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The immediate meniscal allograft transplantation achieved better chondroprotection and less meniscus degeneration than the conventional delayed transplantation in the long-term

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the long-term clinical and radiological outcomes between the immediate and delayed meniscus allograft transplantation (MAT).

Methods

Nine menisci were transplanted immediately after total meniscectomy (immediate group, IM), and 10 menisci were delayed transplanted in patients with the median of 35 months (range 9–92 months) after total meniscectomy (delayed group, DE). Patient’s subjective clinical outcomes including VAS, IKDC, Lysholm and Tegner scores as well as muscle strength measures were compared. Joint degeneration was evaluated by both radiographs to assess joint space width narrowing, Kellegren–Lawrence (KL) grade and MRI with T2 mapping sequences to quantitatively analyze both cartilage and meniscal allograft degeneration.

Results

The median follow-up time was 10.8 years (range 10–14 years). The IKDC (IM vs DE, 89.8 vs 80.9, n.s.) and Lysholm scores (IM vs DE, 87.7 vs 78.0, n.s.) were close in two groups, while the IM group showed slightly lower VAS (IM vs DE, 0.2 vs 1.5, p = 0.031), higher Tegner score (IM vs DE, 7 vs 3.5 p = 0.021) and better quadriceps muscle strength. The IM group had less joint space narrowing (IM vs DE, 0.35 mm vs 0.71 mm, n.s.), less KL grade progression (IM vs DE, 0.6 vs 1.7, p = 0.041) on radiographs and less chondral lesions development on MRIs (Cartilage Degeneration Index, IM vs DE, 252 vs 2038, p = 0.025). All meniscal grafts exhibited degeneration by showing grade 3 signal on MRI, and 4 (4/9) in the IM group and 8 (8/10) cases in the DE group. The T2 value of cartilage and meniscal allograft in the IM group was close to that of the healthy control and was significantly lower than that of the DE group.

Conclusion

Compared to the conventional delayed MAT, the immediate MAT achieved better cartilage and meniscus protection in the long-term, while its superiority in patient-reported outcomes was limited.

Level of evidence

IV.

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Funding

National Natural Science Foundation of China (51920105006 and 81630056).

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Author notes

  1. First authors: Ding-yu Wang and Cassandra A. Lee.

Authors and Affiliations

  1. Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People’s Republic of China

    Ding-yu Wang, Bo Zhang, Yan-zhang Li, Xiang-yu Meng, Dong Jiang & Jia-kuo Yu

  2. Institute of Sports Medicine of Peking University, Beijing, 100191, People’s Republic of China

    Ding-yu Wang, Bo Zhang, Yan-zhang Li, Xiang-yu Meng, Dong Jiang & Jia-kuo Yu

  3. Department of Orthopedic Surgery, Sports Medicine and Arthroscopy, University of California at Davis, Sacramento, CA, 95816, USA

    Cassandra A. Lee

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Contributions

DW: design the study, follow-up the patients and write the manuscript. CAL: write the manuscript. BZ: follow-up the patients. YL: follow-up the patients. XM: follow-up the patients. DJ: design the study, analyze the results. JY: design the study, analyze the results.

Corresponding authors

Correspondence to Dong Jiang or Jia-kuo Yu.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of our hospital approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Wang, Dy., Lee, C.A., Zhang, B. et al. The immediate meniscal allograft transplantation achieved better chondroprotection and less meniscus degeneration than the conventional delayed transplantation in the long-term. Knee Surg Sports Traumatol Arthrosc 30, 3708–3717 (2022). https://doi.org/10.1007/s00167-022-06982-9

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