Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.
Institute of Sports Medicine of Peking University, Beijing, 100191, People's Republic of China.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov;30(11):3708-3717. doi: 10.1007/s00167-022-06982-9. Epub 2022 Apr 28.
The purpose of this study was to compare the long-term clinical and radiological outcomes between the immediate and delayed meniscus allograft transplantation (MAT).
Nine menisci were transplanted immediately after total meniscectomy (immediate group, IM), and 10 menisci were delayed transplanted in patients with the median of 35 months (range 9-92 months) after total meniscectomy (delayed group, DE). Patient's subjective clinical outcomes including VAS, IKDC, Lysholm and Tegner scores as well as muscle strength measures were compared. Joint degeneration was evaluated by both radiographs to assess joint space width narrowing, Kellegren-Lawrence (KL) grade and MRI with T2 mapping sequences to quantitatively analyze both cartilage and meniscal allograft degeneration.
The median follow-up time was 10.8 years (range 10-14 years). The IKDC (IM vs DE, 89.8 vs 80.9, n.s.) and Lysholm scores (IM vs DE, 87.7 vs 78.0, n.s.) were close in two groups, while the IM group showed slightly lower VAS (IM vs DE, 0.2 vs 1.5, p = 0.031), higher Tegner score (IM vs DE, 7 vs 3.5 p = 0.021) and better quadriceps muscle strength. The IM group had less joint space narrowing (IM vs DE, 0.35 mm vs 0.71 mm, n.s.), less KL grade progression (IM vs DE, 0.6 vs 1.7, p = 0.041) on radiographs and less chondral lesions development on MRIs (Cartilage Degeneration Index, IM vs DE, 252 vs 2038, p = 0.025). All meniscal grafts exhibited degeneration by showing grade 3 signal on MRI, and 4 (4/9) in the IM group and 8 (8/10) cases in the DE group. The T2 value of cartilage and meniscal allograft in the IM group was close to that of the healthy control and was significantly lower than that of the DE group.
Compared to the conventional delayed MAT, the immediate MAT achieved better cartilage and meniscus protection in the long-term, while its superiority in patient-reported outcomes was limited.
IV.
本研究旨在比较半月板同种异体移植（MAT）即刻与延迟两种方式的长期临床和影像学结果。
9 个半月板在全半月板切除术后即刻移植（即刻组，IM），10 个半月板在全半月板切除术后中位时间 35 个月（9-92 个月）延迟移植（延迟组，DE）。比较患者的主观临床结果，包括 VAS、IKDC、Lysholm 和 Tegner 评分以及肌肉力量测量。通过 X 线片评估关节退变，包括关节间隙变窄、Kellgren-Lawrence（KL）分级和 MRI 与 T2 映射序列定量分析软骨和半月板同种异体移植物退变。
中位随访时间为 10.8 年（范围 10-14 年）。两组 IKDC（IM 比 DE，89.8 比 80.9，n.s.）和 Lysholm 评分（IM 比 DE，87.7 比 78.0，n.s.）相近，而 IM 组 VAS 评分略低（IM 比 DE，0.2 比 1.5，p=0.031），Tegner 评分较高（IM 比 DE，7 比 3.5，p=0.021），股四头肌力量更好。IM 组关节间隙变窄程度较小（IM 比 DE，0.35mm 比 0.71mm，n.s.），KL 分级进展程度较小（IM 比 DE，0.6 比 1.7，p=0.041），MRI 上软骨损伤发展程度较小（软骨退变指数，IM 比 DE，252 比 2038，p=0.025）。所有半月板移植物均显示 3 级信号 MRI 退变，IM 组 4 个（4/9），DE 组 8 个（8/10）。IM 组软骨和半月板同种异体移植物的 T2 值接近健康对照组，明显低于 DE 组。
与传统的延迟 MAT 相比，即刻 MAT 在长期内可更好地保护软骨和半月板，但其在患者报告结果方面的优势有限。
IV 级。
