Return to Sport and Patient Satisfaction After Meniscal Allograft Transplantation

2020 ◽  
Vol 36 (9) ◽  
pp. 2456-2463 ◽  
Author(s):  
Gregory L. Cvetanovich ◽  
David R. Christian ◽  
Grant H. Garcia ◽  
Joseph N. Liu ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Return To Sport ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
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 Medial Meniscal Allograft Transplantation

2021 ◽  
Vol 1 (1) ◽  
pp. 263502542199002
Author(s):  
Jordan D. Walters ◽  
Brian C. Werner
Keyword(s):  
Return To Sport ◽  
Clinical Results ◽  
Cartilage Defects ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Root ◽  
Meniscal Allograft ◽  
Meniscal Tissue ◽  
Magnetic Resonance Imaging Mri ◽  
Surgical Setting

Background: This technique video reviews medial meniscal allograft transplantation (MAT) using a representative case example. Indications: Medial meniscal allograft transplantation is indicated in symptomatic patients with a deficient medial tibiofemoral compartment that has not progressed to arthritic changes. Concomitant procedures to address focal cartilage defects, ligamentous laxity, and/or limb malalignment should be performed prior to MAT or in the same surgical setting. Technique Description: Preoperative workup includes magnetic resonance imaging (MRI), prior arthroscopic pictures, and sizing radiographs. The Pollard radiographic method measures for the appropriate cryopreserved allograft size. Arthroscopic instruments remove residual meniscal tissue to a 1 mm base around the capsule. Percutaneous lengthening of the medial collateral ligament (MCL) at its femoral attachment aids visualization/instrumentation. This technique employs 8-mm bone plugs for anterior and posterior meniscal root fixation. Tunnels size 8.5 mm diameter and 10 mm depth are created. Once the meniscal allograft is placed in the joint, inside-out sutures are placed throughout the meniscal body. Sutures from the meniscal roots are secured with an anchor in the anterior proximal tibia. Results: There are numerous outcomes studies of meniscal allograft transplantation with a reported overall graft survivorship of roughly 70% at 10 years and 60% at 15 years follow-up. Discussion/Conclusion: Meniscal allograft transplantation is a temporizing measure that provides good midterm clinical results, although long-term failure rates increase incrementally. Most studies suggest return to sport is possible although activity modification is recommended.

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

2020 ◽  
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.

Meniscal Deficiency Period and High Body Mass Index Are Preoperative Risk Factors for Joint Space Narrowing After Meniscal Allograft Transplantation

2021 ◽  
Vol 49 (3) ◽  
pp. 693-699
Author(s):  
Sang-Min Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Kuen Tak Suh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Condyle ◽  
Joint Space ◽  
Preoperative Risk ◽  
Meniscal Allograft Transplantation ◽  
Time Points ◽  
Allograft Transplantation ◽  
Preoperative Risk Factors ◽  
Meniscal Allograft ◽  
The Difference

Background: Several studies have reported further reduction in joint space width (JSW) after meniscal allograft transplantation; some contributing postoperative factors are known, although preoperative factors remain unclear. This study is the first to analyze the preoperative risk factors for reduced JSW in patients after lateral meniscal allograft transplantation (LMAT). Hypothesis: Poor cartilage status and high preoperative body mass index (BMI) influence the postoperative progression of joint space narrowing. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively studied 79 patients after LMAT who were observed for at least 5 years. JSWs on weightbearing flexion posteroanterior radiographs were measured preoperatively and at the 5-year mark. Differences in JSW were divided into more progression and less progression groups. The modified Outerbridge cartilage grades based on magnetic resonance imaging assessments were compared at subtotal/total meniscectomy and at LMAT to determine the difference between time points. Preoperative between-group differences in sex, age, surgical side, follow-up period, weight, height, BMI, and meniscal deficiency period were analyzed. Clinical outcomes were evaluated using the Lysholm score. Data were examined using univariate and multivariate logistic regressions. Results: Radiographically, the overall change in JSW from preoperative to follow-up was 0.58 mm (range, –0.23 to 1.83 mm). Reductions in JSW in the more progression and less progression groups were 0.94 ± 0.32 and 0.22 ± 0.21 mm (mean ± SD), respectively. There was no difference in cartilage status between the groups at meniscectomy or LMAT; however, changes between time points were significant on the lateral femoral condyle and lateral tibial plateau. Clinically, there were significant differences in weight, BMI, and meniscal deficiency period between the 2 groups. Postoperative Lysholm scores increased as compared with the preoperative scores, but there was no difference among the postoperative time points. In the univariate logistic regression risk analysis, weight, BMI, meniscal deficiency period, and the difference in cartilage status between time points for the lateral femoral condyle and lateral tibial plateau were identified as significant. In the subsequent multivariate logistic regression, BMI (odds ratio, 1.45; P = .016) and meniscal deficiency period (odds ratio, 1.21; P = .037) were the statistically significant factors. Conclusion: BMI and meniscal deficiency period were preoperative risk factors for JSW narrowing after LMAT. This suggests that the meniscal deficiency period from meniscectomy to LMAT may be shortened and that proper weight management can lead to successful LMAT.

scholarly journals THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Haley E. Smith ◽  
Madeline M. Lyons ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
National Database ◽  
Control Group ◽  
Meniscal Allograft Transplantation ◽  
Children's Hospitals ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

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