Beel Wouter, Firth Andrew D, Tulloch Scott, Abdelrehman Taher, Olotu Olumide, Bryant Dianne, Getgood Alan
Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada.
Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
Arthroscopy. 2025 Mar;41(3):785-797.e2. doi: 10.1016/j.arthro.2024.02.045. Epub 2024 Mar 21.
To provide an update on the incidence and extent of graft extrusion after meniscal allograft transplantation (MAT) and to systematically review the literature to identify whether the type of root fixation or additional surgical techniques may reduce the risk of graft extrusion development.
A systematic search, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, was conducted using the MEDLINE database, EMBASE database, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL) database. Patients undergoing medial meniscal allograft transplantation (MMAT) or lateral meniscal allograft transplantation (LMAT) were included. The primary outcome measure was meniscal extrusion measured on postoperative magnetic resonance imaging scans taken more than 6 weeks after MAT. The following extrusion outcomes were investigated: absolute extrusion (AE), relative percentage of extrusion (RPE), and proportion of major extrusion (PME). Additional surgical techniques that reduced the risk of graft extrusion development in the included comparative studies were identified.
For MMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.2 mm versus 3.36 mm and RPE of 44.43% versus 33.18%. The pooled mean PME for MMAT with soft-tissue fixation was 51.62%. For LMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.72 mm versus 2.78 mm, RPE of 31.89% versus 29.47%, and PME of 64.37% versus 35.80%. Additional capsulodesis was identified as a technique to reduce LMAT extrusion.
This study highlights that graft extrusion is a common finding after MMAT and LMAT, independent of the root fixation technique. However, MAT extrusion with bony fixation was, depending on the outcome measurement, lower than or equal to that with soft-tissue fixation.
Level IV, systematic review of Level I, III, and IV studies.
提供半月板同种异体移植（MAT）后移植物挤出的发生率和程度的最新情况，并系统回顾文献，以确定根部固定类型或其他手术技术是否可降低移植物挤出发生的风险。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，使用MEDLINE数据库、EMBASE数据库、Cochrane系统评价数据库和Cochrane对照试验中心注册库（CENTRAL）数据库进行系统检索。纳入接受内侧半月板同种异体移植（MMAT）或外侧半月板同种异体移植（LMAT）的患者。主要结局指标是在MAT术后6周以上进行的磁共振成像扫描上测量的半月板挤出情况。研究了以下挤出结局：绝对挤出（AE）、相对挤出百分比（RPE）和严重挤出比例（PME）。在纳入的比较研究中确定了降低移植物挤出发生风险的其他手术技术。
对于MMAT，软组织固定与骨固定的汇总平均挤出结局如下：AE分别为3.2 mm和3.36 mm，RPE分别为44.43%和33.18%。MMAT软组织固定的汇总平均PME为51.62%。对于LMAT，软组织固定与骨固定的汇总平均挤出结局如下：AE分别为3.72 mm和2.78 mm，RPE分别为31.89%和29.47%，PME分别为64.37%和35.80%。额外的关节囊缝合术被确定为一种减少LMAT挤出的技术。
本研究强调，移植物挤出是MMAT和LMAT术后的常见现象，与根部固定技术无关。然而，根据结局测量，骨固定的MAT挤出低于或等于软组织固定的情况。
IV级，对I、III和IV级研究的系统评价。
