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Published on: January 23, 2018
Clinical and Radiological Outcomes After Lateral Meniscal Allograft Transplantation Through a Medial Arthrotomy: A
Nam-Hong Choi1, Bong-Seok Yang2, Dong-Min Lee3
1Department of Orthopedic Surgery, Eulji Medical Center, Seoul, Republic of Korea.
Background:
Previous studies have demonstrated that lateral meniscal allograft transplantation (MAT) through medial arthrotomy showed less extrusion than that of the lateral arthrotomy. However, there is a paucity of literature reporting clinical and radiological outcomes after lateral MAT through the medial arthrotomy.
Hypothesis:
Lateral MAT through a medial arthrotomy would show significantly improved clinical scores and minimal joint space narrowing compared with preoperative status.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between 2001 and 2019, a retrospective chart review was conducted for all patients who underwent lateral MAT using the bony bridge technique through medial arthrotomy. Inclusion criteria were patients who underwent lateral MAT after subtotal or total meniscectomy of the lateral meniscus. A total of 27 patients who were not followed up for >4 years or had follow-up magnetic resonance imaging after surgery were excluded. At final follow-up, Lysholm scores and Tegner activity scale scores were collected. Graft extrusion, trough angle, and position of the bony bridge were measured by magnetic resonance imaging at 6 months after MAT. Joint space width (JSW) of the lateral compartment on Rosenberg view was measured and compared preoperatively and at follow-up.
Results:
A total of 28 patients were included in this study. Their mean age was 29.8 years (range, 15-48 years) with a mean follow-up of 11.4 years. Preoperative Lysholm scores and Tegner activity scale scores (66.5 ± 16.6 and 3.1 ± 1.9, respectively) significantly improved at follow-up (84.8 ± 11.1 [P < .001] and 4.4 ± 1.5 [P = .008], respectively). The JSW decreased from 6.2 ± 1.6 mm to 5.7 ± 1.4 mm (P = .014). Extrusion was 2.2 ± 1.5 mm, and trough angle was 1.5°± 8.9°. The bony bridge was positioned at 43.9% ± 4.3% from the lateral edge on the entire tibial plateau. Nine patients (32.1%) underwent subsequent procedures. Partial meniscectomies were performed in 2 patients, meniscal repairs in 2, manipulation under anesthesia in 1, and lateral capsular plication in 1. Three patients who underwent total meniscectomy or revision surgery were regarded as having a failure; therefore, 89.3% grafts survived.
Conclusion:
Lateral MAT through the medial arthrotomy demonstrated satisfactory clinical and radiological outcomes at long-term follow-up.
Insights
Lateral meniscal allograft transplantation (MAT) via medial arthrotomy shows improved clinical scores and minimal joint space narrowing. This technique demonstrates satisfactory long-term outcomes for patients with lateral meniscus deficiency.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Lateral meniscal allograft transplantation (MAT) is a viable option for treating lateral meniscus deficiency.
- Previous research suggests medial arthrotomy may lead to less graft extrusion compared to lateral arthrotomy.
- Limited data exists on clinical and radiological outcomes of lateral MAT performed through a medial arthrotomy approach.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes of lateral MAT performed via a medial arthrotomy approach.
- To assess the long-term efficacy and safety of this surgical technique.
Main Methods:
- Retrospective chart review of 28 patients undergoing lateral MAT using the bony bridge technique through medial arthrotomy between 2001 and 2019.
- Clinical outcomes assessed using Lysholm and Tegner scores.
- Radiological outcomes evaluated via MRI for graft extrusion, trough angle, and bony bridge position, and X-ray for joint space width (JSW).
Main Results:
- Significant improvements in Lysholm (66.5 to 84.8) and Tegner (3.1 to 4.4) scores were observed.
- A small but significant decrease in lateral compartment JSW (6.2 to 5.7 mm) was noted.
- Graft extrusion averaged 2.2 mm, trough angle 1.5°, and bony bridge position 43.9% from the lateral edge.
- Graft survival rate was 89.3% at a mean follow-up of 11.4 years.
Conclusions:
- Lateral MAT through medial arthrotomy yields satisfactory long-term clinical and radiological outcomes.
- This approach is a safe and effective treatment option for lateral meniscus deficiency.
- Further research may explore optimal graft positioning and techniques to minimize joint space narrowing.
