Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations

Abstract

Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts were transplanted. Eleven of the medial allograft procedures were associated with a high tibial osteotomy. The patients were evaluated clinically at the time of transplantation and at the final follow-up using the modified HSS scoring system. The knee injury and osteoarthritis outcome score (KOOS) was used as an evaluation tool for patient-related outcome at the final follow-up. Joint space width narrowing and Fairbank changes were radiological outcome parameters, which were available for 32 patients. Femoral and tibial cartilage degeneration, graft extrusion and signal intensity were scored on MRI scans obtained in 17 patients approximately 1 year after transplantation and at the final follow-up (>10 years). For statistical analysis the patients were divided into three groups: lateral meniscal allograft (LMT), medial meniscal allograft transplantation with a high tibial osteotomy (MMT+HTO) and without (MMT). The modified HSS score revealed a significant improvement in pain and function at the final follow-up for all groups. Further analysis also revealed that an MMT+HTO procedure resulted in a greater improvement at the final follow-up when compared to MMT. Nonetheless, the KOOS scores obtained at the final follow-up revealed the presence of substantial disability and symptoms, in addition to a reduced quality of life. Radiographical analysis revealed no further joint space narrowing in 13/32 knees (41%). Fairbank changes remained stable in 9/32 knees (28%). MRI analysis showed no progression of cartilage degeneration in 6/17 knees (35%). An increased signal intensity of the allograft was present, as was partial graft extrusion in the majority of patients at the final follow-up. Seven cases had to be converted to a total knee arthroplasty during the follow-up; the overall failure rate was 18%. Long-term results after viable meniscus allograft transplantation are encouraging in terms of pain relief and improvement of function. Despite this significant improvement, substantial disability and symptoms were present in all investigated subgroups. Progression of further cartilage degeneration or joint space narrowing was absent in a considerable number of cases, indicating a potential chondroprotective effect. Level of evidence is therapeutic study, Level IV and retrospective analysis of prospectively collected data.

O papel do adesivo de fibrina e da sutura na fixação do transplante de menisco preservado por ultracongelamento em coelhos

“…A fixação do menisco ao receptor pode ser realizada por uma variedade de técnicas operatórias; desde a sutura do corpo e cornos meniscais aos tecidos moles ou por meio da fixação óssea por túneis no platô tibial com ou sem bloco ósseo, mas sempre associado à fixação do menisco na membrana sinovial adjacente (2,5,6,18,12,27) . Independente da cirurgia aberta ou videoassistida, as técnicas são trabalhosas e demandam um tempo operatório considerável para sua consecução.…”

“…A reposição do menisco lesado por outro homólogo é uma proposição testada há décadas; contudo, alguns aspectos do procedimento ainda são controversos e merecem a atenção dos pesquisadores. A fixação do menisco apresenta um grau de dificuldade técnica que é um fator de limitação importante do procedimento, principalmente após o advento da cirurgia videoassistida (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) . Nesse contexto, o uso de uma substância adesiva que possa fixar o menisco transplantado seria um avanço na diminuição do tempo do procedimento, na facilidade de sua realização e na recuperação do paciente (21) .…”

Meniscal Allograft Transplantation: Where are we Standing?

“…The factors potentially related to graft extrusion include, but not limited to, fixation method (bone fixation less extrusion than suture fixation) [45], type of allograft (medial allograft more extrusion than lateral allograft) [41], area of the meniscus (anterior horn and body more extrusion than posterior horn) [31,42], and graft sizing method [42,43]. Despite the high incidence of meniscal allograft extrusion, this complication has not been clearly related to worsening of clinical, functional, and radiographic outcomes [41,[43][44][45][46][47].…”

“…There are also several studies employing osteotomy as combined procedure to MAT [6,7,9]. Essentially, pain relief, clinical and functional outcomes are not worsened by the addition of femoral/tibial osteotomy to MAT [10,11,34,47,60,74]. The presented evidence suggests that MAT can be associated with any needed additional procedure without high risk of worst results.…”

“…Studies with the longest follow-up focus on progression of radiological changes in the affected knee. These studies found a range from progression observed in all treated cases when using lyophilized and deep-frozen grafts [79], to progression evidenced in 59% of the cases with use of cultured viable grafts [47]. Verdonk et al wrote that surgeons may expect a chondroprotective effect of MAT in about 30% of patients [9], but this has to be further investigated in the coming years.…”