Does Lateral Meniscal Allograft Transplantation Using the Keyhole Technique Restore the Anatomic Location of the Native Lateral Meniscus?

2016 ◽  
Vol 44 (7) ◽  
pp. 1744-1752 ◽  
Author(s):  
Nam-Ki Kim ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Chang-Rack Lee
Keyword(s):  
Relative Position ◽  
Sagittal Plane ◽  
Lateral Meniscus ◽  
Coronal Plane ◽  
Absolute Position ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
The Mean ◽  
The Absolute

Background: It is important to restore the normal anatomy of the native meniscus in meniscal allograft transplantation (MAT) for successful surgical results. Purpose/Hypothesis: The purpose of this study was to compare the anatomic positions of the anterior horn (AH) and posterior horn (PH) between the preoperative lateral meniscus and postoperative meniscal allograft after lateral MAT using the keyhole technique. We hypothesized that the keyhole technique could restore the preoperative anatomy of the native lateral meniscus. Study Design: Case series; Level of evidence, 4. Methods: Between December 2012 and December 2014, a total of 70 patients underwent lateral MAT using the keyhole technique. The anatomic positions of both horns of the native lateral meniscus and the meniscal allograft were measured on magnetic resonance imaging (MRI). Preoperative MRI was performed 1 day before lateral MAT, while postoperative MRI was performed 2 days after lateral MAT. A percentage reference method was used to measure the location of both horns. Results: For the AH, the mean delta value of the absolute position was 0.7 ± 1.8 mm (95% CI, 0.3-1.1 mm) in the coronal plane and 0.5 ± 1.6 mm (95% CI, 0.2-0.9 mm) in the sagittal plane, and the mean delta value of the relative position was 1.0% ± 2.3% (95% CI, 0.5%-1.6%) in the coronal plane and 1.1% ± 3.3% (95% CI, 0.2%-1.8%) in the sagittal plane. For the PH, the mean delta value of the absolute position was 2.4 ± 2.6 mm (95% CI, 1.8 to 3.1 mm) in the coronal plane and −0.1 ± 2.1 mm (95% CI, −0.6 to 0.4 mm) in the sagittal plane, and the mean delta value of the relative position was 3.3% ± 3.5% (95% CI, 2.5% to 4.2%) in the coronal plane and −0.3% ± 4.4% (95% CI, –1.3% to 0.8%) in the sagittal plane. Therefore, the AH moved by a mean of 0.7 mm laterally and 0.5 mm anteriorly (absolute values) and 1.0% laterally and 1.1% anteriorly (relative values) compared with the preoperative position. The PH moved by a mean of 2.4 mm laterally and 0.1 mm posteriorly (absolute values) and 3.3% laterally and 0.3% posteriorly (relative values) compared with the preoperative position. For the AH, the proportion of patients with an absolute delta value of ≥5 mm was 4.3% in the coronal plane and 2.9% in the sagittal plane. For the PH, the proportion of patients with an absolute delta value of ≥5 mm was 18.6% in the coronal plane and 4.3% in the sagittal plane. Conclusion: When comparing the position of the horns preoperatively and postoperatively, both horns showed mean relative postoperative positional changes of <5% of relative values and <5 mm of absolute values in both the coronal and sagittal planes. The keyhole technique in lateral MAT can reconstruct the lateral meniscus close to its native anatomic position by avoiding displacement of >5 mm in both the coronal and sagittal planes.

scholarly journals Progression of Allograft Extrusion in Both the Coronal and Sagittal Planes at Midterm Follow-up After Medial Meniscal Allograft Transplant

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097235
Author(s):  
Hanwook Kim ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Dong-Wook Sohn
Keyword(s):  
Sagittal Plane ◽  
Coronal Plane ◽  
Relative Percentage ◽  
Positive Correlation ◽  
Time Points ◽  
Axial Alignment ◽  
Meniscal Allograft ◽  
The Mean ◽  
The Absolute

Background: Although many studies have examined allograft extrusion after medial meniscal allograft transplant (MMAT), it is unclear whether allograft extrusion progresses at midterm follow-up. Hypothesis: After MMAT, allograft extrusion would not progress during the midterm follow-up period. Study Design: Case series; Level of evidence, 4. Methods: A total of 30 patients who underwent MMAT between December 1996 and March 2016 were enrolled. Allograft extrusion was measured on magnetic resonance imaging scans obtained at 6 weeks, 1 year, and 3 to 7 years postoperatively. In the coronal plane, the absolute allograft extrusion and relative percentage of extrusion were measured. In the sagittal plane, the absolute and relative anterior cartilage meniscal distance and posterior cartilage meniscal distance were measured. The joint-space width (JSW) on radiographic Rosenberg view was measured at 3 time points. The axial alignment was measured preoperatively and at the midterm follow-up. Results: In the coronal plane, there were no significant differences in absolute and relative coronal extrusions between 6 weeks and 1 year postoperatively; however, the values were significantly increased at midterm follow-up compared with both of the earlier follow-up periods. Similarly, in the sagittal plane, the mean absolute and relative anterior and posterior cartilage meniscal distances were not significantly different between 6 weeks and 1 year postoperatively but showed significant increases at midterm follow-up compared with both of the earlier follow-up periods. The mean preoperative axial alignment showed a positive correlation with the delta value of relative percentage of extrusion in the coronal plane ( r = 0.378; P = .036). The mean JSW was 4.42 ± 0.88 mm preoperatively, 4.30 ± 0.83 mm at 1-year follow-up, and 3.96 ± 1.06 mm at the midterm follow-up. No significant difference was found between the preoperative and postoperative 1-year values, but the mean JSW was significantly decreased at midterm follow-up compared with both of the other time points ( P = .001 for both). Conclusion: Allograft extrusion did not progress until 1 year after MMAT; however, by midterm follow-up, extrusion had progressed in both the coronal and the sagittal planes. Preoperative axial alignment showed a positive correlation with allograft extrusion in the coronal plane.

Meniscal Extrusion Does Not Progress During the Midterm Follow-up Period After Lateral Meniscal Transplantation

2016 ◽  
Vol 45 (4) ◽  
pp. 900-908 ◽  
Author(s):  
Nam-Ki Kim ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Chang-Rack Lee ◽  
Jae-Hyan Kim
Keyword(s):  
Sagittal Plane ◽  
Lysholm Score ◽  
Coronal Plane ◽  
Meniscal Extrusion ◽  
Time Points ◽  
Meniscal Allograft ◽  
Significant Difference ◽  
The Mean ◽  
The Absolute

Background: Meniscal extrusion is related to degeneration of the native knee joint. However, the clinical effect of the phenomenon after meniscal allograft transplantation (MAT) has not been clearly identified. Purpose/Hypothesis: The purpose of this study was to evaluate the change in meniscal extrusion in both the coronal and sagittal planes after lateral MAT through the midterm follow-up period. We hypothesized that meniscal extrusion does not progress during the midterm follow-up period. Study Design: Case series; Level of evidence, 4. Methods: A total of 46 patients with a mean follow-up of 51.1 ± 7.1 months were included in the study. The patients underwent lateral MAT using the keyhole technique. Postoperative magnetic resonance imaging (MRI) was performed at 6-week, 1-year, and midterm (3- to 5-year) follow-up. In the coronal plane, the absolute value of meniscal subluxation and the relative percentage of extrusion (RPE) were measured. In the sagittal plane, meniscal subluxation was measured as the absolute and relative anterior cartilage meniscal distance (ACMD) and posterior cartilage meniscal distance (PCMD). The joint-space width (JSW) on weightbearing radiographs with 2 different knee positions was measured preoperatively and at 1-year and midterm follow-up. The Lysholm score was assessed at the same time points. Results: In the coronal plane, the mean absolute meniscal extrusion at 6-week, 1-year, and final follow-up was 2.90 ± 0.94, 2.85 ± 0.97, and 2.83 ± 0.89 mm, respectively, and the mean RPE was 27.0% ± 9.4%, 27.1% ± 10.1%, and 27.8% ± 9.7%, respectively. There were no statistically significant differences in absolute and relative coronal extrusion among the 3 time periods ( P > .05). The percentage of patients with meniscal extrusion (≥3 mm) was 37.0% at 6-week follow-up and 34.8% at 1-year and final follow-up. In the sagittal plane, the mean absolute ACMD was 2.59 ± 1.75, 2.58 ± 1.85, and 2.37 ± 1.60 mm, respectively, and the mean relative ACMD was 20.7% ± 13.1%, 20.6% ± 13.8%, and 19.0% ± 12.2%, respectively, at the 3 follow-up time points. The mean absolute PCMD was −1.23 ± 3.34, −1.28 ± 3.08, and −1.42 ± 2.77 mm, respectively, and the mean relative PCMD was −10.3% ± 25.9%, −11.0% ± 24.6%, and −12.2% ± 23.2%, respectively, at the same time points. Sagittal extrusion was not significantly different between the time points ( P > .05). The mean JSW at 2 days preoperatively, 1 year postoperatively, and midterm follow-up was 5.40 ± 1.07, 5.44 ± 1.04, and 5.43 ± 0.98 mm, respectively, on anterior-posterior radiographs with full extension, and it was 4.90 ± 0.94, 4.94 ± 0.98, and 4.89 ± 0.96 mm, respectively, on posterior-anterior radiographs with 45° of flexion. The mean JSW values were not significantly different between the 3 different time points ( P > .05). The mean preoperative Lysholm score was 58. 9 ± 8.3; the score increased to 90.4 ± 9.7 at 1 year postoperatively and 90.5 ± 10.1 at final follow-up, which is a significant improvement compared with the preoperative status ( P < .05). There was no statistically significant difference between the scores at the 2 postoperative time points ( P > .05). Conclusion: This study demonstrated that extrusion of the meniscal allograft did not significantly progress either in the coronal or sagittal plane after lateral MAT during the midterm follow-up period.

Importance of Independent Measurement of Width and Length of Lateral Meniscus During Preoperative Sizing for Meniscal Allograft Transplantation

2011 ◽  
Vol 39 (7) ◽  
pp. 1541-1547 ◽  
Author(s):  
Jung-Ro Yoon ◽  
Taik-Sun Kim ◽  
Joon-Ho Wang ◽  
Ho-Hyun Yun ◽  
Hyungtae Lim ◽  
...  
Keyword(s):  
Lateral Meniscus ◽  
Meniscal Allograft Transplantation ◽  
Independent Measurement ◽  
Allograft Transplantation ◽  
Meniscal Allograft

scholarly journals Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711881846 ◽  
Author(s):  
Joseph N. Liu ◽  
Anirudh K. Gowd ◽  
Michael L. Redondo ◽  
David R. Christian ◽  
Brandon C. Cabarcas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Lysholm Score ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Patient Reported ◽  
The Mean ◽  
Clinically Significant

Background: Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery. Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS. Results: A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m2. The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A ), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL). Conclusion: This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers’ compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT.

Absolute Meniscal Extrusion After Lateral Meniscal Allograft Transplantation Does Not Progress During Long-term Follow-up: Average of 10.3 Years’ Follow-up Longitudinal Magnetic Resonance Imaging Study

2019 ◽  
Vol 48 (2) ◽  
pp. 326-333 ◽  
Author(s):  
Sang-Min Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Jun-Gu Park
Keyword(s):  
Sagittal Plane ◽  
Coronal Plane ◽  
Meniscal Extrusion ◽  
Meniscal Allograft ◽  
Long Term Follow Up ◽  
The Mean ◽  
Width Reduction ◽  
Time Point

Background: Long-term outcomes after lateral meniscal allograft transplantation (MAT) are not completely understood. Purpose/Hypothesis: We investigated changes in meniscal extrusion in the coronal and sagittal planes using magnetic resonance imaging (MRI) after lateral MAT through long-term follow-up. We hypothesized that meniscal extrusion would progress during follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients subjected to lateral MAT were followed up by MRI evaluation in both planes at 1, 4 to 6, and >8 years after MAT. Meniscal extrusion and entire meniscal widths in the coronal plane and anterior (ACMD) and posterior (PCMD) cartilage meniscal distances in the sagittal plane were measured, and values were compared at each time point. Clinical outcomes were evaluated using the Lysholm score. Results: A total of 27 lateral MATs were included with a mean MRI follow-up period of 10.3 years (range, 8.1-15.3 years). The mean absolute meniscal extrusion (coronal plane) was not significantly different at each time point. However, the relative value differed (0.27 ± 0.04 at 1 year; 0.33 ± 0.06 at >8 years after MAT) owing to entire meniscal width reduction. There was no difference in the mean absolute value of the ACMD in the sagittal plane. However, relative values differed (0.21 ± 0.01 at 1 year; 0.27 ± 0.06 at >8 years) owing to entire meniscal width reduction. Absolute and relative values of the PCMD remained unaffected at each time point. The Lysholm score increased after surgery but did not differ postoperatively. Conclusion: During the long-term follow-up of extrusion after lateral MAT using MRI, absolute extrusion remained unchanged across all planes. Relative extrusion in the coronal plane and of the ACMD in the sagittal plane significantly increased, with no differences in the PCMD on follow-up. Clinical outcomes after surgery improved compared with those before surgery and were maintained throughout the long-term follow-up period.

The Kaplan Fibers of the Iliotibial Band Can Be Identified on Routine Knee Magnetic Resonance Imaging

2019 ◽  
Vol 47 (12) ◽  
pp. 2895-2903 ◽  
Author(s):  
Lachlan Batty ◽  
Jerome Murgier ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
Julian A. Feller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Joint Line ◽  
Coronal Plane ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Lateral Gastrocnemius ◽  
The Mean

Background: The Kaplan fibers (KFs) of the iliotibial band have been suggested to play a role in anterolateral rotational instability of the knee, particularly in the setting of an anterior cruciate ligament (ACL) rupture. Description of the normal magnetic resonance imaging (MRI) anatomy of the KFs may facilitate subsequent investigation into the MRI signs of injury. Purpose: To assess if the KF complex can be identified on 3-T MRI using standard knee protocols. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: 3-T MRI scans of 50 ACL-intact knees were reviewed independently by a musculoskeletal radiologist and 2 orthopaedic surgeons. Identification of the KFs was based on radiological diagnostic criteria developed a priori. Identification of the KFs in the sagittal, coronal, and axial planes was recorded. Interobserver reliability was assessed using the Kappa statistic. Detailed anatomy including distance to the joint line and relationship to adjacent structures was recorded. Results: The mean patient age was 43 years (range, 15-81 years), 58% were male, and 50% were right knees. The KFs were identified by at least 2 reviewers on the sagittal images in 96% of cases, on the axial images in 76% of cases, and on the coronal images in 4% of cases. The mean distance from the KF distal femoral insertion to the lateral joint line was 50.1 mm (SD, 6.6 mm) and the mean distance to the lateral gastrocnemius tendon origin was 10.8 mm (SD, 8.6 mm). The KFs were consistently identified immediately anterior to the superior lateral geniculate artery on sagittal imaging. Interobserver reliability for identification was best in the sagittal plane (Kappa 0.5) and worst in the coronal plane (Kappa 0.1). Conclusion: The KF complex can be identified on routine MRI sequences in the ACL-intact knee; however, there is low to moderate interobserver reliability. Imaging in the sagittal plane had the highest rate of identification and the coronal plane the lowest. There is a consistent relationship between the most distal KF femoral attachment and the lateral joint line, lateral gastrocnemius tendon, and superior lateral geniculate artery.

Meniscal Deficiency Period and High Body Mass Index Are Preoperative Risk Factors for Joint Space Narrowing After Meniscal Allograft Transplantation

2021 ◽  
Vol 49 (3) ◽  
pp. 693-699
Author(s):  
Sang-Min Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Kuen Tak Suh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Condyle ◽  
Joint Space ◽  
Preoperative Risk ◽  
Meniscal Allograft Transplantation ◽  
Time Points ◽  
Allograft Transplantation ◽  
Preoperative Risk Factors ◽  
Meniscal Allograft ◽  
The Difference

Background: Several studies have reported further reduction in joint space width (JSW) after meniscal allograft transplantation; some contributing postoperative factors are known, although preoperative factors remain unclear. This study is the first to analyze the preoperative risk factors for reduced JSW in patients after lateral meniscal allograft transplantation (LMAT). Hypothesis: Poor cartilage status and high preoperative body mass index (BMI) influence the postoperative progression of joint space narrowing. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively studied 79 patients after LMAT who were observed for at least 5 years. JSWs on weightbearing flexion posteroanterior radiographs were measured preoperatively and at the 5-year mark. Differences in JSW were divided into more progression and less progression groups. The modified Outerbridge cartilage grades based on magnetic resonance imaging assessments were compared at subtotal/total meniscectomy and at LMAT to determine the difference between time points. Preoperative between-group differences in sex, age, surgical side, follow-up period, weight, height, BMI, and meniscal deficiency period were analyzed. Clinical outcomes were evaluated using the Lysholm score. Data were examined using univariate and multivariate logistic regressions. Results: Radiographically, the overall change in JSW from preoperative to follow-up was 0.58 mm (range, –0.23 to 1.83 mm). Reductions in JSW in the more progression and less progression groups were 0.94 ± 0.32 and 0.22 ± 0.21 mm (mean ± SD), respectively. There was no difference in cartilage status between the groups at meniscectomy or LMAT; however, changes between time points were significant on the lateral femoral condyle and lateral tibial plateau. Clinically, there were significant differences in weight, BMI, and meniscal deficiency period between the 2 groups. Postoperative Lysholm scores increased as compared with the preoperative scores, but there was no difference among the postoperative time points. In the univariate logistic regression risk analysis, weight, BMI, meniscal deficiency period, and the difference in cartilage status between time points for the lateral femoral condyle and lateral tibial plateau were identified as significant. In the subsequent multivariate logistic regression, BMI (odds ratio, 1.45; P = .016) and meniscal deficiency period (odds ratio, 1.21; P = .037) were the statistically significant factors. Conclusion: BMI and meniscal deficiency period were preoperative risk factors for JSW narrowing after LMAT. This suggests that the meniscal deficiency period from meniscectomy to LMAT may be shortened and that proper weight management can lead to successful LMAT.

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