Capsular fixation limits graft extrusion in lateral meniscal allograft transplantation

• Published in: International orthopaedics Vol. 43; no. 11; pp. 2549 - 2556
• Main Authors: Masferrer-Pino, Angel, Monllau, Joan C., Abat, Ferran, Gelber, Pablo E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2019
• Subjects: Adult; Allografts; Arthroscopy; Female; Humans; Joint Capsule - surgery; Knee Injuries - surgery; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Menisci, Tibial - diagnostic imaging; Menisci, Tibial - surgery; Menisci, Tibial - transplantation; Middle Aged; Original Paper; Orthopedics; Prospective Studies; Reconstructive Surgical Procedures - adverse effects; Reoperation; Suture Techniques; Transplantation, Homologous; Knee; Meniscal extrusion; Meniscus; Meniscal transplantation; Capsulodesis
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-019-04398-8

Purpose The main purpose of this investigation was to compare the amount of graft extrusion of lateral meniscal allograft transplantation (MAT) performed with a suture-only technique with or without a capsulodesis. Secondarily, the assessment of functional results was also covered. We hypothesized that capsular fixation reduces the post-operative degree of allograft extrusion and it does not affect the functional outcomes during the short-term follow-up period studied. Methods Prospective series of 29 lateral MAT. Fifteen were fixed with a suture-only technique (group A). The remaining 14 cases (group B) also included arthroscopic lateral capsular fixation (capsulodesis). Functional results were assessed with Lysholm, Tegner, and VAS for pain. Magnetic resonance imaging (MRI) was performed to determine the degree of meniscal extrusion. Millimeters of extrusion and percentage of extruded meniscal tissue were calculated for both groups. The degree of extrusion was considered minor if it was < 3 mm or major if it was > 3 mm. Results Group A had 11 cases (73.3%) of major extrusion and group B had 4 cases (28.6%) ( p  = 0.02). The percentage of extruded meniscal tissue was 35% in group A and 24.6% in group B ( p  = 0.04). At a mean 3.4 years (range 1–4) post-operatively, the Lysholm score had a mean 89.60 ± 6.93 and 91.43 ± 6.19 points in groups A and B, respectively ( p  < 0.001). The median follow-up Tegner score improved from 4 (range 3–5) to 7 (range 6–9) in group A ( p  < 0.001) and from 4 (range 3–5) to 7 (range 6–8) in group B ( p  < 0.001). VAS dropped 5 and 7.3 points in groups A and B, respectively ( p  < 0.001). There were no complications in this series. Conclusions In lateral MAT with the suture-only fixation technique, the described capsulodesis minimized meniscal extrusion. In terms of functional results, there were no differences between the groups at a mean 3.4-year follow-up.