Influence of Varus Alignment on Survivorship After Lateral Meniscal Allograft Transplantation

Song, Ju-Ho; Bin, Seong‐Il; Kim, Jong Min; Lee, Bum-Sik; Lee, Chang-Rack

doi:10.1177/0363546520914592

Cited by 11 publications

(6 citation statements)

References 22 publications

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“…Therefore, we think that alignment had little effect on survival rate and is a correctable factor. According to Song et al, 30 the results of lateral MAT were good when the varus was .3°. In medial MAT, the expected survival rate of the graft is higher with greater valgus alignment.…”

Section: Discussionmentioning

confidence: 92%

Effect of ICRS Lesion Grade on Graft Survival After Medial Meniscal Allograft Transplantation: MRI-Based Objective Evaluation

et al. 2022

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Background: Data are lacking regarding the survival rate after medial meniscal allograft transplantation (MAT) alone. Furthermore, little information is available about prognostic factors for graft survival that affect the outcomes of medial MAT. Purpose: To investigate the prognostic factors and survival rate of allograft after medial MAT. Study Design: Case-control study; Level of evidence, 3. Methods: The records of 78 consecutive patients who underwent primary medial MAT between 1996 and 2018 were reviewed. Kaplan-Meier survival analysis was performed to analyze the anatomic and clinical survival rates. Anatomic failure was defined as a tear covering >50% of the allograft or unstable peripheral rim. Clinical failure was considered Lysholm score <65 or need for additional surgery such as meniscal repair, revision MAT, realignment osteotomy, and meniscectomy for >50% of the allograft. Patient factors affecting anatomic and clinical failure were analyzed. Results: The mean follow-up period was 6.9 ± 5.3 years (range, 2-21 years). Anatomic failure was noted in 19 patients (24.4%), and none of these patients had a persistent poor Lysholm score of <65; of these, 2 patients who underwent meniscal repair also had clinical failure. Clinical failure was noted in 7 patients (9.0%); 4 patients had Lysholm score <65, 2 patients underwent meniscal repair, and 1 patient underwent realignment osteotomy. The estimated 10-year anatomic and clinical survival rates were 73.89% and 87.90%, respectively. Anatomic survival was significantly associated with only high-grade International Cartilage Regeneration & Joint Preservation (ICRS) lesion (ICRS grade 3 or 4) (hazard ratio, 3.171; 95% CI, 1.124-8.944; P = .029). However, the clinical survival rate was not significantly associated with any factors. Patients with low-grade ICRS lesion (ICRS grade 0, 1, or 2) showed a higher estimated 10-year anatomic survival rate compared with patients with high-grade ICRS lesions (87.6% vs 63.3%, respectively; P = .022). Conclusion: Low-grade ICRS lesion was associated with higher anatomic survival rate after medial MAT. In patients with high-grade ICRS lesions, the clinical outcome might be good; however, the status of an allograft might be poor. The surgeon should be aware of this and explain to the patient that close observation is necessary.

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Section: Discussionmentioning

confidence: 92%

Effect of ICRS Lesion Grade on Graft Survival After Medial Meniscal Allograft Transplantation: MRI-Based Objective Evaluation

et al. 2022

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“…This finding may be partially due to the observation that patients with malalignment may achieve higher PROs, as Verdonk et al described, and because they may have had lower baseline PROs, which we found decreases time to MCID achievement. 7,30 Higher age had a limited effect on the time to MCID achievement. This mixed report has also been reported in prior studies.…”

Section: Discussionmentioning

confidence: 99%

Time to Achieving Clinically Significant Outcomes After Meniscal Allograft Transplantation

et al. 2022

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Purpose To determine the time to achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient-reported outcome (PRO) measures and risk factors affecting achievement of clinically significant outcomes in patients undergoing meniscal allograft transplantation (MAT). Methods A prospectively maintained MAT registry was retrospectively reviewed from April 2014 to May 2019. Patients who underwent revision MAT or did not complete preoperative PROs or one post operative time point were excluded. Patients who underwent concomitant procedures were included in the analysis. PROs were administered preoperatively and at 6 months, 1 year, and 2 years postoperatively. Previously defined MCID and PASS thresholds were utilized and Kaplan-Meier survival curve analysis with interval censoring was used to calculate the cumulative percentages of MCID and PASS achievement at each follow-up time interval (5-7, 11-13, and 23-25 months). Results Eighty patients (age: 28.35 ± 9.76, 50% male) who completed preoperative, 6-month ( n = 69, 86% compliance), and 1-year ( n = 76, 95% compliance) PROs were included. The majority of patients (>50%) achieved MCID and PASS on most included PROs. Workers’ compensation status was found to significantly delay achievement of MCID and PASS on all PROs except for PASS on Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life (QoL). Higher body mass index (BMI) significantly delayed time to achieving MCID on KOOS Pain and activities of daily living (ADL), as well as PASS on KOOS Symptoms and KOOS QoL. Conclusion This study suggests that the majority of patients have clinically significant improvements in pain and function after MAT, with more than 50% of patients experiencing clinically significant improvement within the first postoperative year. Workers’ compensation status and high BMI may prolong time to achievement of MCID and PASS after MAT.

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“…Physically active patients with meniscus‐deficient knees were indicated for index surgery if they complained of persistent localised pain in the corresponding compartment [1]. Rosenberg view was used to verify if the joint space was preserved [17], after which MRI was performed to determine the cartilage status. International Cartilage Repair Society (ICRS) grade 3 or less as well as localised grade 4 defects confined to the area covered by the meniscus were considered acceptable indications.…”

Section: Methodsmentioning

confidence: 99%

Meniscal allograft transplantation shows a mismatch between anatomic and clinical failures

Song

Bin

Kim

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeClinical results of meniscal allograft transplantation (MAT) are not always consistent with graft status. This study aimed to investigate (1) the degree and pattern of mismatch between anatomic and clinical failures in MAT and (2) preoperative factors associated with the mismatch. MethodsTwo hundred and ninety‐eight consecutive patients who underwent primary medial or lateral MAT during 2004–2015 were reviewed. Anatomic failure was defined as an allograft showing meniscal tear involving > 50% of the graft or unstable peripheral rim. Clinical failure included poor Lysholm score of < 65 and any requirement for re‐operations such as arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (more than 50% of the graft or to the zone of meniscocapsular junction). Failure cases were categorised according to the type of failure as follows: (1) type 1, anatomic failure followed by clinical failure; (2) type 2, anatomic failure did not lead to clinical failure; and (3) type 3, clinical failure without anatomic failure. Preoperative factors including age, sex, body mass index, MAT compartment, time from previous meniscectomy, alignment, cartilage status, and accompanying procedures were analysed according to the failure type. ResultsForty (13.4%) patients showed anatomical or clinical failure during the median (25th–75th percentile) follow‐up duration of 47 (30–72) months (range 24–178 months). Eleven (3.7%) patients showed both anatomical and clinical failure (type 1 failure). Seventeen (5.7%) patients showed anatomic failure that did not lead to clinical failure (type 2 failure). Twelve (4.0%) patients failed clinically without meniscal tear (> 50% of graft) or unstable peripheral rim (type 3 failure). Comparative analyses among failure types found a significant difference in MAT compartment (p = 0.01). In particular, the incidence of type 3 failure was higher in medial than in lateral MAT (p = 0.003). ConclusionA notable number of failure cases of MAT showed a mismatch between anatomic and clinical failures. Even with anatomic failure, MAT did not always lead to poor clinical scores or re‐operations, whereas MAT could have poor results without substantial allograft problems. Therefore, both anatomic and clinical aspects should be considered when evaluating MAT. In particular, type 3 failure occurred more frequently in medial than in lateral MAT. Level of evidenceIII.

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Influence of Varus Alignment on Survivorship After Lateral Meniscal Allograft Transplantation

Cited by 11 publications

References 22 publications

Effect of ICRS Lesion Grade on Graft Survival After Medial Meniscal Allograft Transplantation: MRI-Based Objective Evaluation

Effect of ICRS Lesion Grade on Graft Survival After Medial Meniscal Allograft Transplantation: MRI-Based Objective Evaluation

Time to Achieving Clinically Significant Outcomes After Meniscal Allograft Transplantation

Meniscal allograft transplantation shows a mismatch between anatomic and clinical failures

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