Preoperative Tibial Subchondral Bone Marrow Lesion Patterns and Associations With Outcomes After Isolated Meniscus Allograft Transplantation

Saltzman, Bryan M.; Cotter, Eric J.; Stephens, Jeffrey P.; Cvetanovich, Gregory L.; Madden, Brett; Wang, Kevin; Yanke, Adam B.; Cole, Brian J.

doi:10.1177/0363546517751690

Cited by 25 publications

(23 citation statements)

References 28 publications

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“…27,40 In appropriately selected candidates, MAT is a viable procedure for joint preservation, although future research will always be needed for methods to gain optimum results. 20,24,37 Given appropriate preliminary results, clinical practice guidelines must be constructed from research to provide the optimal methodology of MAT. An increasing focus is being placed on clinically significant results over statistically significant results to demonstrate clinical benefit.…”

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confidence: 99%

Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation

Liu

Gowd

Redondo

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery.Purpose:To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS.Results:A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m2. The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A ), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL).Conclusion:This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers’ compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT.

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confidence: 99%

Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation

Liu

Gowd

Redondo

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…6,14,24 Previous studies about autologous chondrocyte implantation showed conflicting results concerning a correlation between subchondral BML and clinical outcomes. 9,12,36,37 For MAT, Saltzman et al 42 first focused on subchondral BML and demonstrated that preoperative subchondral BML in the tibia was associated with clinical scores after isolated MAT.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous studies have considered subchondral BML as present or not present. 22,42 Considering that the purpose of the present study was to verify the association between MAT extrusion and subchondral BML, the binary determination was enough for the analyses. Second, MAT extrusion was only determined at a single point.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Adverse effects of graft extrusion after meniscal allograft transplantation (MAT) are difficult to assess and can be determined only in the long term using a simple radiograph. Recently, subchondral bone marrow lesions (BMLs) detected on magnetic resonance imaging (MRI) scans have been used to evaluate the outcomes or prognoses of various knee surgeries. However, whether subchondral BMLs on MRI scans reflect the effects of allograft extrusion remains unclear. Hypothesis: Subchondral BML in the lateral compartment of the knee joint on postoperative MRI scans would be associated with graft extrusion after lateral MAT. Study Design: Case-control study; Level of evidence, 3. Methods: Overall, 170 patients with lateral MAT between 2008 and 2013 were classified into extrusion (≥3 mm) and nonextrusion (<3 mm) groups based on findings on MRI scans obtained 3 to 6 months postoperatively. Subchondral BMLs in the lateral compartment were evaluated on the latest MRI scans. To exclude any bone marrow signal changes other than those caused by allograft extrusion, the latest MRI scans were compared with those obtained 3 to 6 months postoperatively. Only subchondral BMLs that occurred after that time point were counted. The association between allograft extrusion and subchondral BML was assessed using chi-square analysis. Logistic regression analysis was performed to control other related factors, including age, sex, body mass index, time from previous meniscectomy, alignment, and cartilage status at the time of MAT. Clinical outcomes according to subchondral BML were evaluated using the Lysholm score. Results: Of the 170 patients, 20 (11.8%) had subchondral BML on the latest MRI scans at a mean 53.6 ± 31.2 months postoperatively, with 14 and 6 patients in the extrusion and nonextrusion groups, respectively. Chi-square analysis showed a significant association between allograft extrusion and subchondral BMLs ( P = .025). Logistic regression analysis showed that extrusion and age were significant factors associated with subchondral BML ( P = .011 and .004, respectively). However, no differences were observed in the Lysholm scores in accordance with the subchondral BML ( P = .248). Conclusion: Subchondral BMLs on postoperative MRI scans were associated with graft extrusion after lateral MAT. However, there was no difference in clinical outcomes according to subchondral BML.

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“…No correlation was found between outcome and the presence of a discoid meniscus or subchondral bone marrow lesions. 65 In one study, 56 preoperative pain, as measured with the Hospital for Special Surgery knee score, was a predictor of transplant failure, while another study 35 found no correlation between the preoperative IKDC score and failure. With regard to the surgeon's skill, one author 47 found that surgeons with a low volume of cases were associated with higher failure rates, while there were no The Journal of Knee Surgery differences in outcome between patients treated by fellowship and nonfellowship trained surgeons.…”

Section: Other Factorsmentioning

confidence: 99%

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

et al. 2019

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This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's (p = 0.0102) and International Knee Documentation Committee (IKDC; p = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation (p = 0.0008). Fresh frozen allografts had higher Lysholm's scores (p < 0.0001) and showed significantly lower failure rates (p < 0.0001) than cryopreserved allografts. Age (p < 0.015, β = 0.80), sex (p < 0.034, β = − 8.52), and body mass index (BMI; p < 0.014, β = −4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.

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Preoperative Tibial Subchondral Bone Marrow Lesion Patterns and Associations With Outcomes After Isolated Meniscus Allograft Transplantation

Cited by 25 publications

References 28 publications

Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation

Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation

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

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

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