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A Comparison of T2 Measurement Changes on MRI and Clinical Correlation in a Pilot Randomised Controlled Trial Comparing Meniscal Allograft Transplantation to Physiotherapy
Nick Smith1, Charles Edward Hutchinson2, Victoria Sherwood3, David Wright4, Peter Thompson5, Andy Metcalfe6, Matthew Costa7, and Tim Spalding5

1Orthopaedics, University Hospital Coventry and Warwickshire, Coventry, United Kingdom, 2Health Sciences, University of Warwick, Coventry, United Kingdom, 3Medical Physics, University Hospital Coventry and Warwickshire, 4University Hospital Coventry and Warwickshire, 5Orthopaedics, University Hospital Coventry and Warwickshire, 6Health Sciences, University of Warwick, 7Orthopaedics, University of Oxford

Synopsis

This pilot study shows the T2 changes that occur within cartilage in patients with meniscal transplantation. A full trial to prove whether meniscal allograph translation is justied

Introduction

Meniscectomy in young patients results in a high risk of early osteoarthritis. Meniscal allograft transplantation has been performed for over 30 years in patients with a symptomatic meniscal deficient knee. It is hoped that the operation is chondroprotective to the articular cartilage, but this has not been determined to date. The aim of this study was to compare changes in T2 MRI measures in a pilot randomised controlled trial (RCT) comparing meniscal allograft transplantation to physiotherapy.

Materials and Methods

A single centre pilot RCT with parallel preference groups was performed on participants with a symptomatic knee compartment that had previously had a (sub-) total meniscectomy. Participants not willing to be randomised entered the preference groups. Participants were studied on a 3-T MRI using a multi-echo sequence for T2 mapping. Changes in T2 values in three femoral cartilage regions of interest (ROI) (anterior, under the posterior horn of the meniscus and posterior) of the affected compartment of the knee were compared at one year. The change in Knee injury and Osteoarthritis Outcome (KOOS4) score at one year was correlated with the ROI using Pearson’s Correlation Coefficient.

Results

Thirty-six participants entered the study; 21 were randomised (mean age 27.5 years, 81% lateral meniscectomies) and 15 chose their treatments (mean age 28.7, 74% lateral meniscectomies). Baseline demographics and treatment outcomes were similar between the randomised and preference groups, allowing pooling of data. The mean change in T2 values at one year in the meniscal allograft transplantation and physiotherapy groups respectively were: 1.97 and 4.23 (p=0.63) in the anterior ROI, 2.30 and 5.13 (p=0.57) in ROI under the posterior horn of the meniscus, and 5.67 and 7.57 (p=0.62) in the posterior ROI. There was a moderate (0.38) correlation between improved clinical scores and lower T2 values, although this had borderline statistical significance (p=0.07).

Conclusions

In this first pilot RCT comparing meniscal allograft transplantation to non-operative treatment, all ROI showed changes in T2 measures favouring surgery. Whilst differences between the trial groups were not statistically significant in this pilot investigation, these results warrant a full trial to determine whether meniscal allograft transplantation may be chondroprotective. There was a moderate correlation between lower T2 values and improved clinical outcomes, suggesting that T2 measurements are clinically relevant.

Acknowledgements

ARUK for fellow ship funding Dr Smith

References

No reference found.
Proc. Intl. Soc. Mag. Reson. Med. 25 (2017)
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