Nonextruded Grafts Result in Better Cartilage Quality After Lateral Meniscal Allograft Transplantation: Quantitative 3-T MRI T2 Mapping

Abstract

Background: Several studies have reported that graft extrusion after meniscal allograft transplantation (MAT) is associated with deterioration of surgical outcomes. However, no study has investigated the effect of graft extrusion on the articular cartilage using objective quantitative methods. Purpose/Hypothesis: This study aimed to investigate the influence of graft extrusion on the chondroprotective effect of lateral MAT on knee articular cartilage. We hypothesized that MAT without graft extrusion would result in better cartilage quality than MAT with graft extrusion. Study Design: Cohort study; Level of evidence, 3. Methods: Altogether, 105 patients who underwent isolated lateral MAT were divided into the extrusion and nonextrusion groups based on postoperative 3-month magnetic resonance imaging. Quantitative T2 mapping was performed on pre- and postoperative magnetic resonance imaging at midterm follow-up (mean ± SD, 3.2 ± 0.7 years). The weightbearing area of the femoral and tibial plateau articular cartilage was divided into 6 segments (F1, F2, F3, TP1, TP2, and TP3) from the anterior to posterior direction according to the meniscal coverage area. Each segment was further segmented into superficial and deep layers for zonal analysis. Longitudinal change in cartilage T2 value was compared between the groups. Lysholm scores were used to evaluate clinical function. Results: The mean T2 value of the nonextrusion group showed a significant improvement in 14 of 18 segments after lateral MAT, whereas the extrusion group demonstrated no statistically significant change. The biochemical properties of cartilage tissue as judged by quantitative T2 mapping indicated improvement in the nonextrusion group as compared with the extrusion group in the F2, TP2, and TP3 segments overall; the deep layers of the F1, F2, and TP2 segments; and the superficial layer of the TP3 segment ( P < .05). Conclusion: This study shows that the nonextruded graft results in better cartilage properties of the knee joint after lateral MAT as compared with the extruded graft at midterm follow-up.

The Principles of Knee Joint Preservation: Operative Treatment Strategies

“…Similarly, meniscal deficiency results in increased forces within the medial and/or lateral compartments 34 , thereby increasing risk of chondral injuries and early osteoarthritis 73,74 . This is evidenced further by studies that have demonstrated the chondroprotective effects of meniscal allograft transplantation as long as the graft is not extruded 75,76 .…”

Single‐incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation

“…Evaluation of allograft healing or failure following MAT is challenging because of the scarcity of research and consensus on this surgical approach [24]. Graft extrusion may be a potential indicator for assessing the prognosis after LMAT surgery [15, 18]. Moreover, the Stoller classification, a radiological finding, incorporates the histological integrity of the allograft based on postoperative MRI signal changes.…”

Effect of Injury to the Lateral Meniscotibial Ligament and Meniscofibular Ligament on Meniscal Extrusion: Biomechanical Evaluation of the Capsulodesis and Centralization Techniques in a Porcine Knee Model

“…14 Restoring the lost function caused by meniscal extrusion can delay osteoarthrosis progression 25 and/or lead to improvement of articular cartilage after a meniscal allograft transplantation. 13 After meniscal extrusion, the tibial cartilage receives all the load with the knee in extension. 10 Previous biomechanical studies on the medial meniscotibial ligament have determined that it contributes to meniscal stability.…”