Long sports career and satisfactory clinical outcomes after Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous sports

Background: Factors associated with graft survival after lateral meniscal allograft transplantation (MAT) have not been fully determined, and survival analysis focused on effect of varus alignment has not been performed. Hypothesis: Varus alignment of the knee leads to better graft survival and clinical outcomes after lateral MAT than normal alignment. Study Design: Cohort study; Level of evidence, 2. Methods: The records of 204 consecutive patients who underwent lateral MAT were reviewed. After exclusion of cases undergoing revision MAT, cases without hip-knee-ankle standing radiographs, and cases with valgus alignment, the patients were categorized into 2 groups, those with normal alignment within −3° to 3° of the mechanical axis and those with varus alignment >3°. Cumulative graft survival rates were compared in the 2 groups before and after controlling for other covariates, including sex, age, body mass index (BMI), time from meniscectomy, the number of accompanying procedures, and cartilage status. Failure was defined as (1) a graft tear involving >50% or unstable peripheral rim of the allograft; (2) a Lysholm score <65 that was not improved afterward; (3) meniscectomy >50% or to the zone of meniscocapsular junction; or (4) conversion to revision MAT, realignment osteotomy, or arthroplasty. Clinical outcomes were compared between the 2 groups by Lysholm score. Results: Of the 190 patients, 149 showed normal alignment of 0.3° ± 1.3° (range, –3° to 3°) and 41 showed varus alignment of 4.8° ± 0.6° (range, 4°-8°). A total of 22 patients (11.6%) experienced MAT failure: 21 patients with normal alignment and 1 with varus alignment. Kaplan-Meier survival analysis showed a significant difference in the cumulative graft survival rates between the 2 groups (log-rank test, P = .001). After controlling for age, sex, BMI, time from meniscectomy, the number of accompanying procedures, and cartilage status, varus alignment was found to be a significant protective factor ( P = .004). On the other hand, there was no difference in clinical improvement measured by the Lysholm score between the 2 groups ( P = .651). Conclusion: Varus alignment was associated with better graft survival after lateral MAT than normal alignment. However, no significant differences in clinical outcomes were observed.

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Meniscal Allograft Transplantation: Preoperative Assessment, Surgical Considerations, and Clinical Outcomes

The Journal of Knee Surgery ◽

10.1055/s-0034-1382080 ◽

2014 ◽

Vol 27 (06) ◽

pp. 443-458 ◽

Cited By ~ 12

Author(s):

Randy Mascarenhas ◽

Adam Yanke ◽

Rachel Frank ◽

Davietta Butty ◽

Brian Cole

Keyword(s):

Clinical Outcomes ◽

Preoperative Assessment ◽

Meniscal Allograft Transplantation ◽

Allograft Transplantation ◽

Meniscal Allograft

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Survivorship and clinical outcomes of 147 consecutive isolated or combined arthroscopic bone plug free meniscal allograft transplantation

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-4035-z ◽

2016 ◽

Vol 24 (5) ◽

pp. 1432-1439 ◽

Cited By ~ 32

Author(s):

Stefano Zaffagnini ◽

Alberto Grassi ◽

Giulio Maria Marcheggiani Muccioli ◽

Andrea Benzi ◽

Margherita Serra ◽

...

Keyword(s):

Clinical Outcomes ◽

Meniscal Allograft Transplantation ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Bone Plug

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Clinical Outcomes of Meniscal Allograft Transplantation With or Without Other Procedures: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546517726963 ◽

2017 ◽

Vol 46 (12) ◽

pp. 3047-3056 ◽

Cited By ~ 17

Author(s):

Bum-Sik Lee ◽

Hyun-Jung Kim ◽

Chang-Rack Lee ◽

Seong-Il Bin ◽

Dae-Hee Lee ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Cochrane Library ◽

Tibial Osteotomy ◽

Failure Rates ◽

Meniscal Allograft Transplantation ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Significant Difference

Background: While additional procedures correcting accompanying pathological conditions can improve the clinical outcomes of meniscal allograft transplantation (MAT), whether those outcomes are comparable or poorer than those of isolated MAT has yet to be clarified. Purpose: To evaluate whether there is a difference in clinical outcomes between isolated MAT and MAT combined with other procedures (combined MAT). Study Design: Meta-analysis and systematic review. Methods: For the comparison of clinical outcomes between isolated MAT and combined MAT, the authors searched MEDLINE, Embase, and the Cochrane Library. Studies that separately reported the clinical outcomes of isolated MAT and combined MAT were included. Clinical outcomes were evaluated in terms of patient-reported outcomes (PROs) and complication, reoperation, survivorship, and failure rates. We conducted a meta-analysis of the PROs that were used in more than 3 studies. Results: A total of 24 studies were included in this study. In the meta-analysis, no significant differences in Lysholm scores (95% CI, –5.92 to 1.55; P = .25), Tegner activity scores (95% CI, –0.54 to 0.22; P = .41), International Knee Documentation Committee subjective scores (95% CI, –5.67 to 3.37; P = .62), and visual analog scale scores (95% CI, –0.15 to 0.94; P = .16) were observed between isolated MAT and combined MAT. For PROs that were not included in the meta-analysis, most studies reported no significant difference between the 2 groups. As for the survivorship and failure rates, studies showed varying outcomes. Four studies reported that additional procedures did not affect MAT failure or survivorship. However, 3 studies reported that ligament surgery, realignment osteotomy, and osteochondral autograft transfer were risk factors of failure. One study reported that the medial MAT group in which high tibial osteotomy was performed showed a higher survival rate than the isolated medial MAT group. Conclusion: Overall, there seems to be no significant difference between the postoperative PROs in terms of isolated MAT and combined MAT. However, more data are required to verify the effects of osteotomy and cartilage procedures on the clinical outcomes of MAT. We could not draw conclusions about the differences in complication, reoperation, survivorship, and failure rates between the 2 groups because we did not obtain sufficient data.

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Midterm and Long-term Results of Medial Versus Lateral Meniscal Allograft Transplantation: A Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546517709777 ◽

2017 ◽

Vol 46 (5) ◽

pp. 1243-1250 ◽

Cited By ~ 21

Author(s):

Seong-Il Bin ◽

Kyung-Wook Nha ◽

Ji-Young Cheong ◽

Young-Soo Shin

Keyword(s):

Clinical Outcomes ◽

Meta Analysis ◽

Survival Rates ◽

Long Term Results ◽

Functional Improvement ◽

Meniscal Allograft Transplantation ◽

Allograft Transplantation ◽

Meniscal Allograft

Background: It is unclear whether lateral meniscal allograft transplantation (MAT) procedures lead to better clinical outcomes than medial MAT. Hypothesis: The survival rates are similar between medial and lateral MAT, but the clinical outcomes of lateral MAT are better than those of medial MAT at final follow-up. Study Design: Meta-analysis. Methods: In this meta-analysis, we reviewed studies that assessed survival rates in patients who underwent medial or lateral MAT with more than 5 years of follow-up and that used assessments such as pain and Lysholm scores to compare postoperative scores on knee outcome scales. The survival time was considered as the time to conversion to knee arthroplasty and/or subtotal resection of the allograft. Results: A total of 9 studies (including 287 knees undergoing surgery using medial MAT and 407 with lateral MAT) met the inclusion criteria and were analyzed in detail. The proportion of knees in which midterm (5-10 years) survival rates (medial, 97/113; lateral, 108/121; odds ratio [OR] 0.71; 95% CI, 0.31-1.64; P = .42) and long-term (>10 years) survival rates (medial, 303/576; lateral, 456/805; OR 0.78; 95% CI, 0.52-1.17; P = .22) were evaluated did not differ significantly between medial and lateral MAT. In addition, both groups had substantial proportions of knees exhibiting midterm survivorship (85.8% for medial MAT and 89.2% for lateral MAT) but much lower proportions of knees exhibiting long-term survivorship (52.6% for medial MAT and 56.6% for lateral MAT). In contrast, overall pain score (medial, 65.6 points; lateral, 71.3 points; 95% CI, −3.95 to −0.87; P = .002) and Lysholm score (medial, 67.5 points; lateral, 72.0 points; 95% CI, −10.17 to −3.94; P < .00001) were significantly higher for lateral MAT compared with medial MAT. Conclusion: Meta-analysis indicated that 85.8% of medial and 89.2% of lateral meniscal allograft transplants survive at midterm (5-10 years) while 52.6% of medial and 56.6% of lateral meniscal allograft transplants survive long term (>10 years). Patients undergoing lateral meniscal allograft transplantation demonstrated greater pain relief and functional improvement than patients undergoing medial meniscal allograft transplantations.

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