Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication

Kempshall, P.; Parkinson, Benjamin; Thomas, Michael; Robb, Curtis; Standell, Hayley; Getgood, Alan; Spalding, Tim

doi:10.1007/s00167-014-3431-5

Cited by 66 publications

(98 citation statements)

References 34 publications

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“…15 Concerning isolated vs. combined MAT, a minority of authors have noted in the past that patients with accompanying deficiencies and needing multiple concomitant procedures were at greater risk of a poor postoperative outcome. 32,40,47,48 Similarly, we noted a higher postoperative Lysholm's score for isolated MAT, although there were no differences in the three other scales between the two situations. In a recent dedicated meta-analysis, Lee et al 16 found no significant differences in terms of PROMs between isolated and combined MATs.…”

Section: Discussionsupporting

confidence: 46%

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

et al. 2019

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This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's (p = 0.0102) and International Knee Documentation Committee (IKDC; p = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation (p = 0.0008). Fresh frozen allografts had higher Lysholm's scores (p < 0.0001) and showed significantly lower failure rates (p < 0.0001) than cryopreserved allografts. Age (p < 0.015, β = 0.80), sex (p < 0.034, β = − 8.52), and body mass index (BMI; p < 0.014, β = −4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.

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Section: Discussionsupporting

confidence: 46%

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

et al. 2019

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“…However, this result hides the fact that there are significant differences according to the cartilage grouping. In our earlier study, 8 advanced cartilage damage appeared to be associated with failure. In this study with longer follow-up, more patients, and more events, cartilage group is shown to be a strong predictor of failure, even when balancing for potential confounders.…”

Section: Discussionmentioning

confidence: 67%

Factors Predicting Meniscal Allograft Transplantation Failure

Parkinson

Smith

Asplin

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined.Purpose:To determine predictors of MAT failure in a large series to refine the indications for surgery and better inform future patients.Study Design:Cohort study; Level of evidence, 3.Methods:All patients undergoing MAT at a single institution between May 2005 and May 2014 with a minimum of 1-year follow-up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation, or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of the index surgery: group 1, intact or partial-thickness chondral loss; group 2, full-thickness chondral loss 1 condyle; and group 3, full-thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure, independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model.Results:There were 125 consecutive MATs performed, with 1 patient lost to follow-up. The median follow-up was 3 years (range, 1-10 years). The 5-year graft survival for the entire cohort was 82% (group 1, 97%; group 2, 82%; group 3, 62%). The probability of failure in group 1 was 85% lower (95% CI, 13%-97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% CI, 16%-89%) than medial allografts at any time.Conclusion:This study showed that the presence of severe cartilage damage at the time of MAT and medial allografts were significantly predictive of failure. Surgeons and patients should use this information when considering the risks and benefits of surgery.

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“…Failure rates varied from 0% to 33.3% with patients undergoing fresh-frozen allograft transplantation with fixation through bone tunnels in the setting of patients with International Cartilage Repair Society (ICRS) chondral grade 3b involving >1 cm 2 or worse presenting with the worst outcomes22,25). High rates of allograft survival were reported in several studies with Rue et al25) reporting an overall failure rate of MAT in only 6.5% patients, indicating a 93.5% MAT survival rate at a mean follow-up of 37.2 months and McCormick et al16) reporting a 95% allograft survival rate at a mean of 5 years.…”

Section: Resultsmentioning

confidence: 99%

“…Despite several studies reporting low failure rates, several revealed high rates of complications (as high as 30%–46%) including tears requiring repair, allograft removal, as well as infections requiring antibiotic treatment and lavage16,18,19,21,22).…”

Section: Resultsmentioning

confidence: 99%

Meniscal Transplants and Scaffolds: A Systematic Review of the Literature

Dangelmajer

Familiari

et al. 2017

Knee Surg Relat Res

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The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal allograft transplantation (MAT) and implants or scaffolds may be considered. The goal of this review was to compare the success and failure rates of two techniques, MAT and meniscal scaffolds, and make an inference which treatment is more preferable at the present time and future. Studies that met inclusion criteria were assessed for technique used, type of transplant used, number of procedures included in the study, mean age of patients, mean follow-up time, number of failures, failure rate, and reported reoperation rate. Fifteen studies for the MAT group and 7 studies for the meniscal scaffold group were identified. In this selection of studies, the average failure rate in the MAT group was 18.7% and average reoperation rate was 31.3%. The average failure rate in the meniscal scaffold group was 5.6%, and average reoperation rate was 6.9%. It appears that although MAT is associated with high reoperation and failure rates, the limited number of studies on both MAT and scaffolds and mainly short-term results of scaffold studies make it difficult to make an objective comparison.

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Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication

Abstract: III.

Cited by 66 publications

References 34 publications

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

Factors Predicting Meniscal Allograft Transplantation Failure

Meniscal Transplants and Scaffolds: A Systematic Review of the Literature

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