Multivariate Analysis of Risk Factors of Graft Extrusion After Lateral Meniscus Allograft Transplantation

Ahn, Ji Hyun; Kang, Ho Won; Yang, Tae Yeong; Lee, Jang Yun

doi:10.1016/j.arthro.2015.12.050

Cited by 37 publications

(38 citation statements)

References 26 publications

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“…This study's analyses support the findings of Parkinson et al [13] and Ahn et al [38] that potential risk factors of age, gender and number of concomitant procedures were not related to surgical failure. However, our study disagrees with those studies, in that Outerbridge classification and lateral vs medial were not found to be significant factors in our analysis.…”

Section: Discussionsupporting

confidence: 89%

“…However, our study disagrees with those studies, in that Outerbridge classification and lateral vs medial were not found to be significant factors in our analysis. Whilst some studies have found that articular cartilage damage at the time of surgery and medial (vs. lateral) allografts are associated with a higher risk of surgical failure [13], this study supports the findings of other papers that conclude that cartilage damage does not make a difference [38][39][40] and that medial allografts are not at a higher risk of surgical failure [40]. Importantly, however, it should be noted that where articular cartilage damage was found in the relevant compartment of a patient's knee at the time of MAT surgery, the articular cartilage pathology was also treated at the same time; with radiofrequency coblation chondroplasty for unstable or rough partial thickness chondral damage, with microfracture for small (<2cm 2 ) fullthickness defects or with articular cartilage grafting (using Chondrotissue grafting) for larger (>2cm 2 ) defects.…”

Section: Discussionsupporting

confidence: 88%

“…The methods in the present study were better controlled compared to some previous research: only fresh-frozen meniscal allografts (which are biologically and mechanically superior to other forms of preservation [41]) were used, and these were all sourced from a single provider, and a single onesurgeon technique was used. Previous authors have either not reported their allograft sources [38,42] or have used multiple providers with different preservation techniques [13]. Additionally, the generally good outcomes following MAT in the present study may be attributable to the surgical technique; suture fixation of the allograft to the capsule combined with trans-tibial bone tunnel suture fixation is the current preferred technique [14,43,44].…”

Section: Discussionmentioning

confidence: 79%

See 2 more Smart Citations

The results of meniscal allograft transplantation surgery: what is success?

Searle

Asopa

Coleman

et al. 2020

BMC Musculoskelet Disord

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Background: Meniscal allograft transplantation (MAT) may improve symptoms and function, and may limit premature knee degeneration in patients with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the different potential definitions of 'success' and 'failure'. Methods: Sixty patients who underwent MAT between 2008 and 2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm < 65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistics analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure. Results: Forty-three patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3.4 (±1.6) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again. Conclusions: None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between 'clinical failure' and 'surgical failure' outcomes means these terms may need redefining using a specific/ bespoke MAT scoring system.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 79%

See 1 more Smart Citation

The results of meniscal allograft transplantation surgery: what is success?

Searle

Asopa

Coleman

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…However, our study disagrees with those studies, in that Outerbridge classification and lateral vs medial were not found to be significant factors in our analysis. Whilst some studies have found that articular cartilage damage at the time of surgery and medial (vs. lateral) allografts are associated with a higher risk of surgical failure (13), this study supports the findings of other papers that conclude that cartilage damage does not make a difference (38)(39)(40) and that medial allografts are not at a higher risk of surgical failure (40). Importantly, however, it should be noted that where articular cartilage damage was found in the relevant compartment of a patient's knee at the time of MAT surgery, the articular cartilage pathology was also treated at the same time; with radiofrequency coblation chondroplasty for unstable or rough partial thickness chondral damage, with microfracture for small (<2cm 2 ) full-thickness defects or with articular cartilage grafting (using Chondrotissue grafting) for larger (>2cm 2 ) defects.…”

Section: Discussionsupporting

confidence: 88%

“…The methods in the present study were better controlled compared to some previous research: only fresh-frozen meniscal allografts (which are biologically and mechanically superior to other forms of preservation (41)) were used, and these were all sourced from a single provider, and a single one-surgeon technique was used. Previous authors have either not reported their allograft sources (38,42) or have used multiple providers with different preservation techniques (13). Additionally, the generally good outcomes following MAT in the present study may be attributable to the surgical technique; suture fixation of the allograft to the capsule combined with trans-tibial bone tunnel suture fixation is the current preferred technique (14,43,44).…”

Section: Discussionmentioning

confidence: 79%

The Results of Meniscal Allograft Transplantation Surgery: What is Success?

Searle

Asopa

Coleman

et al. 2020

Preprint

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Background : Meniscal allograft transplantation (MAT) may improve symptoms and function, and limit premature knee degeneration in patients under 50 years with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the potential definitions of ‘success' or ‘failure’. Methods : 60 patients who underwent MAT between 2008-2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm <65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistical analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure. Results : 43 patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3 (±1.9) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again. Conclusions: None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between ‘clinical failure’ and ‘surgical failure’ means these terms may need re-defining using a bespoke MAT scoring system.

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

Gopinatth,

Warrier,

Jawanda

et al. 2024

Knee surg. sports traumatol. arthrosc.

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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.

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Multivariate Analysis of Risk Factors of Graft Extrusion After Lateral Meniscus Allograft Transplantation

Cited by 37 publications

References 26 publications

The results of meniscal allograft transplantation surgery: what is success?

The results of meniscal allograft transplantation surgery: what is success?

The Results of Meniscal Allograft Transplantation Surgery: What is Success?

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

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