Abstract
Purpose
This study aimed to evaluate graft survivorship according to the size and location of chondral defects and its effect on clinical outcomes after meniscal allograft transplantation (MAT). It was hypothesized that large chondral defects would be associated with inferior outcomes.
Methods
Patients who underwent lateral MAT with fresh-frozen allografts between 2007 and 2016 were retrospectively reviewed. The inclusion criteria were patients with femoral or tibial chondral defects (International Cartilage Repair Society grade 4) who were followed up more than 2 years with 3.0-T magnetic resonance imaging (MRI) scans. Maximal lesion diameter and location were assessed on MRI. The patients were divided into two groups, with chondral defects of < 3 and ≥ 3 cm2 on the tibial side. Graft survivorship was compared between the two groups. Graft failure was defined as revisional MAT, meniscal tear or meniscectomy greater than one-third of the allograft on MRI. Clinical outcomes were evaluated using the modified Lysholm score.
Results
Twenty-eight knees in 26 patients (mean age 37.4 ± 10.3 years) with a mean follow-up of 3.6 ± 1.0 (range 2.0–5.4) years were identified. Nineteen knees in 17 patients had both femoral and tibial chondral defects, 7 knees in 7 patients had only femoral chondral defects, and 2 knees in 2 patients had only tibial chondral defects. The mean preoperative femoral and tibial chondral defect sizes were 1.7 ± 1.2 and 3.0 ± 1.4 cm2, respectively. Among the seven graft failures, no graft failure occurred in the cases with tibial chondral defects of < 3 cm2. Tibial chondral defects of ≥ 3 cm2 were significantly associated with graft failure (P = 0.004; odds ratio 28.3; 95% confidence interval 2.5–4006.7). Defects of < 3 cm2 were located primarily in the posterior aspect of the lateral tibial plateau, and most lesions were covered by allograft (7/9, 77.8%). The modified Lysholm scores significantly improved irrespective of chondral defects size (P < 0.001).
Conclusions
Larger chondral defects, more than 3 cm2 on the tibial side, were associated with inferior graft survivorship but did not influence the clinical outcomes after MAT at the 3.6-year follow-up. Chondral defect location was associated with defect size.
Level of evidence
IV.
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References
Bloch B, Asplin L, Smith N, Thompson P, Spalding T (2019) Higher survivorship following meniscal allograft transplantation in less worn knees justifies earlier referral for symptomatic patients: experience from 240 patients. Knee Surg Sports Traumatol Arthrosc 27(6):1891–1899
Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85-A(Suppl 2):58–69
Campbell AB, Knopp MV, Kolovich GP, Wei W, Jia G, Siston RA, Flanigan DC (2013) Preoperative MRI underestimates articular cartilage defect size compared with findings at arthroscopic knee surgery. Am J Sports Med 41(3):590–595
Hangody L, Vasarhelyi G, Hangody LR, Sukosd Z, Tibay G, Bartha L, Bodo G (2008) Autologous osteochondral grafting—technique and long-term results. Injury 39(Suppl 1):S32–39
Hergan D, Thut D, Sherman O, Day MS (2011) Meniscal allograft transplantation. Arthroscopy 27(1):101–112
Hommen JP, Applegate GR, Del Pizzo W (2007) Meniscus allograft transplantation: ten-year results of cryopreserved allografts. Arthroscopy 23(4):388–393
Jakob RP, Franz T, Gautier E, Mainil-Varlet P (2002) Autologous osteochondral grafting in the knee: indication, results, and reflections. Clin Orthop Relat Res 401:170–184
Kempshall PJ, Parkinson B, Thomas M, Robb C, Standell H, Getgood A, Spalding T (2015) Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication. Knee Surg Sports Traumatol Arthrosc 23(1):280–289
Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Jt Surg Am 89(10):2105–2112
Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14(11):1119–1125
Lee BS, Kim JM, Sohn DW, Bin SI (2013) Review of meniscal allograft transplantation focusing on long-term results and evaluation methods. Knee Surg Relat Res 25(1):1–6
Lee BS, Bin SI, Kim JM, Kim JH, Han GW (2016) Proper cartilage status for meniscal allograft transplantation cannot be accurately determined by patient symptoms. Am J Sports Med 44(3):646–651
Lee BS, Bin SI, Kim JM, Kim WK, Choi JW (2017) Survivorship after meniscal allograft transplantation according to articular cartilage status. Am J Sports Med 45(5):1095–1101
Mahmoud A, Young J, Bullock-Saxton J, Myers P (2018) Meniscal allograft transplantation: the effect of cartilage status on survivorship and clinical outcome. Arthroscopy 34(6):1871–1876
McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Jt Surg Br 88(12):1549–1556
McDermott ID, Lie DT, Edwards A, Bull AM, Amis AA (2008) The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures. Knee Surg Sports Traumatol Arthrosc 16(6):553–560
Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063
Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11(6):684–687
Rosso F, Bisicchia S, Bonasia DE, Amendola A (2015) Meniscal allograft transplantation: a systematic review. Am J Sports Med 43(4):998–1007
Saltzman BM, Meyer MA, Leroux TS, Gilelis ME, Debot M, Yanke AB, Cole BJ (2018) The influence of full-thickness chondral defects on outcomes following meniscal allograft transplantation: a comparative study. Arthroscopy 34(2):519–529
Slauterbeck JR, Kousa P, Clifton BC, Naud S, Tourville TW, Johnson RJ, Beynnon BD (2009) Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Jt Surg Am 91(9):2094–2103
Smith NA, MacKay N, Costa M, Spalding T (2015) Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(1):270–279
Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 24(9):2923–2935
Stone KR, Pelsis JR, Surrette ST, Walgenbach AW, Turek TJ (2015) Meniscus transplantation in an active population with moderate to severe cartilage damage. Knee Surg Sports Traumatol Arthrosc 23(1):251–257
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Vundelinckx B, Vanlauwe J, Bellemans J (2014) Long-term subjective, clinical, and radiographic outcome evaluation of meniscal allograft transplantation in the knee. Am J Sports Med 42(7):1592–1599
Waugh N, Mistry H, Metcalfe A, Loveman E, Colquitt J, Royle P, Smith NA, Spalding T (2019) Meniscal allograft transplantation after meniscectomy: clinical effectiveness and cost-effectiveness. Knee Surg Sports Traumatol Arthrosc 27(6):1825–1839
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Ethical approval for the present study was obtained from the institutional review board of Asan Medical Center (AMC IRB No. 2018-1237).
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Park, JG., Bin, SI., Kim, JM. et al. Large chondral defect not covered by meniscal allograft is associated with inferior graft survivorship after lateral meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 29, 82–89 (2021). https://doi.org/10.1007/s00167-019-05713-x
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DOI: https://doi.org/10.1007/s00167-019-05713-x