Comparative Matched-Pair Analysis of Keyhole Bone-Plug Technique Versus Arthroscopic-Assisted Pullout Suture Technique for Lateral Meniscal Allograft Transplantation

Abstract

To compare the clinical outcomes and meniscal extrusion measured by magnetic resonance imaging (MRI) between the keyhole bone-plug technique and arthroscopic-assisted pullout suture technique in lateral meniscal allograft transplantation (MAT). Between October 2009 and February 2015, patients who underwent lateral MAT were retrospectively reviewed. The inclusion criteria were patients with symptomatic knees that had undergone total or subtotal meniscectomy who were treated with lateral MAT with a minimum follow-up period of 2years. We excluded 13 patients with anterior cruciate ligament injury to the ipsilateral knee and 6 patients with combined cartilage procedures. In addition, we excluded 19 patients because they did not undergo follow-up MRI and 13 patients who did not undergo more than 2years of follow-up. Thirty-seven patients who underwent lateral MAT with the keyhole bone-plug technique were identified and assigned to group A. Forty-five patients who underwent lateral MAT with the arthroscopic-assisted pullout suture technique (group B) were then matched by age, body mass index, and time from previous meniscectomy to lateral MAT. Clinical outcome assessments included preoperative and postoperative subjective International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores and the visual analog scale (VAS) score for pain evaluation. MRI was used to assess meniscal extrusion. The mean follow-up period was 35.8 ± 6.5months (range, 24-65months) in group A and 34.6 ± 6.2months (range, 24-55months) in group B. Significant improvements in the VAS pain score, subjective IKDC score, Tegner score, and Lysholm score after lateral MAT were found (P < .001), and there were no significant differences between the 2 groups at final follow-up (VAS score, 1.4 ± 0.8 in group A and 1.2 ± 1.0 in group B [P= .164]; subjective IKDC score, 72.9 ± 8.1 in group A and 74.2 ± 7.3 in group B [P= .427]; Tegner activity score, 4.0±0.9 in group A and 4.1 ± 0.8 in group B [P= .374]; and Lysholm score, 75.5 ± 10.6 in group A and 76.2 ± 11.8 in group B [P= .786]). On MRI, the meniscal extrusion extent was 3.1 ± 0.9mm in group A and 2.9 ± 0.8mm in group B (P= .223), and the relative percentages of extrusion were 27.0% ± 3.9% and 26.1% ± 4.2%, respectively (P= .273). Compared with the keyhole bone-plug technique, the arthroscopic-assisted pullout suture technique in lateral MAT showed comparable clinical and MRI results at short-term follow-up. Level IV, case series with intragroup comparisons.