Meniscal allograft transplantation in discoid meniscus patients achieves good clinical outcomes and superior chondroprotection compared to meniscectomy in the long term

Abstract

Purpose To compare the long-term clinical and radiological results of meniscal allograft transplantation (MAT) for discoid lateral meniscus (DLM) patients with MAT for non-discoid lateral meniscus patients and meniscectomy (ME) for DLM patients and, thus, to determine whether DLM patients are suitable candidates for MAT. Methods Eight MAT cases in DLM patients were identiied (discoid MAT group), six MAT cases in non-discoid lateral meniscus patients (non-discoid MAT group) and ten total meniscectomy cases in DLM patients (discoid ME group) were matched as controls. Subjective evaluations, postoperative radiography and magnetic resonance imaging (MRI) were conducted at 5 years and 10-14 years, respectively. Joint degeneration was evaluated by the Kellgren-Lawrance (KL) grade and joint space width (JSW). MRI with T2 mapping sequences was used to quantitatively evaluate degeneration of the joint cartilage and shrinkage of the allografts. Student's t test was used to compare quantitative variables and the Mann-Whitney U test was used to compare categorical variables. Results There was no diference in Lysholm, IKDC, Tegner or VAS scores amongst the discoid MAT, non-discoid MAT and discoid ME groups at the inal follow-up. No revision surgery was performed in any MAT patient. The JSW narrowing in the discoid MAT group was better than that in the discoid ME group (0.8 ± 0.4 mm vs. 2.1 ± 1.3 mm, p = 0.012) and worse than that in the non-discoid MAT group (0.1 ± 0.1 mm, p = 0.003). The KL progression of the discoid MAT group was less than that of the discoid ME group (1.3 ± 0.7 vs. 2.3 ± 0.9, p = 0.034). The discoid ME group had worse cartilage lesion progression than the discoid MAT and non-discoid MAT groups. The allograft width of the DLM patients shrank more than that of the non-discoid patients at the meniscus midbody (3.6 ± 0.9 mm vs. 6.2 ± 1.9 mm, p = 0.015). Conclusion Compared to meniscectomy, MAT achieved similar long-term symptom relief and superior chondroprotection in discoid meniscus patients. Despite more graft shrinkage, the outcomes of MAT in discoid meniscus patients were comparable to those in non-discoid meniscus patients. Therefore, DLM patients may be suitable candidates for MAT procedures. Level of evidence Level III.

Discoid meniscus: Treatment considerations and updates

“…Meniscal allograft transplantation: Another modality of treatment aimed at circumventing osteoarthritis-related meniscectomy is meniscal allograft transplantation (MAT). Wang et al [ 27 ] compared the outcomes of patients with DLM treated with MAT or partial meniscectomy. In the follow-up, Lysholm, the International Knee Documentation Committee (IKDC), Tegner and VAS scores were used for assessment.…”

Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation

“…Meniscal allograft transplantation (MAT) is an established effective treatment for relieving pain in patients who underwent meniscectomy with a 10‐year survival rate ranging from 73 to 86% [6, 10, 19, 27, 29]. Despite such a high mid‐to‐long‐term survival rate, it occurs occasionally for early postoperative failure [7, 31].…”

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

“…Lateral meniscal allograft transplantation (LMAT) is an effective treatment to alleviate pain, enhance knee joint function and delay cartilage degeneration in patients with lateral meniscal deficiency caused by injury or meniscectomy [6,8,12,20,[28][29][30]. The success of well-executed LMAT has been consistently demonstrated, leading to an increasing number of LMAT procedures being performed [4,27].…”