Improved graft positioning and reduced extrusion using the bone-plug technique compared to the bone-bridge technique
1Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Purpose:
To compare graft positioning, meniscal extrusion and clinical outcomes between the bone-plug and bone-bridge techniques for arthroscopic lateral meniscal allograft transplantation (MAT).
Methods:
This retrospective matched cohort study included 72 patients who underwent lateral MAT performed by a single surgeon between 2012 and 2017 (36 using the bone-plug technique and 36 using the bone-bridge technique). Graft extrusion and positioning were assessed using magnetic resonance imaging (MRI) 1 year postoperatively. Functional outcomes (Lysholm and Tegner scores), radiographic osteoarthritis progression (Kellgren-Lawrence grade), operative time and second-look arthroscopic graft healing were also evaluated. Statistical comparisons were performed using the Student's t-test and Fisher's exact test.
Results:
The bone-plug group demonstrated significantly less meniscal extrusion (1.9 ± 0.9 mm vs. 4.1 ± 1.4 mm, p < 0.001); lower percentage of extrusion (17.2% ± 8.2% vs. 34.8% ± 17.3%, p < 0.001); lower axial obliquity angle (7.7° ± 4.3° vs. 13.9° ± 6.6°, p < 0.001); and shorter mean operative time (109.1 ± 7.2 min vs. 130.5 ± 23.4 min, p < 0.001) than the bone-bridge group. Final Lysholm and Tegner activity scores were comparable between the two groups (Lysholm: 90.8 ± 4.2 in the bone-plug group vs. 90.6 ± 4.9 in the bone-bridge group, p = 0.838; Tegner: median 7.0, [Interquartile range (IQR), 7.0-7.0] vs. 7.0 [IQR 6.0-7.0], p = 0.200). Radiographic osteoarthritis progression and graft healing on second-look arthroscopy (complete healing in all examined cases) showed no significant group differences (p = 0.245, p > 0.999, respectively).
Conclusions:
The bone-plug technique for lateral MAT showed improved graft positioning, reduced extrusion and shorter operative time compared with the bone-bridge technique, while achieving similar clinical outcomes, healing rates and osteoarthritis progression. Thus, it could be an effective and technically efficient alternative to lateral MAT.
Level Of Evidence:
Level III, retrospective comparative study.
