Good clinical outcomes can be expected after meniscal allograft transplantation at 15 years of follow-up

Abstract

PurposeThe aim of this study was to evaluate graft survivorship and report the functional and radiographic results of Meniscal allograft transplantation (MAT) throughout a minimum 15‐year follow‐up period. MethodsFifty‐one patients that had undergone an isolated MAT procedure during the period studied were included. The results were assessed with the Lysholm and Tegner scores as well as the Visual Analog Scale. Magnetic resonance imaging and a complete radiographic series were carried out to determine the degree of meniscal extrusion and joint space narrowing. A comparison was made between the radiological findings of the last follow‐up, the 5‐year mid‐term follow‐up and those from the preoperative period. ResultsThirty‐eight patients were available for the final follow‐up. The mean follow‐up was 17.4 years. There were 23 (60.5%) medial menisci and 15 lateral menisci (39.4%). Meniscal extrusion increased from the 29.7% ± 14.9 obtained at the 5‐year follow‐up to the 72.5% ± 22.5 seen at the end of the follow‐up (p = 0.0001). The joint space distance was almost unchanged from the initial evaluation (3.3 ± 1.5 mm) to the 5‐year follow‐up measurement (3.1 ± 1.7 mm, n.s.). However, it did decrease at the last follow‐up (1.9 ± 1.5 mm, p < 0.05). The functional outcomes improved from the preoperative period to the mid‐term follow‐up and later worsened at the final follow‐up. The mean preoperative Lysholm score at the initial follow‐up was 61.5 ± 9.6, 86.9 ± 10.9 for the 5‐year evaluation and stood at 77.4 ± 11.5 (p = 0.0001) at the final follow‐up. Regarding the Tegner score, those pre‐operative scores were compared to the ones at the last follow‐up (median: 3; range 0–6 vs. 5.5; 3–6, respectively; p = 0.0001). The VAS went down from 6.6 ± 1.7 at the initial evaluation to 2.5 ± 1.9 at the final follow‐up (p = 0.0001). The joint‐space width remained unchanged from the initial evaluation (3.35 ± 1.5 mm) up to the 5‐year follow‐up measurement (3.1 ± 1.7 mm, n.s.). However, this joint‐space distance had decreased by the last evaluation in the long‐term follow‐up (1.9 ± 1.4 mm, p < 0.05). Five patients (13.1%) presented with a MAT failure at 5 years, which was followed by extirpation of the meniscal graft. At the final follow‐up, a total of 16 patients (42.1%) presented with a failure. At that time, there were 4 more MAT removals and seven patients that required a total knee replacement. The mean time to failure of the meniscal graft was 206.2 months ± 13.4 (18.0 years). ConclusionsMeniscal allograft transplantation produces good functional results at a minimum 15‐year follow‐up. However, degenerative arthritis in the affected compartment progressed during that period. Level of evidenceIII.

Meniscus allograft transplantation for biologic knee preservation: gold standard or dilemma?

“…While there is literature supporting adequate long‐term graft survivorship in patients with greater degrees of chondral changes, many surgeons still prefer to avoid implanting new meniscal tissues into chondral‐damaged knee joints because of the higher risk of failure [6]. Overall, despite these variations in indication for MAT, most research generally reports adequate pain relief, improved knee stability, chondroprotective effects, return to work and, in some cases, even return to sport with the surgery [2, 4, 8, 10, 13, 14, 17].…”

Bone bridge technique for lateral meniscal allograft transplantation: no difference in clinical outcome compared to the soft tissue technique

“…The study was performed to determine whether a change from the soft tissue technique to the bone bridge technique would result in improved outcome and fewer complications. While the risk of long-term failure of the allograft [18,[25][26][27][28][29][30][31][32], and progression of arthritis at some stage following transplantation is well recognised [33][34][35] there remains an important rate of early re-operation. McCormick et al reported a re-operation rate of 32% using the bone bridge technique [36], and Grassi et al [37] reported a 26% re-operation rate using the soft tissue ixation method, rates comparable to our series.…”

Meniscal allograft transplantation in discoid meniscus patients achieves good clinical outcomes and superior chondroprotection compared to meniscectomy in the long term

“…It is well documented that meniscectomy can greatly change the knee biomechanics, with increased stress on the cartilage [4, 20], and knee osteoarthritis may develop in the long term [1, 15]. MAT was reported to confer moderate chondroprotection in non‐discoid patients [8, 31], and several studies found no KL grade progression and significantly delayed JSW narrowing after MAT [17, 29]. In this study, MAT in DLM patients led to less JSW narrowing, less KL progression, less CDI increase and less T2 relaxation time than those in discoid ME patients.…”

“…For patients with complex and immense tears and meniscus degeneration, resecting the entire DLM is inevitable [16, 18]. Some meniscus‐deficient patients consistently develop symptoms after meniscectomy and are potential candidates for meniscal allograft transplantation (MAT), which is an effective procedure to relieve pain and restore knee function in meniscus‐deficient patients [8, 29].…”