Skip to main content
SpringerLink
Log in

Various factors contribute to graft extrusion in lateral meniscus allograft transplantation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Lateral meniscus allograft transplantation (LMAT) is a feasible surgical option for young meniscus-deficient patients. Although several studies have explored the factors that contribute to graft extrusion, they have not been fully elucidated. The aim of this study was to determine the various factors that contribute to graft extrusion.

Methods

Patients with knees that had received LMAT using a keyhole technique (n = 87 knees in 82 patients) were reviewed. The median age of these patients was 22 years (range 19–54 years), and the median postprocedural follow-up interval was 5 days (range 1–136 days). Twelve magnetic resonance imaging (MRI) measurement parameters (axial and coronal location of the bone block) that could potentially influence graft extrusion were evaluated, along with absolute graft extrusion and relative percentage of extrusion (RPE).

Results

A significant correlation was found between 8 of the 12 MRI measurement parameters and both the absolute extrusion and RPE (r = 0.241–0.438, p < 0.05). The absolute middle distance and depth of the bone block were independent predictors of the absolute extrusion (β = 0.30 and 0.15, respectively; p < 0.05), and the relative middle distance and relative bone-block elevation were found to be predictors of RPE (β = 2.29 and 1.44, respectively; p < 0.05).

Conclusion

The rate of graft extrusions after LMAT was high in this study. Both the coronal and axial locations of the bone block were found to influence graft extrusion in LMAT. Therefore, correct positioning of the bone block, including in both the axial and coronal planes, is essential to minimize graft extrusion. Future studies need to investigate the long-term clinical outcome and longevity of extruded menisci after transplantation.

Level of evidence

Therapeutic case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Choi NH, Yoo SY, Victoroff BN (2011) Position of the bony bridge of lateral meniscal transplants can affect meniscal extrusion. Am J Sports Med 39:1955–1959

    Article  PubMed  Google Scholar 

  2. Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand 51:871–879

    Article  CAS  PubMed  Google Scholar 

  3. Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG (2010) Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. Am J Sports Med 38:2448–2455

    Article  PubMed  Google Scholar 

  4. Henning CE, Lynch MA (1985) Current concepts of meniscal function and pathology. Clin Sports Med 4:259–265

    CAS  PubMed  Google Scholar 

  5. Kim CW, Kim JM, Lee SH, Kim JH, Huang J, Kim KA, Bin SI (2011) Results of isolated lateral meniscus allograft transplantation: focus on objective evaluations with magnetic resonance imaging. Am J Sports Med 39:1960–1967

    Article  PubMed  Google Scholar 

  6. Kim JM, Lee BS, Kim KH, Kim KA, Bin SI (2012) Results of meniscus allograft transplantation using bone fixation: 110 cases with objective evaluation. Am J Sports Med 40:1027–1034

    Article  PubMed  Google Scholar 

  7. Kurosawa H, Fukubayashi T, Nakajima H (1980) Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res 149:283–290

    Google Scholar 

  8. Lee DH, Kim JM, Jeon JH, Cha EJ, Bin SI (2015) Effect of sagittal allograft position on coronal extrusion in lateral meniscus allograft transplantation. Arthroscopy 31:266–274

    Article  PubMed  Google Scholar 

  9. Lee DH, Kim JM, Lee BS, Kim KA, Bin SI (2012) Greater axial trough obliquity increases the risk of graft extrusion in lateral meniscus allograft transplantation. Am J Sports Med 40:1597–1605

    Article  PubMed  Google Scholar 

  10. Lee DH, Kim TH, Lee SH, Kim CW, Kim JM, Bin SI (2008) Evaluation of meniscus allograft transplantation with serial magnetic resonance imaging during the first postoperative year: focus on graft extrusion. Arthroscopy 24:1115–1121

    Article  PubMed  Google Scholar 

  11. Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13:1–11

    CAS  PubMed  Google Scholar 

  12. Northmore-Ball MD, Dandy DJ, Jackson RW (1983) Arthroscopic, open partial, and total meniscectomy. A comparative study. J Bone Joint Surg Br 65:400–404

    CAS  PubMed  Google Scholar 

  13. Noyes FR, Barber-Westin SD (2015) A systematic review of the incidence and clinical significance of postoperative meniscus transplant extrusion. Knee Surg Sports Traumatol Arthrosc 23:290–302

    Article  PubMed  Google Scholar 

  14. Noyes FR, Barber-Westin SD, Rankin M (2004) Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 86:1392–1404

    Article  PubMed  Google Scholar 

  15. Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11:684–687

    Article  CAS  PubMed  Google Scholar 

  16. Renstrom P, Johnson RJ (1990) Anatomy and biomechanics of the menisci. Clin Sports Med 9:523–538

    CAS  PubMed  Google Scholar 

  17. Rijk PC (2004) Meniscal allograft transplantation—part I: background, results, graft selection and preservation, and surgical considerations. Arthroscopy 20:728–743

    Article  PubMed  Google Scholar 

  18. Rodeo SA (2001) Meniscal allografts—where do we stand? Am J Sports Med 29:246–261

    CAS  PubMed  Google Scholar 

  19. Roumazeille T, Klouche S, Rousselin B, Bongiorno V, Graveleau N, Billot N, Hardy P (2015) Arthroscopic meniscal allograft transplantation with two tibia tunnels without bone plugs: evaluation of healing on MR arthrography and functional outcomes. Knee Surg Sports Traumatol Arthrosc 23:264–269

    Article  PubMed  Google Scholar 

  20. Samitier G, Alentorn-Geli E, Taylor DC, Rill B, Lock T, Moutzouros V, Kolowich P (2015) Meniscal allograft transplantation. Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation. Knee Surg Sports Traumatol Arthrosc 23:310–322

    Article  PubMed  Google Scholar 

  21. Samitier G, Alentorn-Geli E, Taylor DC, Rill B, Lock T, Moutzouros V, Kolowich P (2015) 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 23:323–333

    Article  PubMed  Google Scholar 

  22. Shaffer B, Kennedy S, Klimkiewicz J, Yao L (2000) Preoperative sizing of meniscal allografts in meniscus transplantation. Am J Sports Med 28:524–533

    CAS  PubMed  Google Scholar 

  23. Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2015) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3573-0

    Google Scholar 

  24. van Arkel ER, de Boer HH (1995) Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up. J Bone Joint Surg Br 77:589–595

    PubMed  Google Scholar 

  25. Verdonk PC, Verstraete KL, Almqvist KF, De Cuyper K, Veys EM, Verbruggen G, Verdonk R (2006) Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc 14:694–706

    Article  PubMed  Google Scholar 

  26. Voloshin AS, Wosk J (1983) Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng 5:157–161

    Article  CAS  PubMed  Google Scholar 

  27. Wilcox TR, Goble EM (1996) Indications for meniscal allograft reconstruction. Am J Knee Surg 9:35–36

    CAS  PubMed  Google Scholar 

  28. Yoon JR, Kim TS, Lee YM, Jang HW, Kim YC, Yang JH (2011) Transpatellar approach in lateral meniscal allograft transplantation using the keyhole method: can we prevent graft extrusion? Knee Surg Sports Traumatol Arthrosc 19:214–217

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, The Armed Forces Capital Hospital, 177 Saemael-ro, Bundang-gu, Sungnam, 13574, Republic of Korea

    Sang Yub Lee, Jaegu Yoon, Young Seo Cho, Rak Chae Son, Sung Kwan Kim, Sang Hyuk Ahn & Hyeon-Kyeong Lee

Authors
  1. Sang Yub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaegu Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Seo Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rak Chae Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sung Kwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sang Hyuk Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyeon-Kyeong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Yub Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.Y., Yoon, J., Cho, Y.S. et al. Various factors contribute to graft extrusion in lateral meniscus allograft transplantation. Knee Surg Sports Traumatol Arthrosc 25, 374–382 (2017). https://doi.org/10.1007/s00167-015-3882-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3882-3

Keywords

Search

Navigation