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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Article info
Publication history
Accepted:
April 16,
2019
Received:
November 9,
2018
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 2896
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Long-Term Outcomes of Fresh-Frozen Meniscal Allografts—Shrinkage Progresses, but Is It Clinically Significant?ArthroscopyVol. 35Issue 10
- PreviewMeniscal 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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