Prospective comparative study between two different fixation techniques in meniscal allograft transplantation

Wiley - Tập 21 - Trang 1516-1522 - 2012
Ferran Abat1, Pablo Eduardo Gelber1,2, Juan I. Erquicia2, Marc Tey2, Gemma Gonzalez-Lucena1, Juan Carlos Monllau1,2
1Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
2ICATME-Institut Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain

Tóm tắt

To compare the functional and radiographic results between two different horn fixation techniques for meniscal allograft transplant. This is a prospective study of 88 meniscal allograft transplants with a mean 5-year follow-up. Forty transplants were performed on the medial compartment and 48 on the lateral compartment. The same surgeon performed all surgeries. Thirty-three grafts were fixed only with sutures (Group A) and 55 only with bony fixation (Group B). Both groups were comparable in terms of age, laterality, time since meniscectomy and preoperative functional and radiographic status. Functional assessment was done with Lysholm and Tegner scores and the Visual Analogical Scale for pain. Joint space narrowing was evaluated in the Rosenberg view. There was a significant improvement in Lysholm, Tegner and VAS scores without differences between Group A and Group B (n.s.). Radiographic evaluation did not show any joint space narrowing (n.s.). No differences in the comparison of all the variables of the two compartments were found. There were complications in 33.3 % of patients in Group A that including 7 graft tears (21.4 %) and in which there was an allograft failure rate of 9 %. Group B showed complications in 16.4 % of the patients and included 4 graft tears (7.3 %, n.s.) with an allograft failure rate of 3.6 %. Meniscal allograft transplantation with either technique provided good functional and radiographic results at mid-term follow-up. Both graft fixation methods showed no differences relative to functional and radiographic results. There was a considerably higher rate of complications in transplantations performed with the only-suture technique than those with bony fixation, although the difference was not statistically significant with the numbers available. The results suggest that similar functional results should be expected whether the meniscal graft includes bone plugs or not. However, graft tears seem to happen more frequently if the MAT is performed without bony fixation. Prospective comparative study, Level II.

Tài liệu tham khảo

Alentorn-Geli E, Seijas Vázquez R, García Balletbó M, Alvarez Díaz P, Steinbacher G, Cuscó Segarra X, Rius Vilarrubia M, Cugat Bertomeu R (2011) Arthroscopic meniscal allograft transplantation without bone plugs. Knee Surg Sports Traumatol Arthrosc 19:174–182 Alhalki MM, Howell SM, Hull ML (1999) How three methods for fixing a medial meniscal autograft affect tibial contact mechanics. Am J Sports Med 27:320–328 Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL (2000) Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res 18:109–115 Bae JH, Lim HC, Kim HJ, Kim TS, Yang JH, Yoon JR (2010) Arthroscopic treatment of acute septic arthritis after meniscal allograft transplantation. Orthopedics 33. doi:10.3928/01477447-20100625-24 Buckland-Wright JC (1999) Radiographic assessment of osteoarthritis: comparison between existing methodologies. Osteoarthritis Cartilage 7:430–433 Chen MI, Branch TP, Hutton WC (1996) Is it important to secure the horns during lateral meniscal transplantation? A cadaveric study. Arthroscopy 12:174–181 Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19:147–157 Elliott DM, Jones R, Setton LA, Scully SP, Vail TP, Guilak F (2002) Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage. Knee Sports Traumatol Arthrosc 10:109–118 Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B:664–670 Gelber PE, Gonzalez G, Lloreta JL, Reina F, Caceres E, Monllau JC (2008) Freezing causes changes in the meniscus collagen net: a new ultrastructural meniscus disarray scale. Knee Surg Sports Traumatol Arthrosc 16:353–359 González-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC (2010) Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients. Arthroscopy 26:1633–1640 Ha JK, Sung JH, Shim JC, Seo JG, Kim JG (2011) Medial meniscus allograft transplantation using a modified bone plug technique: clinical, radiologic, and arthroscopic results. Arthroscopy 27:944–950 Hale CA, Fleiss JL (1993) Interval estimation under two study designs for kappa with binary classifications. Biometrics 49:523–534 Hergan D, Thut D, Sherman O, Day MS, Phil M (2011) Meniscal allograft transplantation. Arthroscopy 27:101–112 Hommen JP, Applegate GR, Del Pizzo W (2007) Meniscus allograft transplantation: ten-year results of cryopreserved allografts. Arthroscopy 23:388–393 Hunt S, Kaplan K, Ishak C, Kummer FJ, Meislin E (2008) Bone plug versus suture fixation of the posterior horn in medial meniscal allograft transplantation: a biomechanical study. Bull NYU Hosp Jt Dis 66:22–26 Jung YH, Choi NH, Victoroff BN (2011) Arthroscopic stabilization of the lateral capsule of the knee in meniscal transplantation. Knee Surg Sports Traumatol Arthrosc 19:189–191 LaPrade RF, Wills NJ, Spiridonov SI, Perkinson S (2010) A prospective outcomes study of meniscal allograft transplantation. Am J Sports Med 38:1804–1812 Lubowitz JH, Verdonk PC, Reid JB 3rd, Verdonk R (2007) Meniscus allograft transplantation: a current concepts review. Knee Surg Sports Traumatol Arthrosc 15:476–492 Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Bonanzinga T, Nitri M, Bondi A, Molinari M, Rimondi E (2012) Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study. Am J Sports Med 40:395–403 Matava MJ (2007) Meniscal allograft transplantation: a systematic review. Clin Orthop Relat Res 455:142–157 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 16:553–560 Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13:1–11 Noyes FR, Barber-Westin SD, Rankin M (2005) Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 87(Suppl 1):149–165 Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11:684–687 Rijk PC, Van Noorden CJF (2002) Structural analysis of meniscal allografts after immediate and delayed transplantation in rabbits. Arthroscopy 18:995–1001 Sekiya JK, Giffin JR, Irrgang JJ, Fu FH, Harner CD (2003) Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction. Am J Sports Med 31:896–906 Spang JT, Dang AB, Mazzocca A, Rincon L, Obopilwe E, Beynnon B, Arciero RA (2010) The effect of medial meniscectomy and meniscal allograft transplantation on knee and anterior cruciate ligament biomechanics. Arthroscopy 26:192–201 Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL (2000) Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients. Arthroscopy 16:343–347 Szomor ZL, Martin TE, Bonar F, Murrell GA (2000) The protective effects of meniscal transplantation on cartilage. An experimental study in sheep. J Bone Joint Surg Am 82:80–88 Tengrootenhuysen M, Meermans G, Pittoors K, van Riet R, Victor J (2011) Long-term outcome after meniscal repair. Knee Surg Sports Traumatol Arthrosc 19:236–241 van Arkel ER, de Boer HH (2002) Survival analysis of human meniscal transplantations. J Bone Joint Surg Br 84:227–231 van der Wal RJ, Thomassen BJ, van Arkel ER (2009) Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med 37:2134–2139 Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2005) Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am 87:715–724 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 Vundelinckx B, Bellemans J, Vanlauwe J (2010) Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sport Med 38:2240–2247 Wirth CJ, von Lewinski G (2004) Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study. Arthroscopy 20:782–783 Yoldas EA, Sekiya JK, Irrgang JJ, Fu FH, Harner CD (2003) Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 11:173–182 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 Zhang H, Liu X, Wei Y, Hong L, Geng XS, Wang XS, Zhang J, Cheng KB, Feng H (2012) Meniscal allograft transplantation in isolated and combined surgery. Knee Surg Sports Traumatol Arthrosc 20:281–289