Abstract
BackgroundInaccurate meniscus allograft size is still an important problem of the currently used sizing methods. The purpose of this study was to evaluate a new three-dimensional (3D) meniscus-sizing method to increase the accuracy of the selected allografts.Methods3D triangular surface models were generated from 280 menisci based on 50 bilateral and 40 unilateral knee joint magnetic resonance imaging (MRI) scans. These models served as an imaginary meniscus allograft tissue bank. Meniscus sizing and allograft selection was simulated for all 50 bilateral knee joints by (1) the closest mean surface distance (MeSD) (3D-MRI sizing with contralateral meniscus), (2) the smallest meniscal width/length difference in MRI (2D-MRI sizing with contralateral meniscus), and (3) conventional radiography as proposed by Pollard (2D-radiograph (RX) sizing with ipsilateral tibia plateau). 3D shape and meniscal width, length, and height were compared between the original meniscus and the selected meniscus using the three sizing methods.ResultsAllograft selection by MeSD (3D MRI) was superior for all measurement parameters. In particular, the 3D shape was significantly improved (p < 0.001), while the mean differences in meniscal width, length, and height were only slightly better than the allograft selected by the other methods. Outliers were reduced by up to 55% (vs. 2D MRI) and 83% (vs. 2D RX) for the medial meniscus and 39% (vs. 2D MRI) and 56% (vs. 2D RX) for the lateral meniscus.Conclusion3D-MRI sizing by MeSD using the contralateral meniscus as a reconstruction template can significantly improve meniscus allograft selection. Sizing using conventional radiography should probably not be recommended.Trial registrationKantonale Ethikkommission Zürich had given the approval for the study (BASEC-No. 2018-00856).
Highlights
Inaccurate meniscus allograft size is still an important problem of the currently used sizing methods
The meniscus plays an important role in the kinematics of the knee joint, reduces contact pressure [1], and improves joint stability [2, 3]
Meniscus allograft transplantation seems to be a valuable option for pain reduction and improvement of function in patients with postmeniscectomy syndrome [5]
Summary
Inaccurate meniscus allograft size is still an important problem of the currently used sizing methods. The purpose of this study was to evaluate a new three-dimensional (3D) meniscus-sizing method to increase the accuracy of the selected allografts. The meniscus plays an important role in the kinematics of the knee joint, reduces contact pressure [1], and improves joint stability [2, 3]. These functions disappear after subtotal or total meniscectomy with resultant early osteoarthritis [4]. Several studies demonstrated good or excellent short- to medium-term results [6,7,8,9,10,11,12]. While midterm survivorship is reported to be 85–90%, long-term survivorship decreases to 50– 70% [13]
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