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.

scholarly journals The Results of Meniscal Allograft Transplantation Surgery: What is Success?

2019 ◽  
Author(s):  
Henry Kelvin Christopher Searle ◽  
Vipin Asopa ◽  
Simon Coleman ◽  
Ian McDermott
Keyword(s):  
Risk Factors ◽  
Outcome Measures ◽  
Return To Sport ◽  
Complication Rates ◽  
Clinical Failure ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Patient Reported ◽  
Surgical Failure

Abstract Background : Meniscal allograft transplantation (MAT) may improve symptoms and function, and limit premature knee degeneration in patients under 50 years with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the potential definitions of ‘success' or ‘failure’. Methods : 60 patients who underwent MAT between 2008-2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm <65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistical analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure. Results : 43 patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again. Conclusions: None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between ‘clinical failure’ and ‘surgical failure’ means these terms may need re-defining using a bespoke MAT scoring system.

Long-term Outcomes of Meniscal Allograft Transplantation With and Without Extrusion: Mean 12.3-Year Follow-up Study

2019 ◽  
Vol 47 (4) ◽  
pp. 815-821 ◽  
Author(s):  
Sang-Min Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Chang-Rack Lee ◽  
...  
Keyword(s):  
Joint Space Width ◽  
Long Term Effects ◽  
Meniscal Allograft Transplantation ◽  
Level Of Evidence ◽  
Time Points ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Long Term Follow Up

Background: Meniscal allograft transplantation (MAT) is a widely performed surgical technique used to reconstruct meniscal deficiencies after meniscectomy. However, the long-term effects of extrusion on clinical and radiologic outcomes are unclear. Hypothesis: In long-term follow-up, extrusion after MAT would show poorer outcomes than nonextrusion and would lead to faster progression of arthritic changes. Study Design: Cohort study; Level of evidence, 3. Methods: Forty-five MAT cases (lateral, n = 36; medial meniscal, n = 9) with a minimum 8-year follow-up period were selected. The mean follow-up period was 12.3 years (range, 8.0-19.6 years). Data were collected on patients’ sex, age, surgical side, and mechanical axis deviation. Patients were categorized into 2 groups: extrusion (≥3 mm) and nonextrusion (<3 mm). Categories were based on extrusion length measured via magnetic resonance imaging taken 1 year after surgery. Joint space width (JSW) on the affected and contralateral sides was measured on bilateral weightbearing posterior-anterior radiographs at 45° of flexion at 3 time points (preoperative, 4-6 years postoperative, and >8 years postoperative). Differences of the measured and relative JSW values between the groups and differences at different time points were analyzed. The Lysholm score was used to evaluate clinical function. Results: Mean ± SD extrusion was 3.07 ± 0.82 mm. The extrusion and nonextrusion groups were composed of 19 (42.2%) and 26 (57.8%) patients, respectively. Analysis of JSW showed a difference in relative JSW between the groups at >8 years ( P = .017). At the point of transition from 4 to 6 years to >8 years, the differences in absolute JSW values were −1.25 ± 0.78 mm (extrusion group) and −0.58 ± 0.66 mm (nonextrusion group; P < .001). Relative JSW values also differed between groups (extrusion group, −0.22 ± 0.13; nonextrusion group, −0.04 ± 0.18; P < .001). No differences were observed in the Lysholm scores between the groups at each time point. Conclusion: Long-term follow-up after MAT revealed a greater decrease in JSW in the extrusion group than in the nonextrusion group. However, no significant differences in clinical outcomes were observed.

scholarly journals Effects of Compliance With Procedure-Specific Postoperative Rehabilitation Protocols on Initial Outcomes After Osteochondral and Meniscal Allograft Transplantation in the Knee

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988429 ◽  
Author(s):  
Kylee Rucinski ◽  
James L. Cook ◽  
Cory R. Crecelius ◽  
Renée Stucky ◽  
James P. Stannard
Keyword(s):  
Risk Factors ◽  
Postoperative Management ◽  
Modifiable Risk Factors ◽  
Failure Rates ◽  
Meniscal Allograft Transplantation ◽  
Postoperative Rehabilitation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Management Protocol ◽  
Rehabilitation Protocols

Background: Osteochondral and meniscal allograft transplantation have been performed in the knee for more than 40 years, with the number of patients treated each year growing as allograft quantity and quality increase. To date, the effects of postoperative management on outcomes after these procedures have received relatively little focus in the peer-reviewed literature. Hypothesis: Compliance with the recommended postoperative management protocol will be associated with significantly higher initial success and significantly lower revision and failure rates for patients undergoing osteochondral and/or meniscal allograft transplantation in the knee. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled into a dedicated registry designed to follow outcomes after osteochondral and/or meniscal allograft transplantation. Patients were included when at least 1 year of follow-up data were available, including data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures, based on the electronic medical record and communication logs with patients’ outpatient physical therapists. Results: For patients meeting the inclusion criteria (N = 162), compliance with the prescribed procedure-specific postoperative management protocol was associated with significantly higher 1- to 3-year success and significantly lower revision and failure rates. Specifically, patients who were compliant were 6.3 times less likely to need allograft revision or total knee arthroplasty and 7.5 times more likely to have a successful outcome at 1 to 3 years after osteochondral and/or meniscal allograft transplantation. In addition to noncompliance, older patient age and higher body mass index were associated with inferior short-term outcomes in this cohort. Conclusion: These data suggest that compliance with procedure-specific postoperative rehabilitation protocols is associated with higher success, lower revision, and lower failure rates for patients undergoing osteochondral and meniscal allograft transplantation. Given these results showing the importance of these modifiable risk factors, our center has devoted resources to preoperative patient assessment and communication to provide education, set appropriate expectations, identify and address modifiable risk factors, impediments, and noncompliance, and monitor and adjust postoperative care as indicated.

scholarly journals The Results of Meniscal Allograft Transplantation Surgery: What is Success?

2020 ◽  
Author(s):  
Henry Kelvin Christopher Searle ◽  
Vipin Asopa ◽  
Simon Coleman ◽  
Ian McDermott
Keyword(s):  
Risk Factors ◽  
Outcome Measures ◽  
Return To Sport ◽  
Complication Rates ◽  
Clinical Failure ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Patient Reported ◽  
Surgical Failure

Abstract Background : Meniscal allograft transplantation (MAT) may improve symptoms and function, and limit premature knee degeneration in patients under 50 years with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the potential definitions of ‘success' or ‘failure’. Methods : 60 patients who underwent MAT between 2008-2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm <65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistical analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure. Results : 43 patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again. Conclusions: None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between ‘clinical failure’ and ‘surgical failure’ means these terms may need re-defining using a bespoke MAT scoring system.

scholarly journals Lateral Capsular Stabilization in Lateral Meniscal Allograft Transplantation

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110286
Author(s):  
Young-Jin Seo ◽  
Nam-Hong Choi ◽  
Byung-Hun Hwangbo ◽  
Ji-Sun Hwang ◽  
Brian N. Victoroff
Keyword(s):  
Tibial Plateau ◽  
Joint Space ◽  
Lysholm Score ◽  
Mri Findings ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Tegner Score ◽  
Group 1

Background: Stabilization of the lateral capsule to the tibial plateau may decrease midbody extrusion after lateral meniscal allograft transplantation (MAT). However, there is a paucity of literature reporting on postoperative magnetic resonance imaging (MRI) findings after lateral capsular stabilization (LCS) at the time of lateral MAT. Purpose/Hypothesis: The purpose was to describe MRI findings after LCS and compare postoperative extrusion between isolated lateral MAT and lateral MAT with LCS. It was hypothesized that allograft extrusion would be reduced after MAT with LCS but that the stabilized capsule would increase the risk of tears to the capsule or allograft. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent lateral MAT with 6-month follow-up MRI. Concomitant LCS was performed for patients with redundant lateral capsule displaced from the lateral tibial plateau as evident on coronal MRI or arthroscopic examination (MAT+LCS group); otherwise, patients underwent MAT only (isolated MAT group). The Lysholm score, Tegner score, and lateral joint space on radiographs were compared between the 2 groups at 2 years postoperatively, and the stabilized lateral capsule and allograft were evaluated using 6-month follow-up MRI. Extrusion, rotation, and position of the allograft bridge were compared between the 2 groups. Regression analysis was performed to identify factors predictive of degree of extrusion. Results: There were 10 patients in the MAT+LCS group and 13 patients in the isolated MAT group. No significant differences were found between groups in preoperative patient characteristics or postoperative Lysholm score, Tegner score, lateral joint space, or MRI parameters. Postoperative extrusion was not related to obliquity angle, position of the bony bridge, or presence of LCS. In the MAT+LCS group, 1 patient showed a tear of the lateral capsule and a radial tear of the allograft, and 3 patients had a meniscocapsular separation at the midbody of the allograft. In the isolated MAT group, 1 patient had a peripheral tear at the midbody, but there was no tear of the allograft in the other patients. Conclusion: LCS did not decrease extrusion of lateral meniscal transplantation, but it can lead to increased risk for graft or capsule tear.

scholarly journals THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Haley E. Smith ◽  
Madeline M. Lyons ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
National Database ◽  
Control Group ◽  
Meniscal Allograft Transplantation ◽  
Children's Hospitals ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

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