Postoperative Subchondral Bone Marrow Lesion Is Associated With Graft Extrusion After Lateral Meniscal Allograft Transplantation

Purpose This study aimed to compare the amount of extrusion of the discoid lateral meniscus (DLM), which was symptomatic and required surgery, with normal meniscuses and asymptomatic DLMs and examine factors associated with the extrusion of symptomatic DLM. Methods Medical records of participants with DLM or normal lateral meniscus (LM) were retrospectively reviewed using magnetic resonance imaging (MRI). DLM cases were divided into symptomatic and asymptomatic groups. The midbody meniscal extrusion was measured using mid-coronal MRI. The association between meniscal extrusion and MRI indings, including the meniscofemoral ligament, meniscotibial ligament (MTL), intrameniscal signal intensity of the peripheral rim, meniscal shift, and skeletal maturity, was evaluated. Results Eighty-six knees with DLM (63 symptomatic) were included. The control group included 31 patients. The symptomatic group showed signiicantly greater meniscal extrusion (mean ± standard deviation symptomatic DLM: 1.0 ± 1.1 mm, asymptomatic DLM: 0.1 ± 0.4 mm, and normal LM: 0.3 ± 0.6 mm, P < 0.001) and had a signiicantly higher incidence of MTL loosening (P = 0.02) and intrameniscal signal (P < 0.001) than the other two groups. In the symptomatic group, multivariable linear regression analysis showed that MTL loosening [β = 1.45, 95% conidence interval (CI) 1.03-1.86, P < 0.001] and intrameniscal signal (β = 0.49, 95% CI 0.09-0.90, P = 0.002) were independent associated factors. Conclusions LM extrusion was signiicantly more common in patients with symptomatic DLM than in those with asymptomatic DLM or a normal LM. MTL loosening and intrameniscal high-signal intensity on MRI were independently associated with meniscal extrusion. These indings help explain the pathogenesis and diagnosis of symptomatic DLM. Level of evidence III.

Section: Introductionmentioning

confidence: 99%

Intrameniscal degeneration and meniscotibial ligament loosening are associated factors with meniscal extrusion of symptomatic discoid lateral meniscus

Nishino

Hashimoto²,

Iida

et al. 2022

“…Rosenberg view radiography and MRI were taken to confirm that the cartilage in the lateral compartment was preserved. International Cartilage Repair Society (ICRS) grade 3 or less and localized grade 4 defects that could be covered by the meniscus were considered acceptable indications [14]. Any malalignment or ligament instability was addressed before MAT.…”

Section: Methodsmentioning

confidence: 99%

Signal intensity of lateral meniscal allografts deteriorates over time: a longitudinal MRI analysis during a minimum follow-up of 8 years

Song

Bin

Kim

et al. 2022

Self Cite

Purpose To evaluate the serial change of magnetic resonance imaging (MRI) signal intensity (SI) of lateral meniscal allografts in a long-term period of > 8 years and to determine whether the SI change adversely afected clinical outcomes. Methods Thirty-three lateral meniscal allograft transplantation (LMAT) patients with MRI taken > 8 years after surgery were included. The allograft was assessed using MRI at ive serial time points (1, 2-4, 4-6, 6-8, and > 8 years after surgery), based on the following grading system: grade 1, globular increased SI not adjacent to the articular surface; grade 2, linear SI within the meniscus; and grade 3, increased SI extended to the articular surface. MRI evaluation was performed for three locations of the allograft (anterior horn, mid-body, and posterior horn), and the serial changes of allograft SI at each location were analyzed using the generalized estimating equation (GEE) with cumulative logit link function. The patients were classiied according to SI change at each location (stationary group and deterioration group), and the two groups were compared in terms of clinical outcomes using the Lysholm score. ResultsThe mean follow-up duration was 9.2 ± 1.2 years. During that period, SI of the allograft deteriorated over time, regardless of the location (anterior horn, p = 0.034; mid-body, p = 0.002; posterior horn, p < 0.001). The amount of SI deterioration at each location of the graft difered with a borderline signiicance (p = 0.050, GEE), and the proportion of grade 3 SI was higher at the posterior horn (36.4%) than at the other locations at the last follow-up (p < 0.001, chi-square test). However, no signiicant diferences in the Lysholm scores were found between the stationary group and the deterioration group at all locations. Conclusion SI of the meniscal allograft deteriorated over time at all locations during the long-term follow-up. Deterioration of the graft was more prominent at the posterior horn than at the other locations. SI deterioration did not adversely afect the clinical outcomes, which should be interpreted with caution, considering the small sample size of this study. In the prognosis of lateral MAT, SI deterioration at the posterior horn is a more determining factor than that at the other part of the allograft. Therefore, SI at the posterior horn needs to be examined with special concern. Level of evidence III.

“…Fresh frozen allografts were matched in size by the methods described by Pollard [12]. Lateral MAT was performed using the key hole technique [16], whereas medial MAT was performed using the double bone plug technique [6]. MAT was initiated with arthroscopic examination of intra‐articular structures, followed by resection of the remaining host meniscus, if needed.…”

Section: Methodsmentioning

confidence: 99%

Meniscal allograft transplantation shows a mismatch between anatomic and clinical failures

Song

Bin

Kim

et al. 2021

Self Cite

PurposeClinical results of meniscal allograft transplantation (MAT) are not always consistent with graft status. This study aimed to investigate (1) the degree and pattern of mismatch between anatomic and clinical failures in MAT and (2) preoperative factors associated with the mismatch. MethodsTwo hundred and ninety‐eight consecutive patients who underwent primary medial or lateral MAT during 2004–2015 were reviewed. Anatomic failure was defined as an allograft showing meniscal tear involving > 50% of the graft or unstable peripheral rim. Clinical failure included poor Lysholm score of < 65 and any requirement for re‐operations such as arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (more than 50% of the graft or to the zone of meniscocapsular junction). Failure cases were categorised according to the type of failure as follows: (1) type 1, anatomic failure followed by clinical failure; (2) type 2, anatomic failure did not lead to clinical failure; and (3) type 3, clinical failure without anatomic failure. Preoperative factors including age, sex, body mass index, MAT compartment, time from previous meniscectomy, alignment, cartilage status, and accompanying procedures were analysed according to the failure type. ResultsForty (13.4%) patients showed anatomical or clinical failure during the median (25th–75th percentile) follow‐up duration of 47 (30–72) months (range 24–178 months). Eleven (3.7%) patients showed both anatomical and clinical failure (type 1 failure). Seventeen (5.7%) patients showed anatomic failure that did not lead to clinical failure (type 2 failure). Twelve (4.0%) patients failed clinically without meniscal tear (> 50% of graft) or unstable peripheral rim (type 3 failure). Comparative analyses among failure types found a significant difference in MAT compartment (p = 0.01). In particular, the incidence of type 3 failure was higher in medial than in lateral MAT (p = 0.003). ConclusionA notable number of failure cases of MAT showed a mismatch between anatomic and clinical failures. Even with anatomic failure, MAT did not always lead to poor clinical scores or re‐operations, whereas MAT could have poor results without substantial allograft problems. Therefore, both anatomic and clinical aspects should be considered when evaluating MAT. In particular, type 3 failure occurred more frequently in medial than in lateral MAT. Level of evidenceIII.