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

Purpose There is considerable debate regarding the optimal method of ixation for lateral meniscus allograft transplantation (MAT), with bone bridge techniques technically harder but allowing maintenance of root attachments, while soft tissue techniques are potentially more challenging for healing. The aim of this study was to compare the clinical results of the bone bridge and soft tissue techniques for lateral MAT in terms of failure, re-operation rate, complications and patient reported outcomes. Methods Retrospective analysis of prospectively collected data for patients undergoing primary lateral MAT with a minimum of 12-month follow-up. Patients following surgery utilising the bone bridge technique (BB) were compared with historical control patients who underwent MAT with the soft tissue technique (ST). Outcome was assessed by failure rate, deined as removal or revision of the meniscus transplant, survivorship by Kaplan-Meir analysis, re-operation rates, and other adverse event. Patient-reported outcome measures (PROMs) were compared using data at the 2-year point or 1 year if not reached 2 years. Results One-hundred and twelve patients following lateral meniscal transplants were included, 31 in the BB group and 81 in the ST historical control group, with no diferences in demographics between both groups. Median follow-up for the BB group was 18 (12-43) months compared to 46 (15-62) months for the ST group. There were 3 failures (9.6%) in the BB group v 2 (2.4%) in the ST group (n.s.) with a mean time to failure of 9 months in both groups. 9 patients (29%) required a re-operation (all cause) in the BB group v 24 patients (29.6%) in the ST group (n.s). There was no diference in complications between both groups. There was signiicant improvement (p < 0.0001) in all PROMs (Tegner, IKDC, KOOS and Lysholm) between baseline and 2-year follow-up for both groups but no between-group diferences. Conclusion Lateral MAT has a high success rate for symptomatic meniscal deiciency with signiicant beneits irrespective of the ixation technique. There is no advantage in performing the more technically demanding BB technique over ST ixation. Level of evidence Level 2. Keywords Lateral meniscus allograft transplantation • Bone bridge technique • Soft tissue ixation* Rahul Bhattacharyya

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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

Bhattacharyya,

Krishnan,

Bausch

et al. 2023

“…Historically, relative indications for MAT included patients without full-thickness cartilage damage and those younger than age 50 [18,46]. These general guidelines, specifically the age criteria, have been challenged prior to the current analysis in the study by Frank et al [11] revealing no significant difference in outcomes after MAT at a final follow-up of 5.1 years when comparing patients younger than 40 to those older than 40.…”

Section: Discussionmentioning

confidence: 99%

Correlation between articular cartilage status on outcomes and survivorship following meniscal allograft transplantation: A systematic review

Gopinatth,

Warrier,

Jawanda

et al. 2024

PurposeTo conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT).MethodsA literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status.ResultsSixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full‐thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT.ConclusionsConflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure.Level of EvidenceLevel IV.

“…The findings of a prior study suggested the need for caution when obtaining answers related to orthopaedic surgery from ChatGPT. This research revealed that ChatGPT's responses were accurate in 65% of cases, either entirely or to a significant extent, but were entirely inaccurate in 15% of instances [20].…”

Section: Chatgpt Model and Its Benefits In Academic Writingmentioning

confidence: 99%

“…ChatGPT is a language generation model designed to generate human‐like text based on its input. There have already been a great number of publications on its use, history and limitations [6, 19–21]. It can provide text from previous data it was fed with.…”

Section: Chatgpt Model and Its Benefits In Academic Writingmentioning

confidence: 99%

Embrace responsible ChatGPT usage to overcome language barriers in academic writing

Kayaalp,

Ollivier,

Winkler

et al. 2023

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