scholarly journals Editorial Commentary: Return to Sport Should Not Be Your Goal Following High Tibial Osteotomy With Concomitant Medial Meniscal Allograft Transplantation

2019 ◽  
Vol 35 (11) ◽  
pp. 3097-3098
Author(s):  
John.C. Richmond
Keyword(s):  
High Tibial Osteotomy ◽  
Return To Sport ◽  
Tibial Osteotomy ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Editorial Commentary ◽  
Meniscal Allograft

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

2017 ◽  
Vol 46 (12) ◽  
pp. 3047-3056 ◽  
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.

Return to Sport and Work After High Tibial Osteotomy With Concomitant Medial Meniscal Allograft Transplant

2019 ◽  
Vol 35 (11) ◽  
pp. 3090-3096 ◽  
Author(s):  
Joseph N. Liu ◽  
Avinesh Agarwalla ◽  
Grant H. Garcia ◽  
David R. Christian ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Return To Sport ◽  
Tibial Osteotomy ◽  
Meniscal Allograft

scholarly journals Patient Satisfaction and Return to Sports after Meniscal Allograft Transplantation

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025
Author(s):  
Gregory Louis Cvetanovich ◽  
David R. Christian ◽  
Grant Hoerig Garcia ◽  
Joseph N. Liu ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Weight Lifting ◽  
Return To Sports ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Patient Reported ◽  
Sporting Activities

Objectives: To investigate the ability of patients to return to sport following arthroscopic meniscal allograft transplantation (MAT). Methods: Patients undergoing arthroscopic MAT between 2013 and 2015 were retrospectively reviewed. Patients completed an outcome survey regarding return to sports in addition to patient reported outcome measures. Subsequent surgery and failure (total meniscectomy, revision MAT, or total or partial knee arthroplasty) were also evaluated. Results: Of 117 MAT performed, 87 patients (74.4%) were available at average 3.6 year follow-up. The average age at time of surgery was 29.0+/-8.3. All 84 patients underwent prior ipsilateral knee surgery with an average of 3.5+/-2.1 prior procedures. MAT was lateral in 44 cases (50.6%), medial in 42 cases (48.3%), and combined medial and lateral in one case (1.1%). Concomitant procedures were performed in 72 patients (82.7%) including cartilage restoration (65, 74.7%), realignment (9, 10.3%), and ACL reconstruction (9, 10.3%). Patients experienced significant improvement compared to preoperative Lysholm, IKDC, KOOS, WOMAC, and SF-12 physical scores (p < 0.001). Within three years prior to MAT, 82 patients (94.3%) reported participation in sporting activities. Due to knee symptoms, 62 patients (75.6%) discontinued at least one sport prior to MAT. Of the 82 patients participating in sports preoperatively, 62 patients (75.6%) returned to at least one sport at an average of 12.3 months after MAT. Rates of return to specific sports were highest for light weight lifting, yoga, swimming, and cycling and all RTS rates are shown in Table 1. The percentage of patients participating in sports above the recreational level declined significantly (46.0% prior to symptoms versus 8.2% after MAT, p < 0.001). The most common reasons for decreasing level of sport postoperatively were: to prevent further damage (73.6%), pain or swelling with sports (51.4%), fear of further injury (48.6%), surgeon recommendation (33.3%), and decision to pursue other activities (11.1%). Patients reported being satisfied with their ability to participate in sports at a rate of 63.2%, and 78.8% reported they would still undergo MAT with the benefit of hindsight. Reoperation was performed in 26 patients (29.9%) with 12 patients experiencing failure (13.7%; 1 TKA, 2 UKA, 9 total meniscectomy). Conclusion: In a complex patient population undergoing arthroscopic MAT, 75.6% of patients were able to return to at least one sport at an average of 12.3 months postoperatively. Level of sport declined compared to baseline, with most patients restricting involvement to recreational sports after MAT. The most common reasons for decreasing level of sport were: to prevent further damage, pain or swelling with sports, and fear of further injury. [Table: see text]

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

2019 ◽  
Author(s):  
Henry Kelvin Christopher Searle ◽  
Vipin Asopa ◽  
Simon Coleman ◽  
Ian McDermott
Keyword(s):  
Risk Factors ◽  
Outcome Measures ◽  
Return To Sport ◽  
Complication Rates ◽  
Clinical Failure ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Patient Reported ◽  
Surgical Failure

Abstract 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.

scholarly journals Return to Sport Activity After Meniscal Allograft Transplantation: At What Level and at What Cost? A Systematic Review and Meta-analysis

2019 ◽  
Vol 11 (2) ◽  
pp. 123-133 ◽  
Author(s):  
Alberto Grassi ◽  
James R. Bailey ◽  
Giuseppe Filardo ◽  
Kristian Samuelsson ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Sport Activity ◽  
Return To Sport ◽  
Meniscal Allograft Transplantation ◽  
Physically Active ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Active Patients

Context: Meniscal injuries are common among both sport- and non–sport-related injuries, with over 1.7 million meniscal surgeries performed worldwide every year. As meniscal surgeries become more common, so does meniscal allograft transplantation (MAT). However, little is known about the outcomes of MAT in active patients who desire to go back to preinjury activities. Objective: The purpose of this systematic review and meta-analysis was to evaluate return to sport, clinical outcome, and complications after MAT in sport-active patients. Data Sources: A systematic search of MEDLINE, EMBASE, and CINAHL electronic databases was performed on February 25, 2018. Study Selection: Studies of level 1 through 4 evidence looking at MAT in physically active patients with reported return to activity outcomes and at least 2-year follow-up were included. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Details of sport-related outcomes and reoperations were extracted and pooled in a meta-analysis. Results: Nine studies were included in this systematic review. A majority (77%) of athletes and physically active patients were able to return to sport after MAT; two-thirds were able to perform at preinjury levels. Graft-related reoperations were reported in 13% of patients, while the joint replacement rate with partial or total knee prosthesis was 1.2%. Conclusion: Physical activity after MAT appears possible, especially for low-impact sports. However, because of the limited number of studies, their low quality, and the short-term follow-up, the participation recommendation for high-impact and strenuous activities should be considered with caution until high-quality evidence of long-term safety becomes available.

scholarly journals Return to Sport and Patient Satisfaction Following Concomitant High Tibial Osteotomy and Osteochondral Allograft Transplantation

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Joseph N. Liu ◽  
David R. Christian ◽  
Avinesh Agarwalla ◽  
Grant H. Garcia ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Sport Activity ◽  
Young Patients ◽  
Return To Sport ◽  
Osteochondral Allograft ◽  
Tibial Osteotomy ◽  
Persistent Symptoms ◽  
Allograft Transplantation ◽  
Cartilage Restoration

Objectives: Varus deformity of the knee predisposes patients to chondral and meniscal pathology of the medial compartment. Young patients with symptomatic chondral defects of the medial femoral with varus alignment often undergo concomitant opening wedge high tibial osteotomy (HTO) and cartilage restoration including allograft transplantation (OCA). Limited information is available regarding return to sporting activities after combined HTO and osteochondral allograft transplantation (OCA). Methods: All patients who underwent concomitant HTO and OCA by a single surgeon for medial knee pain due to a focal chondral defect of the medial femoral condyle were retrospectively identified through a prospectively collected data base. The primary indication for HTO was varus malalignment ≥ 5 degrees. At final follow-up, patients completed a subjective sports questionnaire, the Marx activity scale, a pain visual analog scale (VAS), a Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Patients were excluded for having undergone any concomitant procedure other than cartilage restoration or < 2 years of follow-up. Results: Of 39 concomitant HTO and OCA patients, 28 (71.8%) were available for follow-up at an average 6.07 +/- 4.09 years (range: 2-13 years). The average age at the time of surgery was 35.8 +/- 8.2 years, and 22 patients (78.6%) of patients were male. Four patients (14.3%) also underwent a concomitant medial meniscal allograft transplantation. Nearly all patients had undergone a prior ipsilateral knee surgery (26 patients, 92.8%). Reoperation was performed in 14 patients (50.0%) by the time of final follow-up for persistent symptoms: 6 patients received a meniscal debridement/meniscectomy, 2 patients received a total knee replacement, 1 patient received a unicompartmental knee arthroplasty, 4 patients underwent hardware removal, and 1 patient underwent autologous chondrocyte implantation of a new defect. Of the 22 patients who participated in sports within 3 years prior to their HTO + OAG, 18 patients (67.9%) returned to sport at an average of 11.4 +/- 6.4 months following operative management; however, only 35.7% of patients were able to return to their pre-injury level. Additionally, 60.7% of patients reported being satisfied or extremely satisfied with their return to sport activity. The most common reasons for discontinuing sports were: to prevent further damage (62.5%), persistent pain (54.2%), persistent swelling (33.3%), and fear of further injury (20.8%). Specific sports had high direct rates of return to sport: golf (100%), cross-fit/high-intensity (83.3%), cycling (88.9%), heavy-weightlifting (100%), swimming (60%), running (44.4%) (Figure 1). Conclusion: In a young and active population, concomitant HTO and OA provides a high rate of return to sport 11.4 months postoperatively, although only 35.7% could return to preinjury level or better. Additionally, at an average of 6.07 years following the index procedure, 60.7% of patients were satisfied regarding their sports and activities. When indicated, concomitant HTO and OCA may provide good results in young and active patients who wish to resume sports and physical activities.

Concomitant Meniscal Allograft Transplantation and Autologous Chondrocyte Implantation

2007 ◽  
Vol 35 (9) ◽  
pp. 1459-1466 ◽  
Author(s):  
Jack Farr ◽  
Ashish Rawal ◽  
Kevin M. Marberry
Keyword(s):  
Articular Cartilage ◽  
Autologous Chondrocyte Implantation ◽  
Knee Function ◽  
Tibial Osteotomy ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background Although recent studies have shown intermediate-term success of both meniscal allograft transplantation (MAT) and autologous chondrocyte implantation (ACI) performed separately, there have been no peer-reviewed studies focused prospectively on the combined procedure. By potentially reestablishing a compartment contact area closer to normal, MAT may allow a more optimal environment for ACI by reducing stress (stress = force/unit area). On the other hand, the literature suggests that MAT alone in the presence of extensive chondrosis performs poorly. Restoring the articular cartilage may allow the MAT to perform more similarly to series with nearly normal articular cartilage. Hypothesis Performed concomitantly, ACI and MAT will result in significant improvements in knee function as measured by functional scoring scales and visual analog pain scales. Study Design Case series; Level of evidence, 4. Methods Preoperative and postoperative comparisons of Browne modified Cincinnati functional levels, Lysholm, visual analog rest and maximum pain, and satisfaction scores were recorded. Thirty-six total procedures were performed between 1999 and 2004. Results Of the 36 patients entering the series, 29 had >2-year evaluation and scores. Four patients were recorded as failures before the 2-year follow-up and required revision surgery. Three patients were lost to follow-up. A total of 21 medial and 8 lateral MAT/femoral condyle ACIs were performed. Sixteen of 29 patients had concomitant procedures performed, including tibial tuberosity osteotomy, anterior cruciate ligament reconstruction, and high tibial osteotomy. Patients demonstrated statistically significant improvement in the standardized outcome surveys, visual analog pain, and satisfaction scores. The Browne Cincinnati (Patient and Clinician, respectively) showed an improvement from 3.9 (standard deviation [SD], 1.5) and 4.0 (SD, 1.4) preoperatively to 6.3 (SD, 1.9) postoperatively for both. The Lysholm also showed an improvement from 57.7 (SD, 16.2) preoperatively to 77.7 (SD, 19.3) postoperatively. There were no significant differences noted in any of the subgroups (medial vs lateral, isolated vs concomitant, or unipolar vs bipolar). Conclusion At a minimum of 2-year follow-up, MAT in combination with ACI demonstrates improvement in both symptoms and knee function. However, the improvements are less than literature-reported outcomes of either procedure performed in isolation.

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