Survivorship and Reoperation of 324 Consecutive Isolated or Combined Arthroscopic Meniscal Allograft Transplants Using Soft Tissue Fixation

Abstract

Background: Meniscal allograft transplant (MAT) is an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy. However, the literature contains a paucity of studies assessing the survival rate and prognostic factors of soft tissue MAT. Purpose: To report the survivorship of a large, single-center cohort of consecutive patients treated with arthroscopic MAT using soft tissue technique and to investigate variables that could potentially influence failures and outcomes. Study design: Case series; Level of evidence, 4. Methods: Consecutive MAT procedures totaling 364 performed in a single institution between June 2004 and April 2019 were screened and assessed for eligibility. Subjective clinical scores (Lysholm score, Tegner activity scale, and visual analog score) were collected preoperatively and at 2, 5, 7, and 10 years of follow-up. Two survival analyses were performed using Kaplan-Meier curves, with surgical failure (defined as any graft revision) and clinical failure (defined as a Lysholm score <65 points) used as endpoints. Univariate analyses were performed using reoperations, surgical failure, clinical failure, and different demographic and surgical characteristics as endpoints. Results: A total of 324 consecutive patients were evaluated at a mean follow-up 5.7 ± 3.0 years. Of these, 189 (58%) underwent an associated surgical procedure. A total of 22 patients (6.8%) were considered to have experienced surgical failure, and no predictors of surgical failure were identified based on the relevant variables. When all patients were considered, a significant improvement in all of the patient-reported outcome measures was present between the preoperative assessment and the last follow-up ( P < .001), with no significant decrease over time. Moreover, 70 (21.6%) patients were considered to have experienced clinical failure; the need for concurrent cartilage procedures (odds ratio, 0.16; P = .001) and anterior cruciate ligament (ACL) reconstruction (odds ratio, 0.40; P = .059) were predictors of failure. Finally, a lower survival rate was reported in female patients compared with male patients (49% vs 69%, respectively; P = .007) and in patients who required cartilage surgery ( P = .014). In particular, patients who required cartilage surgery showed nearly half the survival rate compared with those with required no cartilage procedures at 10-year follow-up (36.4% vs 71%, respectively; P = .029). Conclusion: Female sex and the need to combine MAT with a cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at midterm follow-up.

Survivorship of 157 Arthroscopic Meniscal Allograft Transplants Using Bone Fixation at a Mean of 7 Years and Prognostic Factors Analysis

“…56 Fourth, the Lysholm score was only collected at the final follow-up as a commonly used parameter for subjective outcome of MAT. 26,48,84 Therefore, it cannot be compared with a preoperative score. However, the KOOS and IKDC score were collected at 2 time points, and a correlation between scores has previously been reported.…”

“…75,77 Furthermore, relevant information such as preoperative Kellgren-Lawrence or To ¨nnis grade, preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade, tibial slope, and leg alignment are often underreported, impeding interpretation of presented data. 11,26,37 Previous studies have identified generalized degenerative arthritis as a prognostic factor for poor allograft function and survival, leading to exclusion of these patients in a variety of studies. 26,48,55,63,73,79 However, recent evidence suggests that even in knees with severe focal chondral damage, MAT can be an effective treatment, leading to improved clinical scores and decreased pain, especially when combined with cartilage procedures.…”

“…11,26,37 Previous studies have identified generalized degenerative arthritis as a prognostic factor for poor allograft function and survival, leading to exclusion of these patients in a variety of studies. 26,48,55,63,73,79 However, recent evidence suggests that even in knees with severe focal chondral damage, MAT can be an effective treatment, leading to improved clinical scores and decreased pain, especially when combined with cartilage procedures. 1,4,22,45,68 However, the potential chondroprotective capability of MAT, and therefore its role as a preventive procedure in the asymptomatic knee, remains controversial.…”

Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation

“…Meniscal allograft transplantation (MAT) is an established effective treatment for relieving pain in patients who underwent meniscectomy with a 10‐year survival rate ranging from 73 to 86% [6, 10, 19, 27, 29]. Despite such a high mid‐to‐long‐term survival rate, it occurs occasionally for early postoperative failure [7, 31].…”

“…Although no absolute definition of failure has been established, many studies have analyzed it based on clinical and surgical failures [8, 13, 20, 31]. Clinical failure is often defined as a Lysholm score of < 65 and surgical failure as the need for additional surgery after MAT [10, 23]. However, these parameters, while easy to measure, have limitations in offering an objective evaluation of the graft.…”