Arthroscopy. 2022 Nov;38(11):3090-3091. doi: 10.1016/j.arthro.2022.07.011.
While studies have shown significant clinical improvement after medial meniscus allograft transplantation (MMAT) with good long-term graft survivorship, progression to osteoarthritis still occurs, even in the presence of intact grafts. Several factors can potentially explain the lack of chondroprotection despite graft survivorship, including meniscal degeneration, tearing, and remodeling after the initial procedure. A major factor contributing to progression of osteoarthritis is meniscal extrusion, which is seen in up to 60% of patients and seems to be more of an issue in medial meniscus transplantation compared to lateral and is present even immediately postoperatively. Grafts without extrusion provide protective effects similar to the native meniscus, while greater than 3 mm of extrusion leads to nearly complete loss of the protective effects. A reconstruction of the meniscotibial ligament, in addition to standard MMAT, may significantly decrease meniscal extrusion. Optimization of graft size, quality, and meniscal root positioning is best to prevent extrusion and restore native biomechanics.
虽然研究表明，内侧半月板同种异体移植（MMAT）后有显著的临床改善，且长期移植物存活率良好，但仍会进展为骨关节炎，即使移植物完整。尽管移植物存活率良好，但仍有几个潜在因素可能导致软骨保护不足，包括初始手术后半月板退变、撕裂和重塑。导致骨关节炎进展的一个主要因素是半月板外突，高达 60%的患者存在这种情况，而且与外侧半月板相比，内侧半月板移植后更容易出现这种情况，甚至在术后即刻就存在。没有外突的移植物提供类似于天然半月板的保护作用，而外突超过 3 毫米则几乎完全丧失了保护作用。除了标准的 MMAT 外，重建半月板胫骨韧带可能会显著减少半月板外突。优化移植物的大小、质量和半月板根部定位是防止外突和恢复天然生物力学的最佳方法。
