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Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations

Peter Verdonk (UGent) , Koenraad Verstraete (UGent) , Karl Almqvist (UGent) , Kristof De Cuyper, Eric Veys (UGent) , August Verbruggen (UGent) and René Verdonk (UGent)
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Abstract
Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts were transplanted. Eleven of the medial allograft procedures were associated with a high tibial osteotomy. The patients were evaluated clinically at the time of transplantation and at the final follow-up using the modified HSS scoring system. The knee injury and osteoarthritis outcome score (KOOS) was used as an evaluation tool for patient-related outcome at the final follow-up. Joint space width narrowing and Fairbank changes were radiological outcome parameters, which were available for 32 patients. Femoral and tibial cartilage degeneration, graft extrusion and signal intensity were scored on MRI scans obtained in 17 patients approximately 1 year after transplantation and at the final follow-up (> 10 years). For statistical analysis the patients were divided into three groups: lateral meniscal allograft (LMT), medial meniscal allograft transplantation with a high tibial osteotomy (MMT+HTO) and without (MMT). The modified HSS score revealed a significant improvement in pain and function at the final follow-up for all groups. Further analysis also revealed that an MMT+HTO procedure resulted in a greater improvement at the final follow-up when compared to MMT. Nonetheless, the KOOS scores obtained at the final follow-up revealed the presence of substantial disability and symptoms, in addition to a reduced quality of life. Radiographical analysis revealed no further joint space narrowing in 13/32 knees (41%). Fairbank changes remained stable in 9/32 knees (28%). MRI analysis showed no progression of cartilage degeneration in 6/17 knees (35%). An increased signal intensity of the allograft was present, as was partial graft extrusion in the majority of patients at the final follow-up. Seven cases had to be converted to a total knee arthroplasty during the follow-up; the overall failure rate was 18%. Long-term results after viable meniscus allograft transplantation are encouraging in terms of pain relief and improvement of function. Despite this significant improvement, substantial disability and symptoms were present in all investigated subgroups. Progression of further cartilage degeneration or joint space narrowing was absent in a considerable number of cases, indicating a potential chondroprotective effect. Level of evidence is therapeutic study, Level IV and retrospective analysis of prospectively collected data.
Keywords
INJURIES, meniscus, FOLLOW-UP, CHONDROMALACIA PATELLAE, KNEE OSTEOARTHRITIS, TENDON ALLOGRAFTS, MATCHED CONTROLS, MENISCECTOMY, REPLACEMENT, allograft, radiology, CRUCIATE LIGAMENT RECONSTRUCTION, transplantation, MRI, SUBLUXATION

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MLA
Verdonk, Peter, Koenraad Verstraete, Karl Almqvist, et al. “Meniscal Allograft Transplantation: Long-term Clinical Results with Radiological and Magnetic Resonance Imaging Correlations.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 14.8 (2006): 694–706. Print.
APA
Verdonk, Peter, Verstraete, K., Almqvist, K., De Cuyper, K., Veys, E., Verbruggen, A., & Verdonk, R. (2006). Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 14(8), 694–706.
Chicago author-date
Verdonk, Peter, Koenraad Verstraete, Karl Almqvist, Kristof De Cuyper, Eric Veys, August Verbruggen, and René Verdonk. 2006. “Meniscal Allograft Transplantation: Long-term Clinical Results with Radiological and Magnetic Resonance Imaging Correlations.” Knee Surgery Sports Traumatology Arthroscopy 14 (8): 694–706.
Chicago author-date (all authors)
Verdonk, Peter, Koenraad Verstraete, Karl Almqvist, Kristof De Cuyper, Eric Veys, August Verbruggen, and René Verdonk. 2006. “Meniscal Allograft Transplantation: Long-term Clinical Results with Radiological and Magnetic Resonance Imaging Correlations.” Knee Surgery Sports Traumatology Arthroscopy 14 (8): 694–706.
Vancouver
1.
Verdonk P, Verstraete K, Almqvist K, De Cuyper K, Veys E, Verbruggen A, et al. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2006;14(8):694–706.
IEEE
[1]
P. Verdonk et al., “Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations,” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, vol. 14, no. 8, pp. 694–706, 2006.
@article{353737,
  abstract     = {Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts were transplanted. Eleven of the medial allograft procedures were associated with a high tibial osteotomy. The patients were evaluated clinically at the time of transplantation and at the final follow-up using the modified HSS scoring system. The knee injury and osteoarthritis outcome score (KOOS) was used as an evaluation tool for patient-related outcome at the final follow-up. Joint space width narrowing and Fairbank changes were radiological outcome parameters, which were available for 32 patients. Femoral and tibial cartilage degeneration, graft extrusion and signal intensity were scored on MRI scans obtained in 17 patients approximately 1 year after transplantation and at the final follow-up (> 10 years). For statistical analysis the patients were divided into three groups: lateral meniscal allograft (LMT), medial meniscal allograft transplantation with a high tibial osteotomy (MMT+HTO) and without (MMT). The modified HSS score revealed a significant improvement in pain and function at the final follow-up for all groups. Further analysis also revealed that an MMT+HTO procedure resulted in a greater improvement at the final follow-up when compared to MMT. Nonetheless, the KOOS scores obtained at the final follow-up revealed the presence of substantial disability and symptoms, in addition to a reduced quality of life. Radiographical analysis revealed no further joint space narrowing in 13/32 knees (41%). Fairbank changes remained stable in 9/32 knees (28%). MRI analysis showed no progression of cartilage degeneration in 6/17 knees (35%). An increased signal intensity of the allograft was present, as was partial graft extrusion in the majority of patients at the final follow-up. Seven cases had to be converted to a total knee arthroplasty during the follow-up; the overall failure rate was 18%. Long-term results after viable meniscus allograft transplantation are encouraging in terms of pain relief and improvement of function. Despite this significant improvement, substantial disability and symptoms were present in all investigated subgroups. Progression of further cartilage degeneration or joint space narrowing was absent in a considerable number of cases, indicating a potential chondroprotective effect. Level of evidence is therapeutic study, Level IV and retrospective analysis of prospectively collected data.},
  author       = {Verdonk, Peter and Verstraete, Koenraad and Almqvist, Karl and De Cuyper, Kristof and Veys, Eric and Verbruggen, August and Verdonk, René},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  keywords     = {INJURIES,meniscus,FOLLOW-UP,CHONDROMALACIA PATELLAE,KNEE OSTEOARTHRITIS,TENDON ALLOGRAFTS,MATCHED CONTROLS,MENISCECTOMY,REPLACEMENT,allograft,radiology,CRUCIATE LIGAMENT RECONSTRUCTION,transplantation,MRI,SUBLUXATION},
  language     = {eng},
  number       = {8},
  pages        = {694--706},
  title        = {Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations},
  url          = {http://dx.doi.org/10.1007/s00167-005-0033-2},
  volume       = {14},
  year         = {2006},
}

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