title: Actifit® scaffold implantation: Influence of preoperative meniscal extrusion on morphological and clinical outcomes.
abstract: 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.
  
  
  OBJECTIVE
  Preoperative absolute meniscal extrusion in the coronal plane predicts poorer morphological and clinical outcomes.
  
  
  METHODS
  Consecutive patients who received an Actifit(®) 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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  IV, prospective study.
authors.affiliation: Hôpital Ambroise-Paré, université de Versailles-Saint-Quentin-en-Yvelines, CHU Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France; Orthopaedic surgery department, hôpital Mignot-Versailles, 78150 Le Chesnay, France. Electronic address: faivrebruno1@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Faivre
authors.affiliation: Orthopaedic surgery center, 20060 Casablanca, Morocco.
authors.forename: H
authors.initials: H
authors.lastname: Bouyarmane
authors.affiliation: Hôpital Raymond-Poincaré, université Versailles Saint-Quentin-en-Yvelines, CHU Paris Île-de-France Ouest, 92380 Garches, France.
authors.forename: G
authors.initials: G
authors.lastname: Lonjon
authors.affiliation: Orthopaedic surgery department, hôpital Mignot-Versailles, 78150 Le Chesnay, France.
authors.forename: P
authors.initials: P
authors.lastname: Boisrenoult
authors.affiliation: Orthopaedic surgery department, hôpital Mignot-Versailles, 78150 Le Chesnay, France.
authors.forename: N
authors.initials: N
authors.lastname: Pujol
authors.affiliation: Orthopaedic surgery department, hôpital Mignot-Versailles, 78150 Le Chesnay, France.
authors.forename: P
authors.initials: P
authors.lastname: Beaufils
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D048091:Guided Tissue Regeneration / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology / Q000601:surgery; D057234:Preoperative Period; D011446:Prospective Studies; D000070600:Tibial Meniscus Injuries; D054457:Tissue Scaffolds; D016896:Treatment Outcome
keywords: Actifit(®); Meniscus extrusion; Meniscus scaffold; Partial meniscectomy