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Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

This study aimed to investigate the graft maturation and safety of single-incision bone bridge lateral meniscus allograft transplantation (LMAT).

Methods

This study involved 35 patients who underwent LMAT between 2019 and 2020. All patients completed at least 2 years of follow-up (median 34 months; range 24–43) and underwent preoperative magnetic resonance imaging (MRI) to assess the trajectory safety of the leading suture passer and all-inside suture instrument (Fast-Fix). Graft status was evaluated according to the Stoller classification.

Results

Based on preoperative MRI measurements, the expected trajectory of the leading suture passer did not transect the common peroneal nerve (CPN), with the closest distance between the expected trajectory and CPN being 1.4 mm and the average distance being 6.8 ± 3.2 mm. The average distance from the lateral meniscal posterior horn (LMPH) to the popliteal neurovascular bundle (PNVB) was 7.4 ± 2.6 mm and the nearest was 4.8 mm. The expected trajectory of the all-inside suturing instrument did not transect the PNVB when the distance was at least 12 mm, from the most lateral margin of the posterior cruciate ligament (PCL). Grade 3 signal intensity in the posterior third of the allograft on MRI was observed in 6 of 35 (17.1%) patients. Amongst the grade 3 signal intensities in the posterior one-third of the allografts, 3 of the 35 (8.5%) LMATs had a distorted contour.

Conclusion

The single-incision bone bridge LMAT technique introduced in this study is a convenient approach that preserves neurovascular safety and provides good results for the distortion of the posterior horn of the allograft and graft maturation. The safety zone for the penetrating devices during the procedure extended from 12 mm laterally to the most lateral margin of the PCL to the medial margin of the popliteal hiatus.

Level of evidence

IV.

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Data availability

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Smith & Nephew for providing funding.

Funding

Funding for study was provided by Smith & Nephew.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Myongji Hospital, 55, Hwasu-Ro 14Beon-Gil, Deogyang-Gu, Goyang-Si, Gyeonggi-Do, 10475, South Korea

    JiHwan Lee, Tae Hyun Kyeong, Jung Wook Lee & Jin Goo Kim

  2. Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, South Korea

    Dhong Won Lee

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Contributions

JHL carried out the figures and tables and coordination to draft the manuscript. DWL participated in the design of the study, and helped to draft the manuscript. THK and JWL carried out the measurement of MRI image and performed statistical analysis. JGK conceived of the study, and participated in discussion and helped to draft the manuscript.

Corresponding author

Correspondence to Jin Goo Kim.

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Conflict of interest

The corresponding author (Jin Goo Kim) declares that he has received funding.

Ethical approval

This study was approved by the institutional review board of the authors’ institution (MJH 2023-02-021), and was conducted in accordance with the tenets of Declaration of Helsinki.

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

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Lee, J., Lee, D.W., Kyeong, T.H. et al. Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07641-3

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