Subscribe to RSS
Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?
Meniscal extrusion (ME) has been identified as a risk factor in the development of knee osteoarthritis. The relevance of this finding when a meniscal scaffold is used has not been extensively studied. The objective of this study was to determine whether preoperative meniscal remnant extrusion (MRE) was correlated with postoperative scaffold extrusion (SE) or with functional outcomes at the 2-year follow-up. Retrospective study included all polyurethane scaffolds implanted with a minimum 2-year follow-up. A magnetic resonance imaging (MRI) was performed preoperatively and postoperatively at 2 years. Extrusion was measured in millimeters in a coronal view. Patients were assigned to either group 1 or 2 depending on the preoperative MRE being either <3 mm (minor extrusion) or 3 mm (major extrusion). Functional outcomes were analyzed by means of the Western Ontario Meniscal Evaluation Tool (WOMET), International Knee Documentation Committee, Kujala and Tegner scores, as well as visual analog scale. Satisfaction was also documented. Sixty-two out of 98 patients were available to undergo an MRI at final follow-up. The mean age was 41.3 years (range, 17–58) and the mean follow-up was 45 months (range, 25–69). The mean preoperative MRE was 2.8 mm (standard deviation [SD] 1.2) and the mean postoperative SE was 3.8 mm (SD 1.8) (p < 0.01). All functional scores improved during the study period. When the correlation (Spearman's rho) between the difference in extrusion between the pre 26 and postoperative periods and their correlation with the different scores was assessed, correlation was only observed in the WOMET (rho 0.61, p = 0.02). The preoperative MRE in Group 1 was 1.85 mm (SD 0.83) and 3.7 mm (SD 2.2) in Group 2 (p < 0.01). At final follow-up, SE was 3.86 mm (SD 0.7) in Group 1, whereas it was 3.98 mm (SD 1) in Group 2 (p = 0.81). No differences were observed in the scores used for these two groups. The SE observed at the 2-year follow-up after the implantation of a polyurethane scaffold did not depend on preoperative MRE (major or minor extrusion). The WOMET score, which was the only meniscal-specific functional scored used, showed some inferior results in the most extruded meniscal scaffolds. This is a retrospective case series. Level of evidence is 4.
Received: 09 November 2019
Accepted: 21 March 2020
Article published online:
25 May 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Lee SJ, Aadalen KJ, Malaviya P. et al. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 2006; 34 (08) 1334-1344
- 2 Parker BR, Hurwitz S, Spang J, Creighton R, Kamath G. Surgical trends in the treatment of meniscal tears: analysis of data from the American Board of Orthopaedic Surgery Certification examination data base. Am J Sports Med 2016; 44 (07) 1717-1723
- 3 Monllau JC, Gelber PE, Abat F. et al. Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years' follow-up. Arthroscopy 2011; 27 (07) 933-943
- 4 Zaffagnini S, Marcheggiani Muccioli GM, Lopomo N. et al. Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10-year follow-up study. Am J Sports Med 2011; 39 (05) 977-985
- 5 Dhollander A, Verdonk P, Verdonk R. Treatment of painful, irreparable partial meniscal defects with a polyurethane scaffold. Midterm clinical outcomes and survival analysis. Am J Sports Med 2016; 44 (10) 2615-2621
- 6 Schüttler KF, Haberhauer F, Gesslein M. et al. Midterm follow-up after implantation of a polyurethane meniscal scaffold for segmental medial meniscus loss: maintenance of good clinical and MRI outcome. Knee Surg Sports Traumatol Arthrosc 2016; 24 (05) 1478-1484
- 7 Monllau JC, Poggioli F, Erquicia J. et al. Magnetic resonance imaging and functional outcomes after a polyurethane meniscal scaffold implantation: minimum 5-year follow-up. Arthroscopy 2018; 34 (05) 1621-1627
- 8 De Coninck T, Huysse W, Willemot L, Verdonk R, Verstraete K, Verdonk P. Two-year follow-up study on clinical and radiological outcomes of polyurethane meniscal scaffolds. Am J Sports Med 2013; 41 (01) 64-72
- 9 Faivre B, Bouyarmane H, Lonjon G, Boisrenoult P, Pujol N, Beaufils P. Actifit® scaffold implantation: influence of preoperative meniscal extrusion on morphological and clinical outcomes. Orthop Traumatol Surg Res 2015; 101 (06) 703-708
- 10 Abat F, Gelber PE, Erquicia JI, Pelfort X, González-Lucena G, Monllau JC. Suture-only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation. Am J Sports Med 2012; 40 (07) 1591-1596
- 11 Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG. Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. Am J Sports Med 2010; 38 (12) 2448-2455
- 12 Lee DH, Kim SB, Kim TH, Cha EJ, Bin SI. Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med 2010; 38 (02) 247-254
- 13 Shin YS, Lee HN, Sim HB, Kim HJ, Lee DH. Polyurethane meniscal scaffolds lead to better clinical outcomes but worse articular cartilage status and greater absolute meniscal extrusion. Knee Surg Sports Traumatol Arthrosc 2018; 26 (08) 2227-2238
- 14 Lee BS, Kim HJ, Lee CR. et al. Clinical outcomes of meniscal allograft transplantation with or without other procedures: a systematic review and meta-analysis. Am J Sports Med 2018; 46 (12) 3047-3056
- 15 Teichtahl AJ, Cicuttini FM, Abram F. et al. Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis. Osteoarthritis Cartilage 2017; 25 (07) 1076-1083
- 16 van der Voet JA, Runhaar J, van der Plas P, Vroegindeweij D, Oei EH, Bierma-Zeinstra SMA. Baseline meniscal extrusion associated with incident knee osteoarthritis after 30 months in overweight and obese women. Osteoarthritis Cartilage 2017; 25 (08) 1299-1303
- 17 Sharma L, Hochberg M, Nevitt M. et al. Knee tissue lesions and prediction of incident knee osteoarthritis over 7 years in a cohort of persons at higher risk. Osteoarthritis Cartilage 2017; 25 (07) 1068-1075
- 18 Jang SH, Kim JG, Ha JG, Shim JC. Reducing the size of the meniscal allograft decreases the percentage of extrusion after meniscal allograft transplantation. Arthroscopy 2011; 27 (07) 914-922
- 19 Jeon B, Kim JM, Kim JM, Lee CR, Kim KA, Bin SI. An osteophyte in the tibial plateau is a risk factor for allograft extrusion after meniscus allograft transplantation. Am J Sports Med 2015; 43 (05) 1215-1221
- 20 Monllau JC, Ibañez M, Masferrer-Pino A, Gelber PE, Erquicia JI, Pelfort X. Lateral capsular fixation: an implant-free technique to prevent meniscal allograft extrusion. Arthrosc Tech 2017; 6 (02) e269-e274
- 21 Kim NK, Bin SI, Kim JM, Lee CR, Kim JH. Meniscal extrusion does not progress during the midterm follow-up period after lateral meniscal transplantation. Am J Sports Med 2017; 45 (04) 900-908
- 22 Jones LD, Mellon SJ, Kruger N, Monk AP, Price AJ, Beard DJ. Medial meniscal extrusion: a validation study comparing different methods of assessment. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1152-1157