J Korean Orthop Assoc.  2016 Oct;51(5):387-394. 10.4055/jkoa.2016.51.5.387.

Clinical and Radiological Short-Term Results after Meniscal Allograft

• Lee YK
• Kwak WS
• Lee JH
• Cho HK
• Kim HJ
• Bae KC

• KMID: 2355503
• DOI: http://doi.org/10.4055/jkoa.2016.51.5.387

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical and radiological results after meniscal allograft transplantation (MAT).
MATERIALS AND METHODS
From October, 2010 to August, 2013, 45 patients, 47 cases who underwent MAT were reviewed. The mean age was 39.9 years and the mean follow-up period was 24.9 months. The clinical results were evaluated using Lysholm score and International Knee Documentation Committee (IKDC) score. All cases were evaluated by serial postoperative radiograph. And 18 cases were performed postoperative magnetic resonance imaging (MRI). Eighteen cases including the 13 cases that had graft dislocation or subluxation and signal changes in MRI underwent second-look arthroscopy.
RESULTS
Lysholm score was elevated from mean 58.4 at preoperative to 92.4 at last follow-up. IKDC score was elevated from mean 50.3 at preoperative to 90.1 at last follow-up. Among the 18 cases who underwent postoperative MRI, subluxation was found in 10 cases (55.6%) and graft dislocation with grade III signal change was found in 3 cases (16.7%). However, the 13 cases showed a well healed state of the graft capsule in second-look arthroscopy. There was no joint space narrowing on radiograph during the follow-up period.
CONCLUSION
After MAT, 93.6% of cases showed improved the clinical results above good. Thus, it is effective in relatively young and active patients with meniscus functional deficit and minor meniscal degeneration.

Keyword

meniscus; allograft transplantation; second-look arthroscopy; magnetic resonance imaging

MeSH Terms

Allografts*
Arthroscopy
Dislocations
Follow-Up Studies
Humans
Joints
Knee
Magnetic Resonance Imaging
Transplants

Figure

• 

  Figure 1 (A) High skin incision on arthroscopic portal for good viewing. (B) Preservation of anterior meniscus peripheral rim for stable graft suture.

• 

  Figure 2 (A) Intraoperative finding of meniscal allograft transplantation (MAT), All inside suture of anteromedial corner. (B) Intraoperative finding of MAT, posterior compartment.

• 

  Figure 3 Lateral subluxation after lateral meniscal allograft on follow-up magnetic resonance imaging.

• 

  Figure 4 Flow diagram. MRI, magnetic resonance imaging.

• 

  Figure 5 Well healed graft on 2nd look arthroscopy.

• 

  Figure 6 Comparison of clinical results between patients with lateral (n=35) and medial (n=11) lesions. IKDC, International Knee Documentation Committee.

Reference

1. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand. 1980; 51:871–879.

2. Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res. 1980; 149:283–290.

3. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64:883–888.

4. Renström P, Johnson RJ. Anatomy and biomechanics of the menisci. Clin Sports Med. 1990; 9:523–538.

5. Voloshin AS, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng. 1983; 5:157–161.

6. Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Relat Res. 1975; 109:184–192.

7. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. Factors effecting late results after meniscectomy. J Bone Joint Surg Am. 1974; 56:719–729.

8. Milachowski KA, Weismeier K, Wirth CJ. Homologous meniscus transplantation. Experimental and clinical results. Int Orthop. 1989; 13:1–11.

9. Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F. Meniscal allograft transplantation. Two- to eight-year results. Am J Sports Med. 2001; 29:410–414.

10. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948; 30:664–670.

11. Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP. Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med. 1995; 23:240–244.

12. Schimmer RC, Brülhart KB, Duff C, Glinz W. Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course. Arthroscopy. 1998; 14:136–142.

13. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. Clinical outcomes following isolated lateral meniscal allograft transplantation. Arthroscopy. 2006; 22:771–780.

14. Lee DH, Kim SB, Kim TH, Cha EJ, Bin SI. Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med. 2010; 38:247–254.

15. Vundelinckx B, Vanlauwe J, Bellemans J. Long-term subjective, clinical, and radiographic outcome evaluation of meniscal allograft transplantation in the knee. Am J Sports Med. 2014; 42:1592–1599.

16. Garrett JC. Meniscal transplantation. Am J Knee Surg. 1996; 9:32–34.

17. Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL. Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients. Arthroscopy. 2000; 16:343–347.

18. Rodeo SA. Meniscal allografts: where do we stand? Am J Sports Med. 2001; 29:246–261.

19. Samitier G, Alentorn-Geli E, Taylor DC, et al. Meniscal allograft transplantation. Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015; 23:323–333.

20. Shelton WR, Dukes AD. Meniscus replacement with bone anchors: a surgical technique. Arthroscopy. 1994; 10:324–327.

21. Wilcox TR, Goble EM, Doucette SA. Goble technique of meniscus transplantation. Am J Knee Surg. 1996; 9:37–42.

22. Cole BJ, Carter TR, Rodeo SA. Allograft meniscal transplantation: background, techniques, and results. Instr Course Lect. 2003; 52:383–396.

23. Lanzer WL, Komenda G. Changes in articular cartilage after meniscectomy. Clin Orthop Relat Res. 1990; 252:41–48.

24. Verdonk P, Depaepe Y, Desmyter S, et al. Normal and transplanted lateral knee menisci: evaluation of extrusion using magnetic resonance imaging and ultrasound. Knee Surg Sports Traumatol Arthrosc. 2004; 12:411–419.

25. Verstraete KL, Verdonk R, Lootens T, Verstraete P, De Rooy J, Kunnen M. Current status and imaging of allograft meniscal transplantation. Eur J Radiol. 1997; 26:16–22.

26. Cho SH, Kim JG. Clinical evaluation using MRI and Arthroscopy after meniscal transplantation. J Korean Orthop Assoc. 2007; 42:77–83.

27. Cho SM, Yoon KH, Lee JH, Bae DK, Song SJ, Kang MC. The clinical results of meniscus allograft transplantation: comparison between medial, lateral, isolated and combined procedure groups. J Korean Arthrosc Soc. 2009; 13:28–33.

28. Choi CH, Choi YJ. Outcomes of meniscal allograft transplantation. J Korean Arthrosc Soc. 2011; 15:36–41.