Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up
Date
2021
Type:
Article
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Abstract
Background: The aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. Methods: Prospective study in patients with PU meniscal scaffolds implanted during 2014e2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Postoperative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. Results: Fourteen patients with an average age of 25.8 years (range: 17e47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39e66) months. Postoperative mean clinical outcomes scores showed significantly improved results compared to the preoperative scores. Lysholm scores increased from 62.4 to 80.2 (P ¼ 0.0023), KOOS from 68.9 to 80 (P ¼ 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P ¼ 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3e6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. Conclusion: The use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. Level of evidence: IV. Case series
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Citation
Journal of Clinical Orthopaedics and Trauma, 2021, vol.15: 16-21
Keywords
Actifit, Meniscal, Implant, Scaffold, Polyurethane