Song Ju-Ho, Bin Seong-Il, Kim Jong-Min, Lee Bum-Sik, Lee Chang-Rack
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Inje University, Busan Paik Hospital, Busan, Republic of Korea.
Am J Sports Med. 2020 May;48(6):1374-1378. doi: 10.1177/0363546520914592. Epub 2020 Apr 7.
Factors associated with graft survival after lateral meniscal allograft transplantation (MAT) have not been fully determined, and survival analysis focused on effect of varus alignment has not been performed.
Varus alignment of the knee leads to better graft survival and clinical outcomes after lateral MAT than normal alignment.
Cohort study; Level of evidence, 2.
The records of 204 consecutive patients who underwent lateral MAT were reviewed. After exclusion of cases undergoing revision MAT, cases without hip-knee-ankle standing radiographs, and cases with valgus alignment, the patients were categorized into 2 groups, those with normal alignment within -3° to 3° of the mechanical axis and those with varus alignment >3°. Cumulative graft survival rates were compared in the 2 groups before and after controlling for other covariates, including sex, age, body mass index (BMI), time from meniscectomy, the number of accompanying procedures, and cartilage status. Failure was defined as (1) a graft tear involving >50% or unstable peripheral rim of the allograft; (2) a Lysholm score <65 that was not improved afterward; (3) meniscectomy >50% or to the zone of meniscocapsular junction; or (4) conversion to revision MAT, realignment osteotomy, or arthroplasty. Clinical outcomes were compared between the 2 groups by Lysholm score.
Of the 190 patients, 149 showed normal alignment of 0.3° ± 1.3° (range, -3° to 3°) and 41 showed varus alignment of 4.8° ± 0.6° (range, 4°-8°). A total of 22 patients (11.6%) experienced MAT failure: 21 patients with normal alignment and 1 with varus alignment. Kaplan-Meier survival analysis showed a significant difference in the cumulative graft survival rates between the 2 groups (log-rank test, = .001). After controlling for age, sex, BMI, time from meniscectomy, the number of accompanying procedures, and cartilage status, varus alignment was found to be a significant protective factor ( = .004). On the other hand, there was no difference in clinical improvement measured by the Lysholm score between the 2 groups ( = .651).
Varus alignment was associated with better graft survival after lateral MAT than normal alignment. However, no significant differences in clinical outcomes were observed.
外侧半月板同种异体移植（MAT）后与移植物存活相关的因素尚未完全明确，且尚未进行聚焦于内翻对线影响的存活分析。
膝关节内翻对线相比于正常对线，可使外侧MAT术后移植物存活及临床疗效更佳。
队列研究；证据等级，2级。
回顾204例连续接受外侧MAT患者的记录。排除接受MAT翻修术的病例、无髋-膝-踝站立位X线片的病例以及外翻对线的病例后，将患者分为两组，机械轴在-3°至3°以内的正常对线组和内翻对线大于3°的组。在控制包括性别、年龄、体重指数（BMI）、半月板切除术后时间、伴随手术数量及软骨状态等其他协变量前后，比较两组的移植物累积存活率。失败定义为：（1）移植物撕裂累及同种异体移植物>50%或不稳定的外周缘；（2）Lysholm评分<65且术后未改善；（3）半月板切除术>50%或至半月板-关节囊交界处区域；或（4）转为MAT翻修术、重新对线截骨术或关节成形术。通过Lysholm评分比较两组的临床疗效。
190例患者中，149例显示正常对线，为0.3°±1.3°（范围，-3°至3°），41例显示内翻对线，为4.8°±0.6°（范围，4°-8°）。共有22例患者（11.6%）经历MAT失败：21例正常对线患者和1例内翻对线患者。Kaplan-Meier存活分析显示两组的移植物累积存活率存在显著差异（对数秩检验，P = .001）。在控制年龄、性别、BMI、半月板切除术后时间、伴随手术数量及软骨状态后，发现内翻对线是一个显著的保护因素（P = .004）。另一方面，两组间通过Lysholm评分衡量的临床改善情况无差异（P = .651）。
外侧MAT术后，内翻对线相比于正常对线与更好的移植物存活相关。然而，未观察到临床疗效有显著差异。
