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Nonanatomic horn position increases early graft failures after lateral meniscal allograft transplantation
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Nonanatomic horn position discrepancy correlated with an increased risk for early graft failures in patients who underwent isolated lateral meniscal allograft transplantation, according to recently published data.
“When the location of the grafted meniscus horn was different from the original position, graft failure within 1 year was increased,” Seong-Il Bin, MD, told Healio.com/Orthopedics. “Meticulous insertion of a bone bridge is needed to avoid early graft failure of lateral [meniscal allograft transplantation] MAT with the keyhole technique.”
Researchers identified 208 patients (214 knees) who underwent primary isolated lateral meniscal allograft transplantation. Fifty cases were nonanatomcally positioned and 160 cases were anatomically positioned. Early failure was either considered grade 3 signal intensities or tears over one-third of the allograft on MRI or removal of more than one-third of allograft due to tears.
Results showed the failure rate in the nonanatomic group was 11.1% and 3.1% in the anatomic group. The overall early failure rate was 5.1%. Investigators noted an increased risk for early graft failure in the nonanatomic horn position group compared with the anatomically positioned group (OR = 3.88). They also noted anteriorized and lateralized position in the nonanatomic group vs. the anatomic group. However, researchers did not notice significant differences between the groups regarding age, sex, BMI, involved knee, cartilage status, alignment of lower extremity and joint space width. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures
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Nicholas A. Sgaglione, MD
The recently published level-3 cohort study by Kim and colleagues reports on early failure following lateral meniscal allograft transplantation for meniscal deficiency. The study highlights the importance of anatomic graft placement and restoration of the correct horn position, specifically avoiding over-anteriorization and lateralization of the bone block. Pre- and postoperative horn positioning was radiographically measured with > 5-mm or 10% discrepancy noted to result in a significantly higher failure rate.
The authors should be commended for their comprehensive and compelling work. Their hypothesis, methodology, results and conclusions are valid and prompt us all to take our game up when performing lateral meniscal allograft transplantation using a keyhole technique. The take-home message is that meticulous attention to detail and anatomic restoration of the lateral meniscal horn positions will potentially reduce the early failures secondary to longitudinal and bucket handle tears seen within the first year.
Professor and chair, Department of Orthopaedics
Zucker School of Medicine
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