Abstract
Purpose
To determine the acceptable amount of graft extrusion based on long term radiographic
outcomes in lateral meniscal allograft transplantation (MAT).
Methods
94 lateral MAT patients with a minimum 5-year follow-up period were reviewed. Graft
extrusion was measured on MRI scans taken 1 year after surgery, and the study population
was divided according to the amount of extrusion: group A, extrusion <3 mm; group
B, 3 mm ≤ extrusion <5 mm; and group C, extrusion ≥5 mm. For radiographic evaluation,
the bilateral lateral joint space widths (JSWs) were measured on a standing 45° flexion
posteroanterior radiograph. To standardize the measurements, the affected JSW was
divided by the contralateral JSW. The change in the standardized JSW (ΔJSWstd) between the preoperative and latest follow-up assessments was analyzed according
to the three groups. Multiple regression analysis was performed to control other related
factors such as lower limb alignment and cartilage status at the time of MAT. The
acceptable amount of graft extrusion was calculated using a receiver operating characteristic
(ROC) curve for the third quartile of ΔJSWstd. Clinical outcomes were evaluated using the Lysholm score and were compared among
the groups.
Results
The mean follow-up duration was 8.3 ± 3.1 years. There were 54, 25, and 15 patients
in group A, group B, and group C, respectively. In multiple regression analysis, both
group B and group C had significant associations with ΔJSWstd and their beta coefficients were comparable (group B, p <0.001, β=0.642; group C,
p <0.001, β=0.613). No significant difference in ΔJSWstd was found between group B and group C (p=0.494). Based on the ROC curve, the acceptable
amount of graft extrusion was 3.74 mm (sensitivity, 81.8%; specificity, 77.8%). There
were no differences in the Lysholm scores among the three groups (p=0.329).
Conclusion
ΔJSWstd differed between graft extrusion <3 mm (group A) and graft extrusion ≥3 mm (group
B and group C). However, there was no significant difference in ΔJSWstd between group B and group C. No significant difference in clinical outcomes was found
according to graft extrusion. This study gave supporting evidence for the currently
recognized acceptable amount of graft extrusion (3 mm).
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Article info
Publication history
Accepted:
January 25,
2023
Received in revised form:
January 16,
2023
Received:
June 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
IRB information: Approved by Asan Medical Center Institutional Review Board (Receipt number S2020-2541-0001, Project number 2020-1564)
Acknowledgement of language help: Editage (http://www.editage.co.kr)
Level of evidence: Level III, retrospective cohort study
Identification
Copyright
© 2023 by the Arthroscopy Association of North America
