Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Traumatology, Semmelweis University, Budapest, Hungary.
Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Sports Medicine Center Funabashi Orthopedic Hospital, Funabashi, Japan.
Arthroscopy. 2019 Jun;35(6):1658-1666. doi: 10.1016/j.arthro.2018.11.063. Epub 2019 Apr 9.
To assess and compare meniscal extrusion rates after lateral "bridge-in-slot" meniscal allograft transplantation (MAT) with arthroscopic versus open insertion.
In this review of prospectively collected data, we analyzed data from patients who underwent arthroscopic or open lateral MAT. Patients who underwent concomitant distal femoral osteotomy, for whom 1-year postoperative magnetic resonance imaging was unavailable, or who underwent open lateral MAT without the use of transosseous sutures were excluded. Meniscal extrusion in the included patients was assessed by 2 independent examiners by measuring the absolute value and the relative percentage of extrusion on 1.5-T magnetic resonance images at 1-year follow-up. The number of MATs with radial displacement larger or smaller than 3 mm was determined.
A total of 20 patients met the inclusion criteria, of whom 10 underwent arthroscopic and 10 underwent open lateral MAT. No statistically significant differences were found in baseline demographic data. Absolute meniscal extrusion was similar between the groups (P = .091). A significantly larger relative percentage of extrusion (arthroscopic MAT, 31 ± 27 mm; open MAT, 10 ± 29 mm; 95% confidence interval, -0.4 to -0.02 mm; P = .03) and a significantly higher extrusion rate were found in patients treated with arthroscopic MAT than in those treated with open MAT (>3 mm in 5 patients [50%] with arthroscopic MAT and 0 patients with open MAT, P = .01).
This study identified similar absolute extrusion and significantly lower postoperative lateral meniscal extrusion rates after open MAT compared with arthroscopic MAT. Transosseous fixation of the meniscal body appears protective against meniscal extrusion after MAT.
Level III, case-control study.
评估并比较关节镜下与开放入路行外侧“桥接式”半月板同种异体移植（MAT）术后半月板外突率。
本前瞻性数据回顾性分析中，我们分析了行关节镜或开放外侧 MAT 的患者数据。排除了同期行股骨远端截骨术、1 年随访时缺乏术后磁共振成像（MRI）或行开放外侧 MAT 但未使用经骨缝线的患者。纳入患者的半月板外突通过 1.5-T MRI 在 1 年随访时测量绝对值和外突相对百分比，由 2 位独立的检查者评估。确定 MAT 中存在大于或小于 3 mm 径向移位的数量。
共 20 例患者符合纳入标准，其中 10 例行关节镜下外侧 MAT，10 例行开放外侧 MAT。两组患者的基线人口统计学数据无统计学差异。两组间半月板外突绝对值无显著差异（P=.091）。关节镜 MAT 组的相对外突百分比（31±27 mm）显著大于开放 MAT 组（10±29 mm；95%置信区间，-0.4 至 -0.02 mm；P=.03），且关节镜 MAT 组的外突率（5 例[50%]患者的外突大于 3 mm 与开放 MAT 组 0 例患者，P=.01）显著更高。
本研究发现，与关节镜 MAT 相比，开放 MAT 术后外侧半月板外突的绝对外突值相似，但术后外侧半月板外突率显著更低。半月板体部的经骨固定似乎对 MAT 后半月板外突有保护作用。
III 级，病例对照研究。
