Acceptable clinical outcomes despite high reoperation rate at minimum 12-month follow-up after concomitant arthroscopically assisted anterior cruciate ligament reconstruction and medial meniscal allograft transplantation
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Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT. We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients’ functional status relative to the US population. P -values < 0.05 were considered significant. The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19–49 years) and mean body mass index (BMI) of 27.9 kg/m 2 (range 22.5–53.3 kg/m 2 ). Mean follow-up time was 56.8 months (range 13–106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction ( p < 0.05). The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low. Level of evidence : IV.
Abstract
Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT. We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients’ functional status relative to the US population. P -values < 0.05 were considered significant. The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19–49 years) and mean body mass index (BMI) of 27.9 kg/m 2 (range 22.5–53.3 kg/m 2 ). Mean follow-up time was 56.8 months (range 13–106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction ( p < 0.05). The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low. Level of evidence : IV.
참고문헌 (22)
- Carter TR, "Meniscal allograft survivorship and outcomes 20 years after implantation", Arthroscopy, 36(8), pp.2268~2274 (2020)[DOI]
- Gilat R, "Meniscal allograft transplantation : indications, techniques", Outcomes Arthrosc, 36(4), pp.938~939 (2020)[DOI]
- van Arkel ER, "Survival analysis of human meniscal transplantations", J Bone Jt Surg Br, 84(2), pp.227~231 (2002)[DOI]
- Saltzman BM, "Concomitant arthroscopic meniscal allograft transplantation and anterior cruciate ligament reconstruction", Arthrosc Tech, 5(5), pp.e1161~e1171 (2016)[DOI]
- Yanke AB, "Medial meniscus transplantation and bone-tendon-bone anterior cruciate ligament reconstruction", J Am Acad Orthop Surg (2021)[DOI]
- Sekiya JK, "Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction", Am J Sports Med, 31(6), pp.896~906 (2003)[DOI]
- Yoldas EA, "Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction", Knee Surg Sports Traumatol Arthrosc, 11(3), pp.173~182 (2003)[DOI]
- von Lewinski G, "Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament", Knee Surg Sports Traumatol Arthrosc, 15(9), pp.1072~1082 (2007)[DOI]
- Ding Y, "Mid-term effectiveness of arthroscopic anterior cruciate ligament reconstruction combined with meniscus allograft transplantation", Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 33(9), pp.1071~1076 (2019)[DOI]
- Yoon KH, "Centralized anterior bone plug results in less graft extrusion in patients undergoing medial meniscus allograft transplantation following anterior cruciate ligament reconstruction", Knee, 27(3), pp.884~890 (2020)[DOI]
- Cella D, "The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years", Med Care, 45(5 Suppl 1), pp.S3~S11 (2007)[DOI]
- DeFroda SF, "Tibial tunnel widening following anterior cruciate ligament reconstruction : a retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection", Knee, 25(6), pp.1107~1114 (2018)[DOI]
- Harris PA, "Research electronic data capture(REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support", J Biomed Inform, 42(2), pp.377~381 (2009)[DOI]
- Harris PA, "The REDCap consortium : building an international community of software platform partners", J Biomed Inform, 95, pp.103208~ (2019)[DOI]
- Kraus TM, "Duration of incapacity of work after tibial plateau fracture is affected by work intensity", BMC Musculoskelet Disord, 19(1), pp.281~ (2018)[DOI]
- Franovic S, "Establishing"normal"patient-reported outcomes measurement information system physical function and pain interference scores : a true reference score according to adults free of joint pain and disability", JB JS Open Access, 4(4), pp.e0019~ (2019)[DOI]
- Tegner Y, "Rating systems in the evaluation of knee ligament injuries", Clin Orthop Relat Res, (198), pp.43~49 (1985)
- Zaffagnini S, "Meniscal allograft transplantation combined with anterior cruciate ligament reconstruction provides good mid-term clinical outcome", Knee Surg Sports Traumatol Arthrosc, 27(6), pp.1914~1923 (2019)[DOI]
- Saltzman BM, "Prospective clinical and radiographic outcomes after concomitant anterior cruciate ligament reconstruction and meniscal allograft transplantation at a mean 5-year follow-up", Am J Sports Med, 45(3), pp.550~562 (2017)[DOI]
- Hays RD, "The RAND 36-Item Health Survey 1. 0", Health Econ, 2(3), pp.217~227 (1993)[DOI]
- Wright RW, "Outcome of revision anterior cruciate ligament reconstruction : a systematic review", J Bone Jt Surg Am, 94(6), pp.531~536 (2012)[DOI]
- Grassi A, "Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results", Br J Sports Med, 50(12), pp.716~724 (2016)[DOI]