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A Magnetic Resonance Imaging Analysis of Shrinkage of Transplanted Fresh-Frozen Lateral Meniscal Allografts During a Minimum Follow-up of 8 Years

      Purpose

      To evaluate the incidence and degree of shrinkage of transplanted fresh-frozen meniscal allografts in a long-term period of >8 years and to investigate whether the shrinkage of allograft progresses and is associated with inferior clinical and radiologic outcomes after meniscal allograft transplantation (MAT) in the long term.

      Methods

      Twenty-two knees were reviewed in 20 patients (mean age, 31.41 ± 9.11 years) who underwent isolated lateral MAT. All patients were followed with magnetic resonance imaging (MRI) for at least 8 years (mean, 11.78 ± 3.10 years). The allograft widths of the anterior horn, mid-body, and posterior horn at 1 and >8 years postoperatively were measured by using MRI. To estimate the degree of shrinkage, the relative changes in widths during intervals were calculated. Patients were categorized into 4 groups according to shrinkage degree: minimal (<10%), mild (10%-25%), moderate (25%-50%), and severe (>50%). The joint space width was measured on the weightbearing radiographs to evaluate the radiologic outcome. The Lysholm score was used to evaluate the clinical outcome.

      Results

      The relative change in the width of the anterior horn, mid-body, and posterior horn, compared with that 1 year postoperatively, was 82.7% (95% confidence interval 77.4%-87.5%), 75.9% (70.7%-81.0%), and 85.0% (81.4%-88.5%), respectively. The shrinkage degree was greater at the mid-body than at the anterior and posterior horns. About 70% of allografts showed ≥10% shrinkage of the posterior horn. Meniscal shrinkage did not show significant correlation with clinical and radiologic outcome.

      Conclusions

      At long-term follow-up (>8 years), shrinkage of transplanted fresh-frozen meniscal allografts progressed at 1 year postoperative. On average, the shrinkage was mild and more prominent in the mid-body than in the anterior or posterior horn. In this study, it could not be concluded that the shrinkage of allografts was significantly associated with inferior clinical and radiologic outcomes in the long term.

      Level of Evidence

      Level IV, therapeutic case series.
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      Linked Article

      • Editorial Commentary: Long-Term Outcomes of Fresh-Frozen Meniscal Allografts—Shrinkage Progresses, but Is It Clinically Significant?
        ArthroscopyVol. 35Issue 10
        • Preview
          Meniscal allograft transplantation has been reported to be an excellent treatment for young patients with symptoms related to meniscal deficiency. To date, several studies reporting on extrusion or shrinkage after a meniscal transplant have failed to correlate these findings with clinical outcomes. However, longevity, graft durability, and overall joint health have yet to be determined in the context of graft extrusion and shrinkage. Given a growing body of evidence showing varying degrees of shrinkage over time with no effect on functional outcome, allograft morphologic changes may not be as clinically important as once thought from a clinical standpoint.
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