Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District Beijing, Beijing, 100191, People's Republic of China.
Institute of Sports Medicine, Peking University, No. 49 North Garden Road, Beijing, 100191, People's Republic of China.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2877-2887. doi: 10.1007/s00167-022-07263-1. Epub 2022 Dec 1.
To compare the long-term clinical and radiological results of meniscal allograft transplantation (MAT) for discoid lateral meniscus (DLM) patients with MAT for non-discoid lateral meniscus patients and meniscectomy (ME) for DLM patients and, thus, to determine whether DLM patients are suitable candidates for MAT.
Eight MAT cases in DLM patients were identified (discoid MAT group), six MAT cases in non-discoid lateral meniscus patients (non-discoid MAT group) and ten total meniscectomy cases in DLM patients (discoid ME group) were matched as controls. Subjective evaluations, postoperative radiography and magnetic resonance imaging (MRI) were conducted at 5 years and 10-14 years, respectively. Joint degeneration was evaluated by the Kellgren-Lawrance (KL) grade and joint space width (JSW). MRI with T2 mapping sequences was used to quantitatively evaluate degeneration of the joint cartilage and shrinkage of the allografts. Student's t test was used to compare quantitative variables and the Mann‒Whitney U test was used to compare categorical variables.
There was no difference in Lysholm, IKDC, Tegner or VAS scores amongst the discoid MAT, non-discoid MAT and discoid ME groups at the final follow-up. No revision surgery was performed in any MAT patient. The JSW narrowing in the discoid MAT group was better than that in the discoid ME group (0.8 ± 0.4 mm vs. 2.1 ± 1.3 mm, p = 0.012) and worse than that in the non-discoid MAT group (0.1 ± 0.1 mm, p = 0.003). The KL progression of the discoid MAT group was less than that of the discoid ME group (1.3 ± 0.7 vs. 2.3 ± 0.9, p = 0.034). The discoid ME group had worse cartilage lesion progression than the discoid MAT and non-discoid MAT groups. The allograft width of the DLM patients shrank more than that of the non-discoid patients at the meniscus midbody (3.6 ± 0.9 mm vs. 6.2 ± 1.9 mm, p = 0.015).
Compared to meniscectomy, MAT achieved similar long-term symptom relief and superior chondroprotection in discoid meniscus patients. Despite more graft shrinkage, the outcomes of MAT in discoid meniscus patients were comparable to those in non-discoid meniscus patients. Therefore, DLM patients may be suitable candidates for MAT procedures.
Level III.
比较半月板同种异体移植（MAT）治疗盘状外侧半月板（DLM）患者与非盘状外侧半月板患者以及半月板切除术（ME）治疗 DLM 患者的长期临床和影像学结果，从而确定 DLM 患者是否适合 MAT。
共纳入 8 例 DLM 患者的 MAT 病例（盘状 MAT 组）、6 例非盘状外侧半月板患者的 MAT 病例（非盘状 MAT 组）和 10 例 DLM 患者的全半月板切除术病例（盘状 ME 组）作为对照组。分别在术后 5 年和 10-14 年进行主观评估、术后影像学检查和磁共振成像（MRI）检查。采用 Kellgren-Lawrance（KL）分级和关节间隙宽度（JSW）评估关节退变。采用 T2 映射序列的 MRI 对关节软骨退变和移植物收缩进行定量评估。采用 Student's t 检验比较定量变量，采用 Mann-Whitney U 检验比较分类变量。
在末次随访时，盘状 MAT 组、非盘状 MAT 组和盘状 ME 组的 Lysholm、IKDC、Tegner 或 VAS 评分均无差异。MAT 患者均未行翻修手术。盘状 MAT 组的 JSW 变窄优于盘状 ME 组（0.8±0.4mm 比 2.1±1.3mm，p=0.012），劣于非盘状 MAT 组（0.1±0.1mm，p=0.003）。盘状 MAT 组的 KL 进展程度低于盘状 ME 组（1.3±0.7 比 2.3±0.9，p=0.034）。盘状 ME 组的软骨病变进展较盘状 MAT 组和非盘状 MAT 组更严重。半月板中部的 DLM 患者的移植物宽度比非盘状患者收缩更多（3.6±0.9mm 比 6.2±1.9mm，p=0.015）。
与半月板切除术相比，MAT 可在 DLM 患者中获得相似的长期症状缓解和更好的软骨保护。尽管移植物收缩较多，但 DLM 患者的 MAT 结果与非 DLM 患者相当。因此，DLM 患者可能是 MAT 手术的合适候选者。
III 级。
