Purpose
To compare meniscal extrusion (ME) following medial meniscus allograft transplantation
(MMAT) with and without meniscotibial ligament reconstruction (MTLR).
Methods
Ten cadaveric knees were size-matched with meniscus allografts. MMAT was performed
via bridge-in-slot technique. Specimens were mounted in a testing system and ME was
assessed via ultrasound anterior, directly over, and posterior to the medial collateral
ligament at the joint line under 4 testing conditions: (1) 0° flexion and 0 newtons
(N) of axial load, (2) 0° and 1,000 N, (3) 30° and 0 N, and (4) 30° and 1,000 N. For
each condition, “mean total extrusion” was calculated by averaging measurements at
each position. Next, MTLR was performed using 2 inside-out sutures through the remnant
allograft meniscotibial ligament and secured to the tibia using anchors. The testing
protocol was repeated. Differences in ME between MMAT alone versus MMAT + MTLR were
examined. Within-group differences between the measurement positions, loading states,
and flexion angles also were assessed.
Results
“Mean total extrusion” was greater following MMAT alone (2.56 ± 1.23 mm) versus MMAT +
MTLR (2.14 ± 1.07 mm; P = .005) in the loaded state at 0° flexion. ME directly over the MCL was greater following
MMAT alone (3.51 ± 1.00 mm) compared with MMAT + MTLR (2.93 ± 0.79 mm; P = .054). Posteriorly, in the loaded state at 0°, ME was greater following MMAT alone
(2.43 ± 1.10 mm) compared with MMAT + MTLR (1.96 ± 0.99 mm; P = .010). In all conditions, ME was greater in the loaded state versus the unloaded
state.
Conclusions
Following MMAT, the addition of MTLR significantly reduced overall ME when compared
with isolated MMAT during loading at 0° of flexion in a cadaveric model; given the
small absolute values of change in extrusion, clinical significance cannot be gleaned
from these findings.
Clinical Relevance
During medial meniscus allograft transplantation, augmentation with meniscotibial
ligament reconstruction may limit meniscal extrusion and improve the biomechanical
milieu of the knee joint following transplant.
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Article info
Publication history
Published online: June 26, 2022
Accepted:
June 6,
2022
Received:
December 13,
2021
Footnotes
See commentary on page 3090
The authors report the following potential conflicts of interest or sources of funding: N.B.C., D.M.K., R.G., A.S.V., D.F., E.F.S., J.C., and B.J.C. report grant funding from Arthrex and the Arthroscopy Association of North America. A.B.Y. reports grants from Arthrex and the Arthroscopy Association of North America, during the conduct of the study; other from AlloSource, grants from Arthrex; other from CONMED Linvatec, JRF Ortho, and Olympus; grants from Organogenesis; other from PatientIQ, Smith & Nephew, and Sparta Biomedical; and grants from Vericel, outside the submitted work. B.J.C. reports grants from Arthrex and Arthroscopy Association of North America, during the conduct of the study; other from Aesculap, National Institutes of Health, and Operative Techniques in Sports Medicine; personal fees from Ossio; personal fees and other from Regentis; other from Smith & Nephew; grants, personal fees, and other from Arthrex; and other from Elsevier Publishing, BandGrip, Acumed LLC, Encore Medical, LP, GE Healthcare, Merck Sharp & Dohme Corporation, SportsTek Medical, Inc, and Vericel Corporation, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
