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Published in: Journal of Orthopaedic Surgery and Research 1/2018

Open Access 01-12-2018 | Regular article

Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up

Authors: Shiyou Ren, Xintao Zhang, Tian You, Xiaocheng Jiang, Dadi Jin, Wentao Zhang

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

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Abstract

Objective

To evaluate the clinical and radiologic outcomes of meniscal allograft transplantation (MAT) using a modified bone plug technique.

Methods

We conducted a retrospective single-center study of 73 patients who underwent MAT between January 2007 and December 2013. The International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score, visual analogue scale (VAS), and physical examinations were retrospectively reviewed to measure clinical outcomes after MAT, and questionnaires regarding activity and factors were analyzed. Magnetic resonance imaging (MRI) was used to assess the cartilage status and meniscal extrusion.

Results

The mean follow-up was 37 months for 61 patients (65 knees), and 12 patients were lost to follow-up. The mean meniscal extrusion was 3.39 ± 0.90 mm, the relative percentage of extrusion (RPE) was 34.82% ± 12.71%, and arthrosis progression was observed in 8 of 61 cases (13.1%). The mean results for VAS, IKDC, and Lysholm scores were significantly improved after MAT (P < 0.05), but there were no significant differences in the range of motion or Tegner score (P > 0.05). Thirty-eight (62.3%) patients were able to return to their previous level of activity, and 23 (37.7%) patients reached a mean 76.7% of the previous level of activity. Of the 23 patients reporting a decrease in activity, 10 reported a fear of reinjury as the primary factor limiting activity. The patient satisfaction rate in the study was 78.7%.

Conclusion

Our modified bone plug method with anatomical meniscal root reinsertion was an effective surgical method, and the majority of active patients with meniscal disorders returned to preinjury levels of activity.
Literature
1.
go back to reference Verdonk R, Volpi P, Verdonk P, Van der Bracht H, Van Laer M, Almqvist KF, et al. Indications and limits of meniscal allografts. Injury. 2013;44(Suppl 1):S21–7.CrossRefPubMed Verdonk R, Volpi P, Verdonk P, Van der Bracht H, Van Laer M, Almqvist KF, et al. Indications and limits of meniscal allografts. Injury. 2013;44(Suppl 1):S21–7.CrossRefPubMed
2.
go back to reference Kaleka CC, Debieux P, da Costa Astur D, Arliani GG, Cohen M. Updates in biological therapies for knee injuries: menisci. Curr Rev Musculoskelet Med. 2014;7:247–55.CrossRefPubMedPubMedCentral Kaleka CC, Debieux P, da Costa Astur D, Arliani GG, Cohen M. Updates in biological therapies for knee injuries: menisci. Curr Rev Musculoskelet Med. 2014;7:247–55.CrossRefPubMedPubMedCentral
3.
go back to reference Milachowski KA, Weismeier K, Wirth CJ. Homologous meniscus transplantation. Experimental and clinical results. Int Orthop. 1989;13:1–11.CrossRefPubMed Milachowski KA, Weismeier K, Wirth CJ. Homologous meniscus transplantation. Experimental and clinical results. Int Orthop. 1989;13:1–11.CrossRefPubMed
4.
go back to reference Hutchinson ID, Moran CJ, Potter HG, Warren RF, Rodeo SA. Restoration of the meniscus: form and function. Am J Sports Med. 2014;42:987–98.CrossRefPubMed Hutchinson ID, Moran CJ, Potter HG, Warren RF, Rodeo SA. Restoration of the meniscus: form and function. Am J Sports Med. 2014;42:987–98.CrossRefPubMed
5.
go back to reference Rijk PC. Meniscal allograft transplantation—part I: background, results, graft selection and preservation, and surgical considerations. Arthroscopy. 2004;20:728–43.CrossRefPubMed Rijk PC. Meniscal allograft transplantation—part I: background, results, graft selection and preservation, and surgical considerations. Arthroscopy. 2004;20:728–43.CrossRefPubMed
7.
go back to reference Sekaran SV, Hull ML, Howell SM. Nonanatomic location of the posterior horn of a medial meniscal autograft implanted in a cadaveric knee adversely affects the pressure distribution on the tibial plateau. Am J Sports Med. 2002;30:74–82.CrossRefPubMed Sekaran SV, Hull ML, Howell SM. Nonanatomic location of the posterior horn of a medial meniscal autograft implanted in a cadaveric knee adversely affects the pressure distribution on the tibial plateau. Am J Sports Med. 2002;30:74–82.CrossRefPubMed
8.
go back to reference Alentorn-Geli E, Seijas Vázquez R, García Balletbó M, Álvarez Díaz P, Steinbacher G, Cuscó Segarra X, et al. Arthroscopic meniscal allograft transplantation without bone plugs. Knee Surg Sports Traumatol Arthrosc. 2011;19:174–82.CrossRefPubMed Alentorn-Geli E, Seijas Vázquez R, García Balletbó M, Álvarez Díaz P, Steinbacher G, Cuscó Segarra X, et al. Arthroscopic meniscal allograft transplantation without bone plugs. Knee Surg Sports Traumatol Arthrosc. 2011;19:174–82.CrossRefPubMed
9.
go back to reference González-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC. Meniscal allograft transplantation without bone blocks: a 5-to 8-year follow-up of 33 patients. Arthroscopy. 2010;26:1633–40.CrossRefPubMed González-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC. Meniscal allograft transplantation without bone blocks: a 5-to 8-year follow-up of 33 patients. Arthroscopy. 2010;26:1633–40.CrossRefPubMed
10.
go back to reference Chen MI, Branch TP, Hutton WC. Is it important to secure the horns during lateral meniscal transplantation? A cadaveric study. Arthroscopy. 1996;12:174–81.CrossRefPubMed Chen MI, Branch TP, Hutton WC. Is it important to secure the horns during lateral meniscal transplantation? A cadaveric study. Arthroscopy. 1996;12:174–81.CrossRefPubMed
11.
go back to reference Paletta GA Jr, Manning T, Snell E, Parker R, Bergfeld J. The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med. 1997;25:692–8.CrossRefPubMed Paletta GA Jr, Manning T, Snell E, Parker R, Bergfeld J. The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med. 1997;25:692–8.CrossRefPubMed
12.
go back to reference Kim JG, Lee YS, Lee SW, Kim YJ, Kong DH, Ko MS. Arthroscopically assisted medial meniscal allograft transplantation using a modified bone plug to facilitate passage: surgical technique. J Knee Surg. 2009;22:259–63.CrossRefPubMed Kim JG, Lee YS, Lee SW, Kim YJ, Kong DH, Ko MS. Arthroscopically assisted medial meniscal allograft transplantation using a modified bone plug to facilitate passage: surgical technique. J Knee Surg. 2009;22:259–63.CrossRefPubMed
13.
go back to reference McConkey M, Lyon C, Bennett DL, Schoch B, Britton C, Amendola A, et al. Radiographic sizing for meniscal transplantation using 3-D CT reconstruction. J Knee Surg. 2012;25:221–5.PubMed McConkey M, Lyon C, Bennett DL, Schoch B, Britton C, Amendola A, et al. Radiographic sizing for meniscal transplantation using 3-D CT reconstruction. J Knee Surg. 2012;25:221–5.PubMed
14.
go back to reference Van Thiel GS, Verma N, Yanke A, Basu S, Farr J, Cole B. Meniscal allograft size can be predicted by height, weight, and gender. Arthroscopy. 2009;25:722–7.CrossRefPubMed Van Thiel GS, Verma N, Yanke A, Basu S, Farr J, Cole B. Meniscal allograft size can be predicted by height, weight, and gender. Arthroscopy. 2009;25:722–7.CrossRefPubMed
15.
go back to reference Verdonk P, Vansintjan P, Verdonk R. Meniscal allograft transplantation. In: Bonnin M, Amendola NA, Bellemans J, MacDonald SJ, Menetrey J, editors. The knee joint: surgical techniques and strategies. Berlin Heidelberg: Springer; 2012. p. 139–47.CrossRef Verdonk P, Vansintjan P, Verdonk R. Meniscal allograft transplantation. In: Bonnin M, Amendola NA, Bellemans J, MacDonald SJ, Menetrey J, editors. The knee joint: surgical techniques and strategies. Berlin Heidelberg: Springer; 2012. p. 139–47.CrossRef
16.
go back to reference Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy. 1995;11:386–94.CrossRefPubMed Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy. 1995;11:386–94.CrossRefPubMed
17.
go back to reference Ha JK, Jang HW, Jung JE, Cho SI, Kim JG. Clinical and radiologic outcomes after meniscus allograft transplantation at 1-year and 4-year follow-up. Arthroscopy. 2014;30:1424–9.CrossRefPubMed Ha JK, Jang HW, Jung JE, Cho SI, Kim JG. Clinical and radiologic outcomes after meniscus allograft transplantation at 1-year and 4-year follow-up. Arthroscopy. 2014;30:1424–9.CrossRefPubMed
18.
go back to reference Lee BS, Bin SI, Kim JM. Articular cartilage degenerates after subtotal/total lateral meniscectomy but radiographic arthrosis progression is reduced after meniscal transplantation. Am J Sports Med. 2016;44:159–65.CrossRefPubMed Lee BS, Bin SI, Kim JM. Articular cartilage degenerates after subtotal/total lateral meniscectomy but radiographic arthrosis progression is reduced after meniscal transplantation. Am J Sports Med. 2016;44:159–65.CrossRefPubMed
19.
go back to reference Ha JK, Sung JH, Shim JC, Seo JG, Kim JG. Medial meniscus allograft transplantation using a modified bone plug technique: clinical, radiologic, and arthroscopic results. Arthroscopy. 2011;27:944–50.CrossRefPubMed Ha JK, Sung JH, Shim JC, Seo JG, Kim JG. Medial meniscus allograft transplantation using a modified bone plug technique: clinical, radiologic, and arthroscopic results. Arthroscopy. 2011;27:944–50.CrossRefPubMed
20.
go back to reference Wang H, Gee AO, Hutchinson ID, Stoner K, Warren RF, Chen TO, et al. Bone plug versus suture-only fixation of meniscal grafts: effect on joint contact mechanics during simulated gait. Am J Sports Med. 2014;42:1682–9.CrossRefPubMedPubMedCentral Wang H, Gee AO, Hutchinson ID, Stoner K, Warren RF, Chen TO, et al. Bone plug versus suture-only fixation of meniscal grafts: effect on joint contact mechanics during simulated gait. Am J Sports Med. 2014;42:1682–9.CrossRefPubMedPubMedCentral
21.
go back to reference Roberson TA, Wyland DJ. Meniscal allograft transplantation with soft tissue in bone socket fixation: arthroscopic technique with technical pearls. Arthrosc Tech. 2017;24(6):e483–9.CrossRef Roberson TA, Wyland DJ. Meniscal allograft transplantation with soft tissue in bone socket fixation: arthroscopic technique with technical pearls. Arthrosc Tech. 2017;24(6):e483–9.CrossRef
22.
go back to reference Ahn JH, Kang HW, Yang TY, et al. Multivariate analysis of risk factors of graft extrusion after lateral meniscus allograft transplantation. Arthroscopy. 2016;32:1337–45.CrossRefPubMed Ahn JH, Kang HW, Yang TY, et al. Multivariate analysis of risk factors of graft extrusion after lateral meniscus allograft transplantation. Arthroscopy. 2016;32:1337–45.CrossRefPubMed
23.
go back to reference Lee BS, Kim HJ, Lee CR, et al. Clinical outcomes of meniscal allograft transplantation with or without other procedures: a systematic review and meta-analysis. Am J Sports Med. 2017;12:036354651772696.CrossRef Lee BS, Kim HJ, Lee CR, et al. Clinical outcomes of meniscal allograft transplantation with or without other procedures: a systematic review and meta-analysis. Am J Sports Med. 2017;12:036354651772696.CrossRef
24.
go back to reference Samitier G, Alentorn-Geli E, Taylor DC, Rill B, Lock T, Moutzouros V, et al. Meniscal allograft transplantation. Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015;23:323–33.CrossRefPubMed Samitier G, Alentorn-Geli E, Taylor DC, Rill B, Lock T, Moutzouros V, et al. Meniscal allograft transplantation. Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015;23:323–33.CrossRefPubMed
26.
27.
go back to reference Myers P, Tudor F. Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy. 2015;31:911–25.CrossRefPubMed Myers P, Tudor F. Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy. 2015;31:911–25.CrossRefPubMed
Metadata
Title
Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up
Authors
Shiyou Ren
Xintao Zhang
Tian You
Xiaocheng Jiang
Dadi Jin
Wentao Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-018-0776-3

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