Risk Factors for Graft Failure After Meniscal Allograft Transplantation: A Systematic Review and Meta-analysis

Abstract

Background: Graft failure after meniscal allograft transplantation (MAT) may necessitate revision surgery or conversion to arthroplasty. A comprehensive understanding of the risk factors for failure after MAT of the knee may facilitate more informed shared decision-making discussions before surgery and help determine whether MAT should be performed based on patient risk. Purpose: To perform a systematic review and meta-analysis of risk factors associated with graft failure after MAT of the knee. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, OVID/Medline, and Cochrane databases were queried in October 2021. Data pertaining to study characteristics and risk factors associated with failure after MAT were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MAT graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs. Qualitative analysis was performed to describe risk factors that were variably reported. Results: In total, 17 studies including 2184 patients were included. The overall pooled prevalence of failure at the latest follow-up was 17.8% (range, 3.3%-81.0%). In 10 studies reporting 5-year failure rates, the pooled prevalence of failure was 10.9% (range, 4.7%-23%). In 4 studies reporting 10-year failure rates, the pooled prevalence was 22.7% (range, 8.1%-55.0%). A total of 39 risk factors were identified, although raw data presented in a manner amenable to meta-analysis only allowed for 3 to be explored quantitatively. There was strong evidence to support that an International Cartilage Regeneration & Joint Preservation Society grade >3a (OR, 5.32; 95% CI, 2.75-10.31; P < .001) was a significant risk factor for failure after MAT. There was no statistically significant evidence to incontrovertibly support that patient sex (OR, 2.16; 95% CI, 0.83-5.64; P = .12) or MAT laterality (OR, 1.11; 95% CI, 0.38-3.28; P = .85) was associated with increased risk of failure after MAT. Conclusion: Based on the studies reviewed, there was strong evidence to suggest that degree of cartilage damage at the time of MAT is associated with graft failure; however, the evidence was inconclusive on whether laterality or patient sex is associated with graft failure.

Meniscal allograft transplantation improves patient‐reported outcomes in both minimal and moderate knee osteoarthritis at 1 and 2 years postoperatively

“…Equally improved clinical outcomes have been generally reported after MMAT and LMAT [ 15 , 32 , 37 ]. A recent systematic review found no significant risk for graft failure between patients receiving either MMAT or LMAT [ 17 ]. In most studies, MAT seems to decrease pain in the affected compartment and provides subjective improvement in up to 70% of patients [ 11 , 30 , 38 ].…”

Significant improvements in clinical outcome measures and patient satisfaction after combined all‐arthroscopic meniscal allograft transplantation and autologous chondrocyte implantation: A single‐centre longitudinal study

“…A 2021 systematic review [27] highlighted conflicting evidence concerning the impact of chondral damage on MAT outcomes. However, a more recent extensive systematic review and meta-analysis [28] identified a pronounced association between the extent of cartilage damage at the time of MAT and subsequent graft failure. Despite these findings, only a few studies have reported outcomes after combined articular cartilage restoration and MAT, demonstrating the potential for positive results and warranting further investigation [29].…”