Imaging of meniscal allograft transplantation: what the radiologist needs to know
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REVIEW ARTICLE
Imaging of meniscal allograft transplantation: what the radiologist needs to know Saeed Dianat 1,2 & Kirstin M. Small 1 & Nehal Shah 1 & Christian Lattermann 3 & Jacob C. Mandell 1 Received: 1 July 2020 / Revised: 23 September 2020 / Accepted: 24 September 2020 # ISS 2020
Abstract Meniscal allograft transplantation is an emerging surgical option for younger patients with symptomatic meniscal deficiency, which aims to restore anatomic biomechanics and load distribution in the knee joint, and by so doing to potentially delay accelerated osteoarthritis. In this review article, we summarize the structure and biomechanics of the native meniscus, describe indications and procedure technique for meniscal allograft transplantation, and demonstrate the spectrum of expected postoperative imaging and role of imaging to identify potential complications. Keywords Meniscal transplantation . Meniscus . Meniscal deficiency . Meniscectomy . MRI
Introduction Meniscal injuries are the second most common type of knee injuries, accounting for about one quarter of knee injuries with an annual incidence of 61 cases per 100,000 individuals [1, 2]. There are an estimated 850,000 patients undergoing meniscal surgery per year in the USA, comprising approximately 10– 20% of all orthopedic surgeries [3]. While patients older than
* Saeed Dianat [email protected] Kirstin M. Small [email protected] Nehal Shah [email protected] Christian Lattermann [email protected] Jacob C. Mandell [email protected] 1
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
2
Division of Musculoskeletal Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
3
Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
45 years of age tend to be treated with partial meniscectomy or debridement, patients younger than 35 years of age are more likely to have meniscal repair surgery [2]. In recent years, there has been growing recognition among orthopedic surgeons to preserve as much meniscal tissue as possible and data shows increased rate of meniscal repair and decreased rate of meniscal debridement [4]. Meniscal repair aims to preserve meniscal function in shock absorption, load distribution, and enhanced joint stability. In contrast, meniscal deficiency can lead to onset and progression of osteoarthritis [5]. The classic teaching is that peripheral meniscal injuries in the “red” (vascular) zone can be treated with repair, and injuries to the inner meniscal “white” (avascular) zone are treated with debridement. However, recently developed suture techniques have been used to repair inner avascular zone tears with some shortterm clinical success reported [6]. Despite these advances, meniscal allograft transplantation (MAT) is an alternative treatment option for more advanced meniscal in
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