Meniscus allograft transplantation: indications, techniques and outcomes

Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Vaisman, Alex; Espregueira-Mendes, João

doi:10.1302/2058-5241.4.180052

Cited by 49 publications

(69 citation statements)

References 24 publications

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“…Several studies demonstrated good or excellent short-to medium-term results [6][7][8][9][10][11][12]. However, while midterm survivorship is reported to be 85-90%, long-term survivorship decreases to 50-70% [13].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional meniscus allograft sizing—a study of 280 healthy menisci

et al. 2020

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Background: Inaccurate meniscus allograft size is still an important problem of the currently used sizing methods. The purpose of this study was to evaluate a new three-dimensional (3D) meniscus-sizing method to increase the accuracy of the selected allografts. Methods: 3D triangular surface models were generated from 280 menisci based on 50 bilateral and 40 unilateral knee joint magnetic resonance imaging (MRI) scans. These models served as an imaginary meniscus allograft tissue bank. Meniscus sizing and allograft selection was simulated for all 50 bilateral knee joints by (1) the closest mean surface distance (MeSD) (3D-MRI sizing with contralateral meniscus), (2) the smallest meniscal width/length difference in MRI (2D-MRI sizing with contralateral meniscus), and (3) conventional radiography as proposed by Pollard (2D-radiograph (RX) sizing with ipsilateral tibia plateau). 3D shape and meniscal width, length, and height were compared between the original meniscus and the selected meniscus using the three sizing methods. Results: Allograft selection by MeSD (3D MRI) was superior for all measurement parameters. In particular, the 3D shape was significantly improved (p < 0.001), while the mean differences in meniscal width, length, and height were only slightly better than the allograft selected by the other methods. Outliers were reduced by up to 55% (vs. 2D MRI) and 83% (vs. 2D RX) for the medial meniscus and 39% (vs. 2D MRI) and 56% (vs. 2D RX) for the lateral meniscus. Conclusion: 3D-MRI sizing by MeSD using the contralateral meniscus as a reconstruction template can significantly improve meniscus allograft selection. Sizing using conventional radiography should probably not be recommended. Trial registration: Kantonale Ethikkommission Zürich had given the approval for the study (BASEC-No. 2018-00856).

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Section: Introductionmentioning

confidence: 99%

Three-dimensional meniscus allograft sizing—a study of 280 healthy menisci

et al. 2020

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“…Meniscal allograft should be not only side and compartment specific but also size specific. 4,16 An oversized graft will not properly load share, thereby increasing the contact pressure in the joint and eventually leading to joint degradation. 9,10,14,15,18 Conversely, grafts that are too small are at risk for failure because of overloading.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the radiographic method devised by Pollard remains the most commonly used in clinical practice. 3,4 Most recently, Kaleka et al 8 compared several methods of predicting meniscal size 6 and reported that MRI and the Pollard method demonstrated good correlation for the medial meniscus. However, for the lateral meniscus, none of the methods alone demonstrated good accuracy for predicting meniscal width and length, thereby illustrating the remaining challenges of obtaining proper measurements for meniscal transplant in the lateral compartment.…”

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confidence: 99%

Radiographic Methods Are as Accurate as Magnetic Resonance Imaging for Graft Sizing Before Lateral Meniscal Transplantation

et al. 2020

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Background: Accurate allograft matching is deemed critical for meniscal transplantation; thus, precise measurements are essential to correctly calculate meniscal size. Several methods for meniscal sizing have been described, but there remains a discussion on which is the most accurate for the lateral meniscus. Purpose: To compare the accuracy of radiographic, anthropometric, and magnetic resonance imaging (MRI) methods of determining width and length of the lateral meniscus with actual dimensions after anatomic dissection. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen human cadaveric knees without any evidence of meniscal or ligamentous injury were primarily imaged using radiography and MRI and subsequently underwent dissection to assess the anatomic size of each meniscus. Four methods were used to predict the size of the lateral menisci: anthropometric, radiographic (Pollard and Yoon), and MRI. Absolute differences in length and width between actual and predicted sizes were determined. Results: The anatomic lateral meniscal width and length were 33.01 ± 4.25 mm (mean ± SD; range, 24.84-40.18 mm) and 31.41 ± 5.06 mm (range, 25.2-40.05 mm), respectively. Regarding width, the anthropometric method demonstrated an absolute difference from anatomic measurement significantly greater when compared with the Pollard technique and MRI ( P = .002). Regarding length, the Pollard method presented an absolute difference significantly greater than all other techniques ( P = .003). In terms of the ability to measure width and length, MRI accurately predicted meniscal size within 10% of the anatomic size in 65% of measurements, the Yoon method in 54%, and the Pollard method in 20% ( P = .01). Radiographs tended to overestimate the true size of the lateral meniscus, while the anthropometric technique overestimated width in all specimens. Conclusion: This study demonstrated that MRI and the Yoon radiographic method are comparable in terms of accuracy for graft sizing before lateral meniscal transplantation. While MRI is useful, a contralateral MRI is required, which makes the Yoon radiographic method recommended given the ease and cost advantage. The original Pollard technique and the anthropometric method are not recommended. Clinical Relevance: Over- and undersizing of meniscal transplants has been implicated in graft failure. Therefore, increasing the reliability of preoperative meniscal measurements is deemed important for the success of meniscal allograft transplantation.

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“…9,16 While these grafts and techniques have proven safe and effective in general, complications including shrinkage, extrusion, progression of joint pathology, and failure persist 9,16,17 that negatively influence outcomes, patient satisfaction, and long-term survivorship due to revision and removal (6%-27%) or conversion to total knee arthroplasty (19%). 10,[18][19][20][21] In an attempt to mitigate these complications, our group has developed and validated a method for preservation of fresh, viable menisci that complies with the United States Food and Drug Administration (FDA) classification of a human cell and tissue product under Section 361 of the Public Health Services Act, as well as techniques for reconstruction or preservation of the menisco-tibial ligament and combined transplantation with fresh tibial osteochondral allograft (OCA). [22][23][24][25][26][27] While safety and initial efficacy for this approach have been documented, comprehensive comparative data are necessary in order to directly compare the currently available MAT techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical techniques for implantation include soft‐tissue, bone plug, and bone bridge methods for root fixation, followed by menisco‐capsular suture repair 9,16 . While these grafts and techniques have proven safe and effective in general, complications including shrinkage, extrusion, progression of joint pathology, and failure persist 9,16,17 that negatively influence outcomes, patient satisfaction, and long‐term survivorship due to revision and removal (6%‐27%) or conversion to total knee arthroplasty (19%) 10,18‐21 …”

Section: Introductionmentioning

confidence: 99%

Comparison of meniscal allograft transplantation techniques using a preclinical canine model

Schreiner

Stannard

Bozynski

et al. 2020

Journal Orthopaedic Research

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Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with meniscocapsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibialosteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with meniscotibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.

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Meniscus allograft transplantation: indications, techniques and outcomes

Cited by 49 publications

References 24 publications

Three-dimensional meniscus allograft sizing—a study of 280 healthy menisci

Three-dimensional meniscus allograft sizing—a study of 280 healthy menisci

Radiographic Methods Are as Accurate as Magnetic Resonance Imaging for Graft Sizing Before Lateral Meniscal Transplantation

Comparison of meniscal allograft transplantation techniques using a preclinical canine model

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