Actifit® scaffold implantation: Influence of preoperative meniscal extrusion on morphological and clinical outcomes

Background: Meniscal substitutes have been suggested for the treatment of knee pain after partial meniscectomy. However, despite the partial nature of the initial meniscectomy, secondary extrusion of the substitute is common. The primary objective of this study was to evaluate morphological outcomes of meniscal substitute implantation and their potential associations with preoperative meniscal extrusion. Hypothesis: Preoperative absolute meniscal extrusion in the coronal plane predicts poorer morphological and clinical outcomes. Material and methods: Consecutive patients who received an Actifit (R) meniscal substitute between 2008 and 2011 were included prospectively. After 1 year and 2 years, the IKDC score and KOOS were determined and magnetic resonance imaging performed. The morphological evaluation consisted in measuring meniscal extrusion and cartilage coverage by the substitute in the coronal and sagittal planes. Results: Twenty patients were included. Among them, 3 required subsequent removal of the substitute. The mean subjective IKDC score increased from 48.1 preoperatively to 56.4 after 2 years. Over the same period, the function/sports/recreational activities component of the KOOS improved significantly (42.9 vs. 55.0, P = 0.04). Positive correlations between preoperative and 1-year values were demonstrated for both cartilage coverage in the coronal and the sagittal planes (P = 0.03 and P = 0.04, respectively) and coronal absolute meniscal extrusion (P = 0.05). No significant differences were found between preoperative and 2-year values of cartilage coverage in the coronal and sagittal planes (P = 0.38). There was a negative correlation linking preoperative meniscal extrusion in the coronal plane to 1-year cartilage coverage in the coronal and sagittal planes (P = 0.01 and P = 0.04, respectively). Preoperative absolute meniscal extrusion in the coronal plane correlated negatively with the subjective IKDC score after 1 year (P = 0.02). Discussion: Preoperative meniscal extrusion in the coronal plane strongly predicts clinical and morphological outcomes. Marked preoperative meniscal extrusion, even in a patient with symptoms after partial meniscectomy, should prompt an appraisal of whether allograft replacement may be more appropriate than a meniscal substitute. (C) 2015 Elsevier Masson SAS. All rights reserved.