Nonanatomic Horn Position Increases Risk of Early Graft Failures After Lateral Meniscal Allograft Transplantation

Kim, Jae Hyan; Bin, Seong‐Il; Lee, Bum-Sik; Kim, Jong Min; Kim, Nam-Ki; Lee, Chang-Rack; Han, Geun-Won

doi:10.1177/0363546518802226

Cited by 17 publications

(33 citation statements)

References 32 publications

(42 reference statements)

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“…9,26,28 But these studies were performed with static and quasi-static loading conditions, which cannot capture the multidirectional forces applied across the knee joint during activities of daily living. It has been further suggested that meniscal allograft keyhole fixation, which maintains relative root positions, may allow the graft to better resist hoop stresses and result in less extrusion of the body of the meniscus 16,17 ; however, these concepts have not been explored biomechanically. Our team previously developed a dynamic model capable of simulating activities of daily living 5,13 and demonstrated that transosseous fixation of medial meniscal allografts provides superior load distribution as compared with sutureonly fixation, particularly during the early stance phase of gait.…”

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confidence: 99%

Lateral Meniscal Graft Transplantation: Effect of Fixation Method on Joint Contact Mechanics During Simulated Gait

et al. 2019

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Background: Controversy exists regarding the optimal bony fixation technique for lateral meniscal allografts. Purpose/Hypothesis: The objective was to quantify knee joint contact mechanics across the lateral plateau for keyhole and bone plug meniscal allograft transplant fixation techniques throughout simulated gait. It was hypothesized that both methods of fixation would improve contact mechanics relative to the meniscectomized condition, while keyhole fixation would restore the distribution of contact stress closer to that of the intact knee. Study Design: Controlled laboratory study. Methods: Six human cadaveric knees were mounted on a multidirectional dynamic simulator and subjected to the following conditions: (1) native intact meniscus, (2) keyhole fixation of the native meniscus, (3) bone plug fixation of the native meniscus, and (4) meniscectomy. Contact area, peak contact stress, and the distribution of stress across the tibial plateau were computed at 14% and 45% of the gait cycle, at which axial forces are at their highest. Translation of the weighted center of contact stress throughout simulated gait was computed. Results: Both bony fixation techniques improved contact mechanics relative to the meniscectomized condition. The keyhole technique was not significantly different from the intact condition for the following metrics: contact area, peak contact stress, distribution of force between the meniscal footprint and cartilage-to-cartilage contact, and the position of the weighted center of contact. In contrast, bone plug fixation resulted in a significant decrease of 21% to 28% in contact area at 14% and 45% of the simulated gait cycle, a significant increase in peak contact stresses of 34% at 45% of the gait cycle, and a shift in the weighted center of contact, which increased forces in the cartilage-to-cartilage contact area at 45% of the gait cycle. Conclusion: While both keyhole and bone plug fixation methods improved lateral compartment contact mechanics relative to the meniscectomized knee, keyhole fixation restored contact mechanics closer to that of the intact knee. Clinical Relevance: Method of meniscal fixation is under the direct control of the surgeon. From a biomechanics perspective, keyhole fixation is advocated for its ability to mimic intact knee joint contact mechanics.

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confidence: 99%

Lateral Meniscal Graft Transplantation: Effect of Fixation Method on Joint Contact Mechanics During Simulated Gait

et al. 2019

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“…We noted considerable methodologic heterogeneity among the studies. We found that 5 studies 20,28,29,37,40 considered age as a binary variable with different cutoff points, whereas 3 studies 15,18,42 considered age as a continuous variable. A total of 3 studies 18,30,40 controlled confounding factors and concluded that older age had a negative effect on MAT survivorship, whereas 4 studies 20,28,29,42 reported no association between age and MAT failure, none of which excluded confounding factors.…”

Section: Discussionmentioning

confidence: 94%

“…Factors included nonanatomic versus anatomic horn position placement, suture fixation of soft tissue only versus bony plug fixation, and low-volume surgeons. 2,15,42 Graft Factors. Limited evidence was found that graft factors such as allograft sizing (undersizing vs matched sizing vs oversizing), 36 sterilization technique (none vs Bio-Cleanse; RTI Surgical), 29 and graft preservation method (fresh-frozen vs viable allograft) 40 affected outcomes.…”

Section: The Orthopaedic Journal Of Sports Medicinementioning

confidence: 99%

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

Wang

Lee

et al. 2021

Orthopaedic Journal of Sports Medicine

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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.

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“…Several studies have identified alignment as a covariate in assessing outcomes of MAT. Those studies handled alignment in MAT as a continuous variable, 1,4,9,21 which only works when alignment affects the outcomes of MAT in a linear fashion. However, if varus alignment has a positive effect on the outcomes, this does not necessarily mean that valgus alignment should negatively affect the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Influence of Varus Alignment on Survivorship After Lateral Meniscal Allograft Transplantation

et al. 2020

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Background: Factors associated with graft survival after lateral meniscal allograft transplantation (MAT) have not been fully determined, and survival analysis focused on effect of varus alignment has not been performed. Hypothesis: Varus alignment of the knee leads to better graft survival and clinical outcomes after lateral MAT than normal alignment. Study Design: Cohort study; Level of evidence, 2. Methods: The records of 204 consecutive patients who underwent lateral MAT were reviewed. After exclusion of cases undergoing revision MAT, cases without hip-knee-ankle standing radiographs, and cases with valgus alignment, the patients were categorized into 2 groups, those with normal alignment within −3° to 3° of the mechanical axis and those with varus alignment >3°. Cumulative graft survival rates were compared in the 2 groups before and after controlling for other covariates, including sex, age, body mass index (BMI), time from meniscectomy, the number of accompanying procedures, and cartilage status. Failure was defined as (1) a graft tear involving >50% or unstable peripheral rim of the allograft; (2) a Lysholm score <65 that was not improved afterward; (3) meniscectomy >50% or to the zone of meniscocapsular junction; or (4) conversion to revision MAT, realignment osteotomy, or arthroplasty. Clinical outcomes were compared between the 2 groups by Lysholm score. Results: Of the 190 patients, 149 showed normal alignment of 0.3° ± 1.3° (range, –3° to 3°) and 41 showed varus alignment of 4.8° ± 0.6° (range, 4°-8°). A total of 22 patients (11.6%) experienced MAT failure: 21 patients with normal alignment and 1 with varus alignment. Kaplan-Meier survival analysis showed a significant difference in the cumulative graft survival rates between the 2 groups (log-rank test, P = .001). After controlling for age, sex, BMI, time from meniscectomy, the number of accompanying procedures, and cartilage status, varus alignment was found to be a significant protective factor ( P = .004). On the other hand, there was no difference in clinical improvement measured by the Lysholm score between the 2 groups ( P = .651). Conclusion: Varus alignment was associated with better graft survival after lateral MAT than normal alignment. However, no significant differences in clinical outcomes were observed.

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Nonanatomic Horn Position Increases Risk of Early Graft Failures After Lateral Meniscal Allograft Transplantation

Cited by 17 publications

References 32 publications

Lateral Meniscal Graft Transplantation: Effect of Fixation Method on Joint Contact Mechanics During Simulated Gait

Lateral Meniscal Graft Transplantation: Effect of Fixation Method on Joint Contact Mechanics During Simulated Gait

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

Influence of Varus Alignment on Survivorship After Lateral Meniscal Allograft Transplantation

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