Survivorship After Meniscal Allograft Transplantation According To Articular Cartilage Status

Transcription

1 # Survivorship After Meniscal Allograft Transplantation According To Articular Cartilage Status Jun-Gu Park, Seong-Il Bin, Jong-Min Kim, Bum Sik Lee Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea

2 Disclosure All authors have no financial conflicts to disclose.

3 Introduction Traditionally, to achieve good outcomes, MAT is indicated for symptomatic meniscectomized knees with intact articular cartilage. Clinical outcomes after meniscal allograft transplantation(mat) in arthritis knees are unclear. Objective estimates of graft survival according to the articular cartilage status have not been performed.

4 Purpose We compared graft survivorship between low-grade and high-grade chondral lesions by using MRI and/or second-look arthroscopic surgery, in addition to clinical graft survivorship, which was determined by poor functional scores

5 Hypothesis We hypothesized that the clinical success rate would be comparable between the groups but that graft survivorship would be poorer in knees with high-grade chondral damage.

6 Materials & Methods Period : 2008 ~ 2013, Patients : 222 patients who underwent primary MAT by a single senior surgeon Medial meniscus : double bone plug technique Lateral meniscus : Keyhole technique Clinical outcomes ; modified Lysholm scores : Poor( <65) Defined as Clinical failures Objective evaluations ; MRI and 2 nd look A/S : Meniscal tear or meniscectomy of greater than 1/3 of the allograft Graft failure

7 Materials & Methods Comparing clinical outcomes and graft survivorship between 3 Groups 3 Groups : According to the degree and articular cartilage degeneration Ideal indication ICRS grade 2 on both femoral and tibial sides Relative indication ICRS grade 3 on either femoral or tibial sides Salvage indication ICRS grade 3 on both sides

8 Results Overall clinical outcomes (mean 44.6 ± 19.7 mo) Lysholm scores ; 63.1 ± ± 14.3 (P < 0.001) No difference between the 3 groups(p = 0.877) Ideal group; 85.7 ± 14.2 / Relative group; 84.7 ± 17.0 / Salvage group; 84.7 ± 14.2 ICRS Grade Category a Low grade on both sides High grade on either side High grade on both sides No. of Patients Clinical Failure, n (%) Clinical Evaluation Estimated Cumulative 5- y Survival Rate, %(95% CI) Graft Failure, n (%) Objective Evaluation Estimated Cumulative 5- y Survival Rate, %(95% CI) 87 6 (6.9) 91.1 ( ) 5 (5.7) 93.8 ( ) (13.5) 82.0 ( ) 6 (8.1) 90.9 ( ) No Different Clinical Outcomes 61 3 (4.9) 93.5 ( ) 14 (23.0) 62.2 ( ) Overall (8.6) 88.3 ( ) 25 (11.3) 83.5 ( ) a Low grade = International Cartilage Repair Society(ICRS) grade 0,1, or 2; high grade = ICRS grade 3 or 4.

9 Results No Different Clinical Survivals Significant Lower Graft Survival Clinical failure ( Lys < 65 ) Graft failure ( Tears > 1/3) Ideal ; Low-Gr Relative ; Unipolar High-Gr Salvage ; Bipolar High-Gr

10 Conclusions Our findings showed that MAT was an effective symptomatic treatment in knees with advanced bipolar chondral lesions. However, better graft survival can be expected when articular cartilage is intact or if chondral damage is limited to a unipolar lesion.

11 Conclusions MAT should be considered before the progression of chondral damage to a bipolar lesion for better graft survivorship and should be performed cautiously in arthritic knees.

12 References 1. Harris JD, Cavo M, Brophy R, Siston R, Flanigan D. Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy.2011;27(3): Hergan D, Thut D, Sherman O, Day MS. Meniscal allograft transplantation. Arthroscopy. 2011;27(1): Kempshall PJ, Parkinson B, Thomas M, et al. Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication. Knee Surg Sports Traumatol Arthrosc. 2015;23(1): Kim CW, Kim JM, Lee SH, et al. Results of isolated lateral meniscus allograft transplantation: focus on objective evaluations with magnetic resonance imaging. Am J Sports Med. 2011;39(9): Lee BS, Bin SI, Kim JM, Kim JH, Han GW. Proper cartilage status for meniscal allograft transplantation cannot be accurately determined by patient symptoms. Am J Sports Med. 2016;44(3): Lee BS, Chung JW, Kim JM, Kim KA, Bin SI. Width is a more important predictor in graft extrusion than length using plain radiographic sizing in lateral meniscal transplantation. Knee Surg Sports Traumatol Arthrosc. 2012;20(1): Lee BS, Kim JM, Sohn DW, Bin SI. Review of meniscal allograft transplantation focusing on long-term results and evaluation methods. Knee Surg Relat Res. 2013;25(1):1-6.