Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up

Ren, Shouxin; Zhang, Xintao; You, Tian; Jiang, Xiaocheng; Jin, Dadi; Zhang, Wentao

doi:10.1186/s13018-018-0776-3

Cited by 13 publications

(21 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on this finding, it is supposed that the graft “extrusion” may be not a progressive problem, but rather may be a problem that already existed immediately after surgery due to assumed reasons including graft size mismatch or inadequate graft position. There were studies on efforts to prevent graft extrusion by reducing the graft size [ 29 ] or using different approach for graft placement [ 30 – 32 ]. In this respect, the authors recently modified medial MAT technique as tensioning the anterior horn of the graft using suture anchor after bone fixation (unpublished data).…”

Section: Discussionmentioning

confidence: 99%

The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation

Kim

Lee

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

BackgroundGraft shrinkage or radial extrusion is a reported complication after meniscus allograft transplantation (MAT). Whether shrinkage or extrusion progress after surgery and whether they are associated with the clinical outcome of MAT remain debatable. In this study, graft shrinkage and extrusion were measured in the coronal and sagittal planes using serial postoperative magnetic resonance imaging (MRI). The purpose of this study was to evaluate if graft shrinkage or extrusion is correlated to the clinical outcome of MAT.MethodsMRIs acquired at 3 and 12 months postoperatively in 30 patients (21 men and 9 women) who underwent MAT (6 medial and 24 lateral menisci) from 2010 to 2016 were analyzed. Two orthopedic surgeons and two musculoskeletal specialized radiologists each performed the MRI measurements. Allograft shrinkage was measured by the width and thickness of the graft at the coronal and sagittal planes. To determine the graft extrusion, distances between the proximal tibia cartilage margin and the extruded graft margin were measured in both coronal (either lateral or medial) and sagittal (both anterior and posterior) plane and relative percentage of extrusion (RPE) were calculated. Subjective International Knee Documentation Committee (IKDC) scores at 12 months were evaluated as a clinical outcome measurement, and correlations between shrinkage or extrusion of allograft and IKDC score were analyzed.ResultsIn the coronal plane, radial RPE averaged 43.6% at postoperative 3 months, but there was no significant progression of extrusion at 12 months (average 42.0%) (P = 0.728). In the sagittal plane, there were no significant progressions of anterior and posterior RPE (P = 0.487 and 0.166, respectively) between postoperative 3 and 12 months. Shrinkage was calculated by multiplying the width and height of the three sections and summing these values. There was no significant progression of shrinkage between postoperative 3 and 12 months (P = 0.150). RPE in the radial (R = 0.147, P = 0.525), anterior (R = 0.249, P = 0.264), and posterior (R = 0.230, P = 0.315) directions and shrinkage (R = 0.176, P = 0.435) were not correlated to IKDC score at postoperative 12 months.ConclusionsIn the coronal and sagittal planes, extrusion and shrinkage did not progress from 3 months to 1 year. Extrusion and shrinkage had no correlation with early clinical outcomes. This finding suggests that graft extrusion or shrinkage may be not a great concern especially in early postoperative period of MAT, and multiple, serial MRI may be not necessary.

show abstract

Section: Discussionmentioning

confidence: 99%

The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation

Kim

Lee

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…A total of 438 were excluded based on the study title and abstract, and 145 full-text articles underwent full-text review, of which 36 articles were subsequently included in the meta-analysis. In summary, 12 articles originated from South Korea, # 7 from Italy, 19,36,37,62-65 5 from the United States, 10,12,18,21,39 4 from the United Kingdom, 8,35,46,51 3 from Spain, 1,3,38 2 from China, 48,66 and 1 each from Australia, 55 Canada, 9 and France. 49 Of the included articles, 21 had a retrospective study design and 15 had a prospective study design (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis

Cheong

Hai

et al. 2021

Am J Sports Med

View full text Add to dashboard Cite

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.

show abstract

“… 35 However, radiographic progression of arthrosis is reduced in knees after MAT compared with meniscus-deficient knees. 17 Two studies 33 , 43 found that delayed implantation after meniscectomy was related to worse clinical outcomes over time. Zaffagnini et al 43 reported that a longer period of time between the first meniscectomy and MAT was associated with an increased postoperative visual analog scale score for pain (4.1 points every 10 years; P = .0147).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors to Determine Survivorship of Meniscal Allograft Transplant: A Systematic Review

Wang

Lee

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

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.

show abstract

Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up

Cited by 13 publications

References 28 publications

The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation

The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation

Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis

Prognostic Factors to Determine Survivorship of Meniscal Allograft Transplant: A Systematic Review

Contact Info

Product

Resources

About