Delayed Rehabilitation After Lateral Meniscal Allograft Transplantation Can Reduce Graft Extrusion Compared With Standard Rehabilitation

2018 ◽  
Vol 46 (10) ◽  
pp. 2432-2440 ◽  
Author(s):  
Dhong Won Lee ◽  
Ji Hwan Lee ◽  
Du Han Kim ◽  
Jin Goo Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Clinical Outcomes ◽  
Joint Space ◽  
Resonance Imaging ◽  
Meniscal Allograft Transplantation ◽  
Meniscal Allograft ◽  
Rehabilitation Protocols ◽  
Graft Extrusion ◽  
Outerbridge Grade ◽  
Group D

Background: Meniscal extrusion prevention would be important for restoring normal knee kinematics, even though the effect of graft extrusion after meniscal allograft transplantation (MAT) has not been clearly identified. Hypothesis: When compared with standard rehabilitation protocols, delayed rehabilitation after lateral MAT could reduce graft extrusion. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 53 patients who underwent lateral MAT with the keyhole technique from June 2011 to March 2015 were included. Graft extrusion and lateral compartment articular cartilage loss on magnetic resonance imaging, joint space width (JSW) on weightbearing radiographs, and clinical outcomes (including subjective scores and functional tests) of 25 patients who underwent standard rehabilitation (group S) after lateral MAT were compared with those of 28 patients who underwent delayed rehabilitation (group D), which included immobilization during the first 3 weeks and use of unloading braces for 9 weeks. Results: Mean ± SD follow-up times for groups S and D were 25.7 ± 6.4 and 24.5 ± 7.1 months, respectively. Although the postoperative clinical outcomes did not differ between the groups, graft extrusion (3.2 ± 1.5 mm vs 1.8 ± 1.6 mm) and relative percentage of extrusion (32.2% ± 14.6% vs 17.3% ± 16.6%) were greater in group S than in group D ( P < .001 for both). The percentage of patients with graft extrusion (≥3 mm) was 52% in group S and 21.4% in group D. JSWs on Rosenberg view decreased by 0.1 mm in group S but increased by 0.3 mm in group D ( P = .035). Kellgren-Lawrence grade and modified Outerbridge grade progressed by 44% and 44% among patients in group S and by 17.9% and 21.4% among patients in group D, respectively. There were significant correlations between the coronal graft extrusion and postoperative JSWs on full extension (–0.452) and Rosenberg (–0.410) views, Kellgren-Lawrence grade (0.727), and modified Outerbridge grade (0.732) on magnetic resonance imaging ( P < .001 for all). Conclusion: Compared with standard rehabilitation, delayed rehabilitation showed less coronal graft extrusion and joint space narrowing on weightbearing and reduced the progression of arthrosis, although the rehabilitation protocols showed no differences in clinical outcomes.

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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