Extrusion After Meniscal Allograft Transplantation Is Lower or Equal With Bony Compared With Soft-Tissue Root Fixation: A Systematic Review

Wouter Beel; Andrew D Firth; Scott Tulloch; Taher Abdelrehman; Olumide Olotu; Dianne Bryant; Alan Getgood

doi:10.1016/j.arthro.2024.02.045

Extrusion After Meniscal Allograft Transplantation Is Lower or Equal With Bony Compared With Soft-Tissue Root Fixation: A Systematic Review

Arthroscopy. 2024 Mar 21:S0749-8063(24)00232-9. doi: 10.1016/j.arthro.2024.02.045. Online ahead of print.

Authors

Wouter Beel¹, Andrew D Firth², Scott Tulloch³, Taher Abdelrehman⁴, Olumide Olotu¹, Dianne Bryant⁵, Alan Getgood⁶

Affiliations

¹ Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada.
² Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
³ Department of Orthopedic Surgery, Western Health, Footscray Hospital, Melbourne, Australia.
⁴ Hull University Hospital NHS Trust, Hull, England.
⁵ School of Physical Therapy, Faculty of Health Science, Western University, London, Canada.
⁶ Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada. Electronic address: alan.getgood@uwo.ca.

PMID: 38521206
DOI: 10.1016/j.arthro.2024.02.045

Abstract

Purpose: To provide an update on the incidence and extent of graft extrusion after meniscal allograft transplantation (MAT) and to systematically review the literature to identify whether the type of root fixation or additional surgical techniques may reduce the risk of graft extrusion development.

Methods: A systematic search, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, was conducted using the MEDLINE database, EMBASE database, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL) database. Patients undergoing medial meniscal allograft transplantation (MMAT) or lateral meniscal allograft transplantation (LMAT) were included. The primary outcome measure was meniscal extrusion measured on postoperative magnetic resonance imaging scans taken more than 6 weeks after MAT. The following extrusion outcomes were investigated: absolute extrusion (AE), relative percentage of extrusion (RPE), and proportion of major extrusion (PME). Additional surgical techniques that reduced the risk of graft extrusion development in the included comparative studies were identified.

Results: For MMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.2 mm versus 3.36 mm and RPE of 44.43% versus 33.18%. The pooled mean PME for MMAT with soft-tissue fixation was 51.62%. For LMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.72 mm versus 2.78 mm, RPE of 31.89% versus 29.47%, and PME of 64.37% versus 35.80%. Additional capsulodesis was identified as a technique to reduce LMAT extrusion.

Conclusions: This study highlights that graft extrusion is a common finding after MMAT and LMAT, independent of the root fixation technique. However, MAT extrusion with bony fixation was, depending on the outcome measurement, lower than or equal to that with soft-tissue fixation.

Level of evidence: Level IV, systematic review of Level I, III, and IV studies.

Publication types

Review