Department of Orthopedic Surgery, Inje University, College of Medicine, Pusan Paik Hospital, Pusan, Korea.
Am J Sports Med. 2011 Sep;39(9):1960-7. doi: 10.1177/0363546511410027. Epub 2011 Jun 23.
Although numerous studies have reported outcomes of meniscus allograft transplantation, only a few dealt with isolated procedures or employed objective evaluation methods.
Isolated lateral meniscus allograft transplantation (LMAT) provides clinical improvements and favorable objective results in symptomatic lateral meniscus-deficient knees.
Case series; Level of evidence, 4.
The authors collected and analyzed the results of 29 consecutive isolated LMATs with a minimum of 24 months' follow-up. The mean age of the patients was 29.6 years (range, 18-48 years). The modified Lysholm scoring system and the Hospital for Special Surgery score were used to evaluate subjective improvements. Every patient underwent postoperative magnetic resonance imaging (MRI) or second-look arthroscopy or both as objective evaluation. The allograft extrusion and relative percentage of extrusion (RPE) was measured on final MRI. Status of the allograft was classified according to the above 3 categories into 3 grades; satisfactory, fair, or poor.
The average length of follow-up was 53.6 months. Symptoms and functions of the involved knee improved in 28 knees (96.6%) at the last follow-up. The average preoperative modified Lysholm score was 69.5, which increased to 89.9 postoperatively (P < .001). The average preoperative Hospital for Special Surgery pain score was 15.3, which increased to 26.7 postoperatively (P < .001). Postoperative MRI alone was performed in 22 knees (75.9%), second-look arthroscopy alone in 1 knee (3.4%), and both examinations in 6 knees (20.7%). The MRI scans revealed 4 gross and 5 small tears in the allograft and also provided valuable information despite magnetic susceptibility artifacts. Mean allograft extrusion was 4.0 mm and mean RPE was 45.4%. At second-look arthroscopy, 3 gross tears and a small flap tear were identified in 4 cases. According to the clinical and the objective criteria, the allografts were graded as satisfactory in 20 cases (69.0%), fair in 5 cases (17.2%), and poor in 4 cases (13.8%).
The results of the present study showed remarkable symptomatic improvements and acceptable objective findings in short- to intermediate-term follow-up. Even in cases with favorable clinical results, MRI or second-look arthroscopy was necessary to identify the actual status of the allograft. Isolated LMAT could be an effective treatment for symptomatic, lateral meniscus-deficient knees.
虽然有许多研究报告了半月板同种异体移植的结果，但只有少数研究涉及单纯的手术或采用客观的评估方法。
单纯外侧半月板同种异体移植（LMAT）可改善症状性外侧半月板缺失膝关节的临床效果，并提供良好的客观结果。
病例系列；证据水平，4 级。
作者收集并分析了 29 例连续接受单纯外侧半月板同种异体移植且随访时间至少 24 个月的患者的结果。患者的平均年龄为 29.6 岁（18~48 岁）。采用改良 Lysholm 评分系统和纽约特种外科医院（HSS）评分评估主观改善情况。每位患者术后均行 MRI 或再次关节镜检查或两者均行客观评估。最后一次 MRI 测量移植物挤出和挤出相对百分比（RPE）。根据上述 3 种情况，将移植物的状态分为 3 个等级：满意、一般和差。
平均随访时间为 53.6 个月。28 例（96.6%）膝关节的症状和功能在最后一次随访时得到改善。术前改良 Lysholm 评分平均为 69.5，术后增加至 89.9（P<.001）。术前 HSS 疼痛评分平均为 15.3，术后增加至 26.7（P<.001）。22 例（75.9%）仅行术后 MRI，1 例（3.4%）仅行再次关节镜检查，6 例（20.7%）两者均行。MRI 扫描显示移植物有 4 处大撕裂和 5 处小撕裂，尽管存在磁敏感伪影，但仍提供了有价值的信息。平均移植物挤出量为 4.0mm，平均 RPE 为 45.4%。再次关节镜检查时，4 例发现 3 处大撕裂和 1 处小瓣撕裂。根据临床和客观标准，20 例（69.0%）移植物评为满意，5 例（17.2%）一般，4 例（13.8%）差。
本研究结果显示，短期至中期随访时症状显著改善，客观结果可接受。即使临床结果良好，仍需要 MRI 或再次关节镜检查来确定移植物的实际情况。单纯外侧半月板同种异体移植可能是治疗症状性外侧半月板缺失膝关节的有效方法。
