Clinical and Radiological Short-Term Results after Meniscal Allograft

Yung-Kuk Lee; Wan-Sub Kwak; Jae-Hoon Lee; Hyon-Ku Cho; Hyung-Joo Kim; Ki-Cheor Bae

doi:10.4055/jkoa.2016.51.5.387

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Lee, Kwak, Lee, Cho, Kim, and Bae: Clinical and Radiological Short-Term Results after Meniscal Allograft

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(5): 387-394.

Published online: 26 October 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.5.387

Clinical and Radiological Short-Term Results after Meniscal Allograft

Yung-Kuk Lee, M.D., Wan-Sub Kwak, M.D., Jae-Hoon Lee, M.D., Hyon-Ku Cho, M.D., Hyung-Joo Kim, M.D.^*, Ki-Cheor Bae, M.D., Ph.D.^*

Department of Orthopedic Surgery, Suseong Hanmi Hospital, Daegu, Korea.

^*Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Correspondence to: Ki-Cheor Bae, M.D., Ph.D. Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. TEL: +82-53-250-7038, FAX: +82-53-250-7205 bkc@dsmc.or.kr

Received 10 November 2015 Revised 8 March 2016 Accepted 15 March 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the clinical and radiological results after meniscal allograft transplantation (MAT).

Materials and Methods

From October, 2010 to August, 2013, 45 patients, 47 cases who underwent MAT were reviewed. The mean age was 39.9 years and the mean follow-up period was 24.9 months. The clinical results were evaluated using Lysholm score and International Knee Documentation Committee (IKDC) score. All cases were evaluated by serial postoperative radiograph. And 18 cases were performed postoperative magnetic resonance imaging (MRI). Eighteen cases including the 13 cases that had graft dislocation or subluxation and signal changes in MRI underwent second-look arthroscopy.

Results

Lysholm score was elevated from mean 58.4 at preoperative to 92.4 at last follow-up. IKDC score was elevated from mean 50.3 at preoperative to 90.1 at last follow-up. Among the 18 cases who underwent postoperative MRI, subluxation was found in 10 cases (55.6%) and graft dislocation with grade III signal change was found in 3 cases (16.7%). However, the 13 cases showed a well healed state of the graft capsule in second-look arthroscopy. There was no joint space narrowing on radiograph during the follow-up period.

Conclusion

After MAT, 93.6% of cases showed improved the clinical results above good. Thus, it is effective in relatively young and active patients with meniscus functional deficit and minor meniscal degeneration.

Keywords: meniscus, allograft transplantation, second-look arthroscopy, magnetic resonance imaging

Figures and Tables

Figure 1

(A) High skin incision on arthroscopic portal for good viewing. (B) Preservation of anterior meniscus peripheral rim for stable graft suture.

Figure 2

(A) Intraoperative finding of meniscal allograft transplantation (MAT), All inside suture of anteromedial corner. (B) Intraoperative finding of MAT, posterior compartment.

Figure 3

Lateral subluxation after lateral meniscal allograft on follow-up magnetic resonance imaging.

Figure 4

Flow diagram. MRI, magnetic resonance imaging.

Figure 5

Well healed graft on 2nd look arthroscopy.

Figure 6

Comparison of clinical results between patients with lateral (n=35) and medial (n=11) lesions. IKDC, International Knee Documentation Committee.

Table 1

Combined Disease or Injury

OCD, osteochondritis dissecans; ACL, anterior cruciate ligament; PCL, posterior cruciate ligament; PLRI, posterolateral rotatory instability.

Table 2

Preoperative and Postoperative Clinical Score

IKDC, International Knee Documentation Committee.

Table 3

Comparison of Clinical Results between Isolated and Combined Lesions

IKDC, International Knee Documentation Committee; OCD, osteochondritis dissecans.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand. 1980; 51:871–879.

2. Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res. 1980; 149:283–290.

3. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64:883–888.

4. Renström P, Johnson RJ. Anatomy and biomechanics of the menisci. Clin Sports Med. 1990; 9:523–538.

5. Voloshin AS, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng. 1983; 5:157–161.

6. Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Relat Res. 1975; 109:184–192.

7. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. Factors effecting late results after meniscectomy. J Bone Joint Surg Am. 1974; 56:719–729.

8. Milachowski KA, Weismeier K, Wirth CJ. Homologous meniscus transplantation. Experimental and clinical results. Int Orthop. 1989; 13:1–11.

9. Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F. Meniscal allograft transplantation. Two- to eight-year results. Am J Sports Med. 2001; 29:410–414.

10. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948; 30:664–670.

11. Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med. 1995; 23:240–244.

12. Schimmer RC, Brülhart KB, Duff C, Glinz W. Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course. Arthroscopy. 1998; 14:136–142.

13. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. Clinical outcomes following isolated lateral meniscal allograft transplantation. Arthroscopy. 2006; 22:771–780.

14. Lee DH, Kim SB, Kim TH, Cha EJ, Bin SI. Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med. 2010; 38:247–254.

15. Vundelinckx B, Vanlauwe J, Bellemans J. Long-term subjective, clinical, and radiographic outcome evaluation of meniscal allograft transplantation in the knee. Am J Sports Med. 2014; 42:1592–1599.

16. Garrett JC. Meniscal transplantation. Am J Knee Surg. 1996; 9:32–34.

17. Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL. Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients. Arthroscopy. 2000; 16:343–347.

18. Rodeo SA. Meniscal allografts: where do we stand? Am J Sports Med. 2001; 29:246–261.

19. Samitier G, Alentorn-Geli E, Taylor DC, et al. Meniscal allograft transplantation. Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015; 23:323–333.

20. Shelton WR, Dukes AD. Meniscus replacement with bone anchors: a surgical technique. Arthroscopy. 1994; 10:324–327.

21. Wilcox TR, Goble EM, Doucette SA. Goble technique of meniscus transplantation. Am J Knee Surg. 1996; 9:37–42.

22. Cole BJ, Carter TR, Rodeo SA. Allograft meniscal transplantation: background, techniques, and results. Instr Course Lect. 2003; 52:383–396.

23. Lanzer WL, Komenda G. Changes in articular cartilage after meniscectomy. Clin Orthop Relat Res. 1990; 252:41–48.

24. Verdonk P, Depaepe Y, Desmyter S, et al. Normal and transplanted lateral knee menisci: evaluation of extrusion using magnetic resonance imaging and ultrasound. Knee Surg Sports Traumatol Arthrosc. 2004; 12:411–419.

25. Verstraete KL, Verdonk R, Lootens T, Verstraete P, De Rooy J, Kunnen M. Current status and imaging of allograft meniscal transplantation. Eur J Radiol. 1997; 26:16–22.

26. Cho SH, Kim JG. Clinical evaluation using MRI and Arthroscopy after meniscal transplantation. J Korean Orthop Assoc. 2007; 42:77–83.

27. Cho SM, Yoon KH, Lee JH, Bae DK, Song SJ, Kang MC. The clinical results of meniscus allograft transplantation: comparison between medial, lateral, isolated and combined procedure groups. J Korean Arthrosc Soc. 2009; 13:28–33.

28. Choi CH, Choi YJ. Outcomes of meniscal allograft transplantation. J Korean Arthrosc Soc. 2011; 15:36–41.

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