University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Am J Sports Med. 2020 Nov;48(13):3163-3169. doi: 10.1177/0363546520959316. Epub 2020 Oct 5.
Adverse effects of graft extrusion after meniscal allograft transplantation (MAT) are difficult to assess and can be determined only in the long term using a simple radiograph. Recently, subchondral bone marrow lesions (BMLs) detected on magnetic resonance imaging (MRI) scans have been used to evaluate the outcomes or prognoses of various knee surgeries. However, whether subchondral BMLs on MRI scans reflect the effects of allograft extrusion remains unclear.
Subchondral BML in the lateral compartment of the knee joint on postoperative MRI scans would be associated with graft extrusion after lateral MAT.
Case-control study; Level of evidence, 3.
Overall, 170 patients with lateral MAT between 2008 and 2013 were classified into extrusion (≥3 mm) and nonextrusion (<3 mm) groups based on findings on MRI scans obtained 3 to 6 months postoperatively. Subchondral BMLs in the lateral compartment were evaluated on the latest MRI scans. To exclude any bone marrow signal changes other than those caused by allograft extrusion, the latest MRI scans were compared with those obtained 3 to 6 months postoperatively. Only subchondral BMLs that occurred after that time point were counted. The association between allograft extrusion and subchondral BML was assessed using chi-square analysis. Logistic regression analysis was performed to control other related factors, including age, sex, body mass index, time from previous meniscectomy, alignment, and cartilage status at the time of MAT. Clinical outcomes according to subchondral BML were evaluated using the Lysholm score.
Of the 170 patients, 20 (11.8%) had subchondral BML on the latest MRI scans at a mean 53.6 ± 31.2 months postoperatively, with 14 and 6 patients in the extrusion and nonextrusion groups, respectively. Chi-square analysis showed a significant association between allograft extrusion and subchondral BMLs ( = .025). Logistic regression analysis showed that extrusion and age were significant factors associated with subchondral BML ( = .011 and .004, respectively). However, no differences were observed in the Lysholm scores in accordance with the subchondral BML ( = .248).
Subchondral BMLs on postoperative MRI scans were associated with graft extrusion after lateral MAT. However, there was no difference in clinical outcomes according to subchondral BML.
半月板同种异体移植（MAT）后移植物挤出的不良影响难以评估，只能通过简单的 X 光片长期确定。最近，磁共振成像（MRI）扫描中检测到的软骨下骨髓病变（BML）已被用于评估各种膝关节手术的结果或预后。然而，MRI 扫描上的软骨下 BML 是否反映移植物挤出仍不清楚。
膝关节外侧术后 MRI 扫描的外侧隔间的软骨下 BML 与外侧 MAT 后移植物挤出有关。
病例对照研究；证据水平，3 级。
总体而言，根据术后 3 至 6 个月 MRI 扫描结果，将 2008 年至 2013 年间进行外侧 MAT 的 170 例患者分为挤出（≥3mm）和未挤出（<3mm）组。在最新的 MRI 扫描中评估外侧隔间的软骨下 BML。为了排除除移植物挤出以外的任何骨髓信号变化，将最新的 MRI 扫描与术后 3 至 6 个月的 MRI 扫描进行比较。仅计算自那时起发生的软骨下 BML。使用卡方分析评估移植物挤出与软骨下 BML 之间的关联。使用逻辑回归分析控制其他相关因素，包括年龄、性别、体重指数、上次半月板切除术的时间、对线和 MAT 时的软骨状态。根据软骨下 BML 评估临床结果采用 Lysholm 评分。
在 170 例患者中，20 例（11.8%）在术后 53.6±31.2 个月的最新 MRI 扫描中出现软骨下 BML，挤出组和未挤出组分别为 14 例和 6 例。卡方分析显示移植物挤出与软骨下 BML 之间存在显著关联（=0.025）。逻辑回归分析显示，挤出和年龄是与软骨下 BML 相关的重要因素（=0.011 和 0.004）。然而，根据软骨下 BML，Lysholm 评分无差异（=0.248）。
外侧 MAT 后，术后 MRI 扫描上的软骨下 BML 与移植物挤出有关。然而，根据软骨下 BML，临床结果没有差异。
