Summary

adding a tenodesis or reconstruction of the IML can significantly limit early extrusion of the meniscal allograft. Clinical outcomes are not different when compared to standard procedure, but it may justify a long-term assessment of these patients in order to know if the incidence of osteoarthritis would decrease with technique.

Abstract

Background

Meniscal allograft transplantation (MAT) is indicated in the treatment of post meniscectomised knee syndrome in young patients without severe cartilage loss. Its clinical efficiency is well established at short to mid-term but osteoarthritis still continues to progress with time. A meniscal extrusion occurs often initially and is irreversible. The aim of this study was to evaluate results of arthroscopic meniscal allograft transplantation associated with a reconstruction of the intermeniscal ligament (IML). The hypothesis was that concomitant reconstruction of the IML would decrease the incidence of early allograft extrusion when compared to conventional soft-tissue techniques.

Materials And Methods

This is a monocentric retrospective comparative study of patients operated on between 2011 and 2018. There were two groups: Group IML (MAT with IML repair, n=14) and Group no IML (MAT without IML repair, n=20). Clinical outcomes were evaluated by using the KOOS score at last follow-up and by assessing the rate of secondary surgical procedures.
MRI was performed at a minimum of 12 months (mean 35+/-25 months) to determine absolute and relative meniscal extrusion, sagittal anterior and posterior extrusion and index of cartilage coverage in the frontal and sagittal cuts.

Results

The KOOS score was not significantly different between the two groups. There was no secondary procedure in Group IML and 4 in Group no IML (13%). There was a meniscal extrusion of the allograft in 43% (6/14) of the cases in group IML versus 85% (17/20) in the no IML Group (p<0.03). Absolute meniscal extrusion was 2,9 mm ([2,2- 3,6] SD=1,2) in Group IML and 5,4 mm ([4,1 - 6,7] ; SD=2,9) (p = 0,004) in Group no IML.

Discussion

adding a tenodesis or reconstruction of the IML can significantly limit early extrusion of the meniscal allograft. Clinical outcomes are not different when compared to standard procedure, but it may justify a long-term assessment of these patients in order to know if the incidence of osteoarthritis would decrease with technique.
Level of evidence : IV ; retrospective cohort study