Meniscal allograft transplantation after meniscectomy: clinical effectiveness and cost-effectiveness

Waugh, Norman; Mistry, Hema; Metcalfe, Andrew; Loveman, Emma; Colquitt, Jill L; Royle, Pamela; Smith, Nick; Spalding, Tim

doi:10.1007/s00167-019-05504-4

Cited by 35 publications

(39 citation statements)

References 58 publications

(241 reference statements)

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“…Once the patient becomes meniscus-deficient, the outcomes after meniscal transplantation are worse than if the patient underwent meniscal repair at their index procedure. 39 The increased rate of knee arthroplasty after meniscectomy further confirms the results of previous studies, with up to 51.5% of patients requiring knee arthroplasty after meniscectomy compared with 33.5% after meniscal repair at the 10-year follow-up. 1,5,13,29 Abram et al 1 utilized the National Health Service database of England to determine that 0.67% of patients who underwent meniscectomy between the ages of 20 and 39 years required subsequent knee arthroplasty.…”

Section: Discussionsupporting

confidence: 87%

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Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

et al. 2020

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Background: Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series. Purpose: To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database. Study Design: Cohort study; Level of evidence, 3. Methods: A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All P values were reported with significance set at P < .05. Results: A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery ( P < .001), meniscal transplantation ( P = .005), or total knee arthroplasty ( P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001). Conclusion: Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.

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Section: Discussionsupporting

confidence: 87%

“…Once the patient becomes meniscus-deficient, the outcomes after meniscal transplantation are worse than if the patient underwent meniscal repair at their index procedure. 39…”

Section: Discussionmentioning

confidence: 99%

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

et al. 2020

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“…One study found no clear evidence of cost-effectiveness for either APM or meniscal scaffold procedures, whereas the other study found that APM was more cost-effective than MAT in the short term but MAT was more effective at delaying total knee arthroplasty in the long term compared with APM. Waugh et al 139 set out to examine cost-effectiveness of MAT in a systematic review; however, they found that a cost-effectiveness analysis was not feasible because they did not find any studies that compared MAT versus nonoperative management.…”

Section: Resultsmentioning

confidence: 99%

“…Two systematic reviews demonstrated good clinical outcomes after MAT, although both concluded that there was insufficient evidence for determining the chondroprotective effects of MAT. 113,139 In a systematic review and meta-analysis of 17 animal studies, MAT was associated with less gross macroscopic cartilage damage compared with meniscectomy but more damage compared with a control group. 112 No difference in osteoarthritic changes after MAT versus meniscectomy was seen, although MAT was associated with more osteoarthritic changes versus a control group.…”

Section: Meniscal Allograft Transplantationmentioning

confidence: 99%

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

Smoak

Matthews

Vinod

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: A large number of systematic reviews and meta-analyses regarding the meniscus have been published. Purpose: To provide a qualitative summary of the published systematic reviews and meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the meniscus and published between July 2009 and July 2019 was performed with PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts, narrative reviews, articles not written in English, commentaries, study protocols, and topics that were not focused on the meniscus were excluded. The most pertinent results were extracted and summarized from each study. Results: A total of 332 articles were found, of which 142 were included. Included articles were summarized and divided into 16 topics: epidemiology, diagnosis, histology, biomechanics, comorbid pathology, animal models, arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root repairs, meniscal allograft transplantation (MAT), meniscal implants and scaffolds, mesenchymal stem cells and growth factors, postoperative rehabilitation, postoperative imaging assessment, patient-reported outcome measures, and cost-effectiveness. The majority of articles focused on APM (20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a single source of the current evidence regarding the meniscus.

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“…Surgical techniques for implantation include soft‐tissue, bone plug, and bone bridge methods for root fixation, followed by menisco‐capsular suture repair 9,16 . While these grafts and techniques have proven safe and effective in general, complications including shrinkage, extrusion, progression of joint pathology, and failure persist 9,16,17 that negatively influence outcomes, patient satisfaction, and long‐term survivorship due to revision and removal (6%‐27%) or conversion to total knee arthroplasty (19%) 10,18‐21 …”

Section: Introductionmentioning

confidence: 99%

Comparison of meniscal allograft transplantation techniques using a preclinical canine model

Schreiner

Stannard

Bozynski

et al. 2020

Journal Orthopaedic Research

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Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with meniscocapsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibialosteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with meniscotibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT.

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Meniscal allograft transplantation after meniscectomy: clinical effectiveness and cost-effectiveness

Cited by 35 publications

References 58 publications

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

Comparison of meniscal allograft transplantation techniques using a preclinical canine model

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