title: Proper Cartilage Status for Meniscal Allograft Transplantation Cannot Be Accurately Determined by Patient Symptoms.
abstract: BACKGROUND
  Candidates for meniscal allograft transplantation (MAT) often already have a significant cartilage lesion when they present with a symptomatic knee. However, the level of symptoms required for MAT to be performed is poorly defined, leading to difficulties in selecting patients and the potential for further cartilage loss.
  
  
  OBJECTIVE
  To evaluate if various clinical evaluation scores reflect the articular cartilage status of the lateral compartment preoperatively in symptomatic, lateral meniscus-deficient knees.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A total of 113 consecutive patients who underwent lateral MAT were reviewed. All patients were preoperatively assessed by the most common patient-reported outcome measures (PROMs), including the visual analog scale (VAS) for pain, Lysholm knee scale, International Knee Documentation Committee (IKDC) subjective form, and Tegner activity scale. The maximum grade from the International Cartilage Repair Society (ICRS) scale on either femoral or tibial articular cartilage was used for a correlation analysis between PROMs and ICRS grades and a comparison of PROMs between patients with low-grade (ICRS grade ≤2) and high-grade (ICRS grade 3 or 4) cartilage degeneration.
  
  
  RESULTS
  More than half of the patients had high-grade cartilage degeneration, even though their mean VAS pain score was low (3.1 ± 1.3). There were no significant relationships between ICRS grades and PROMs, except for the IKDC subjective score, which was weakly associated with the ICRS grade (Spearman ρ test, 2-sided, ρ = -.200, P = .034). When comparing patients with low-grade versus high-grade cartilage degeneration, there were no differences in PROMs except for the Lysholm score (67.8 ± 14.7 vs 62.3 ± 13.9, respectively; P = .044). Notably, 37 of 58 patients (63.8%) with high-grade chondral lesions only felt pain during severe exertion.
  
  
  CONCLUSIONS
  Mild or tolerable symptoms did not necessarily mean that articular cartilage was well preserved in patients undergoing MAT. The study findings suggest a need for close observation and greater caution concerning possible chondral damage in the treatment of meniscus-deficient knees.
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Catholic University, Incheon St Mary's Hospital, Incheon, South Korea.
authors.forename: Bum-Sik
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea sibin@amc.seoul.kr.
authors.forename: Seong-Il
authors.initials: SI
authors.lastname: Bin
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: Jae Hyan
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: Geun-Won
authors.initials: GW
authors.lastname: Han
mesh_terms: D000328:Adult; D064591:Allografts / Q000637:transplantation*; D002358:Cartilage, Articular / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065466:Lysholm Knee Score; D008297:Male; D008592:Menisci, Tibial / Q000637:transplantation*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D057234:Preoperative Period; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000706:statistics & numerical data
keywords: cartilage; lateral; meniscal allograft transplantation