a focus on patient-reported outcomes, complication rates and surgical revision rates.

METHODS

This prospective comparative cohort study included 60 patients (ages 18-60 years) undergoing meniscal reconstruction. Patients were divided into an allograft group (n = 31) and an autograft group (n = 29; Hamstring tendon = 25 and patellar tendons = 4). Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) score and EuroQol-5D (EQ-5D) score. Surgical revision rates, reoperation rates and complication rates were recorded. Time-to-reoperation was analyzed using Kaplan-Meier survival curves and a Cox hazards model was used to identify predictors of time-to-reoperation/revision (failure).

RESULTS

At 2 years, the autograft group had higher KOOS pain scores (89.93 vs. 86.87, p = 0.002) and EQ-5D scores (0.884 vs. 0.802, p = 0.002) compared to the allograft group. There were no differences in KOOS sports, symptoms, activities of daily living or UCLA scores between the groups. The allograft group had a higher complication (relative risk [RR] = 2.34, 95% confidence interval [CI]: 0.49-11.13, p = 0.266), reoperation (RR = 1.87, 95% CI: 0.51-6.80, p = 0.329) and revision surgery rates (RR = 2.81, 95% CI: 0.31-25.48, p = 0.334), although not statistically significant. Cox modelling identified autograft as a significant predictor of reduced reoperation risk (hazards ratio = 0.057, 95% CI: 0.004-0.036, p = 0.036), with higher preoperative KOOS pain and sports scores also associated with reduced reoperation risk.

CONCLUSION

These preliminary results show that meniscal reconstruction using autograft tissue is associated with better clinical outcomes in terms of pain relief and quality of life, as well as lower reoperation and complication rates, compared to allograft tissue. However, these observations need to be validated by well-powered research.

LEVEL OF EVIDENCE

Level III prospective.

Insights and implications from the study on meniscus reconstruction using tendon autograft

This letter addresses the recent study by Zhu et al on the predictive factors for coronal and sagittal graft extrusion length following medial meniscus reconstruction using tendon autografts. The study provides valuable insights into the importance of preoperative joint space width and tunnel positioning as predictors of graft extrusion. Specifically, it found strong correlations between preoperative joint space width and medial, posterior, and mean graft extrusion at both 1 week and 8 months post-operation. Additionally, tunnel edge distance at 1 week post-operation correlated with anterior and posterior graft extrusion. These findings offer critical guidance for improving surgical outcomes. However, the letter highlights the need for further research with larger sample sizes and comparative studies involving different graft types to strengthen these findings and broaden their applicability in clinical settings. The study's contributions to understanding meniscus reconstruction using tendon autografts are acknowledged, along with suggestions for future research directions.