Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Arthroscopy. 2018 Dec;34(12):3216-3223. doi: 10.1016/j.arthro.2018.06.036. Epub 2018 Oct 3.
To evaluate whether fresh-frozen meniscal allograft shrinkage occurs only during the first year of the early remodeling period or progresses over the delayed period of midterm years and to determine whether these changes were associated with certain clinical and radiologic outcomes.
We retrospectively reviewed meniscal allograft transplantations (MATs) performed by 1 senior surgeon (S-I.B.) using fresh-frozen allograft from 2008 to 2013. The inclusion criteria were the patients who had midterm follow-up magnetic resonance imaging (MRI) scans between 3 and 6 years after isolated lateral MATs. We excluded the graft tears found on the 1-year or midterm MRI scans. MATs were indicated for the treatment persistent compartmental pain in young to middle-aged, physically active patients who had well-aligned nonarthritic joint without ligament insufficiency. The meniscal width of the transplants at the midbody and posterior horn was measured on day 2 (as a reference), at 1 year (after early remodeling period), and after 3 to 6 years (delayed period) postoperatively. Joint space width changes during each interval were measured on 45° flexion posteroanterior views. The Lysholm score and Tegner activity scale were used to evaluate clinical outcomes.
Eighty-four isolated lateral MATs with the midterm MRI scans were identified. Of these, 17 graft tears were found; therefore, we analyzed 67 patients (32 male and 35 female patients) with a mean age of 30.9 years (range, 15-52 years). The mean relative meniscal width at the midbody decreased to 93.7% (95% confidence interval [CI], 91.8%-95.6%; P < .001) at 1 year postoperatively and to 88.0% (95% CI, 85.6%-90.3%; P < .001) at the midterm follow-up of 4.0 ± 1.0 years. The posterior horn shrank less than the midbody during the same period (96.0%; 95% CI, 94.8%-97.1%) at 1 year (P < .001) and 92.5% (95% CI, 91.0%-94.1%) at the last follow-up (P < .001). Although there was no severe shrinkage (>50% of the initial size), the incidence of moderate (25%-50%) changes at the midbody increased from 1 (1.5%) at 1 year to 5 (7.5%) at the last follow-up, respectively. We could not find any significant positive correlations between the relative meniscal width and patient-reported outcomes or joint space width changes after 1 year or at the last follow-up.
Shrinkage of fresh-frozen meniscal transplants occurred during both the early remodeling and delayed midterm periods. Although the changes were greater in the midbody than in the posterior horn, the overall changes were less than those of the previous studies using cryopreserved grafts. We could not find that the meniscal shrinkage over the midterm period were significantly associated with inferior outcomes in this series.
Level IV, therapeutic case series.
评估新鲜冷冻半月板同种异体移植物的缩小仅发生在早期重塑期的第一年，还是在中期的延迟期内进展，并确定这些变化是否与某些临床和影像学结果相关。
我们回顾性地审查了 2008 年至 2013 年间由 1 位资深外科医生（S-I.B.）使用新鲜冷冻同种异体移植物进行的半月板同种异体移植（MAT）。纳入标准是在单独外侧 MAT 后 3 至 6 年有中期随访磁共振成像（MRI）检查的患者。我们排除了在 1 年或中期 MRI 扫描中发现的移植物撕裂。MAT 适用于治疗年轻至中年、身体活跃的患者持续的节段性疼痛，这些患者的关节排列良好，没有关节不稳。在第 2 天（作为参考）、术后 1 年（早期重塑期后）和 3 至 6 年后（延迟期），测量移植体中部和后角的半月板宽度。在 45°膝关节屈曲前后位片上测量每个间隔的关节间隙宽度变化。Lysholm 评分和 Tegner 活动量表用于评估临床结果。
确定了 84 例有中期 MRI 扫描的孤立外侧 MAT，其中 17 例移植物撕裂，因此我们分析了 67 例患者（32 名男性和 35 名女性），平均年龄为 30.9 岁（范围，15-52 岁）。术后 1 年，半月板中部的相对宽度平均减少至 93.7%（95%置信区间[CI]，91.8%-95.6%；P<0.001），在 4.0±1.0 年的中期随访时降至 88.0%（95%CI，85.6%-90.3%；P<0.001）。同一时期，后角的缩小小于中部（术后 1 年为 96.0%[95%CI，94.8%-97.1%]；P<0.001）和最后一次随访时为 92.5%（95%CI，91.0%-94.1%；P<0.001）。虽然没有严重的缩小（>50%的初始大小），但中部中度（25%-50%）变化的发生率从 1 年时的 1（1.5%）增加到最后一次随访时的 5（7.5%）。我们在术后 1 年或最后一次随访时均未发现相对半月板宽度与患者报告的结果或关节间隙宽度变化之间存在任何显著的正相关关系。
新鲜冷冻半月板移植物的缩小发生在早期重塑和中期延迟两个时期。虽然中部的变化大于后角，但总体变化小于以前使用冷冻保存移植物的研究。在本系列中，我们无法发现中期的半月板缩小与较差的结果有显著相关性。
IV 级，治疗性病例系列。
