Return to Sports Following Meniscal Allograft Transplantation is Possible but Remains Questionable: A Systematic Review

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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Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

The Journal of Knee Surgery ◽

10.1055/s-0039-1695043 ◽

2019 ◽

Cited By ~ 1

Author(s):

Daniele Fanelli ◽

Michele Mercurio ◽

Giorgio Gasparini ◽

Olimpio Galasso

Keyword(s):

Systematic Review ◽

Qualitative Analysis ◽

Normal Weight ◽

Cochrane Central Register ◽

Failure Rates ◽

Meniscal Allograft Transplantation ◽

Level Of Evidence ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Patient Reported

AbstractThis systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's (p = 0.0102) and International Knee Documentation Committee (IKDC; p = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation (p = 0.0008). Fresh frozen allografts had higher Lysholm's scores (p < 0.0001) and showed significantly lower failure rates (p < 0.0001) than cryopreserved allografts. Age (p < 0.015, β = 0.80), sex (p < 0.034, β = − 8.52), and body mass index (BMI; p < 0.014, β = −4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.

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Patient Satisfaction and Return to Sports after Meniscal Allograft Transplantation

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00251 ◽

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]

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Meniscal allograft transplantation. Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3334-5 ◽

2014 ◽

Vol 23 (1) ◽

pp. 310-322 ◽

Cited By ~ 34

Author(s):

Gonzalo Samitier ◽

Eduard Alentorn-Geli ◽

Dean C. Taylor ◽

Brian Rill ◽

Terrence Lock ◽

...

Keyword(s):

Systematic Review ◽

Graft Fixation ◽

Meniscal Allograft Transplantation ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Graft Extrusion ◽

Graft Shrinkage

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Biological Knee Reconstruction: A Systematic Review of Combined Meniscal Allograft Transplantation and Cartilage Repair or Restoration

Yearbook of Orthopedics ◽

10.1016/j.yort.2011.04.124 ◽

2011 ◽

Vol 2011 ◽

pp. 210-211

Author(s):

B.F. Morrey

Keyword(s):

Systematic Review ◽

Cartilage Repair ◽

Meniscal Allograft Transplantation ◽

Knee Reconstruction ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

And Cartilage

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

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118819723 ◽

2019 ◽

Vol 11 (2) ◽

pp. 123-133 ◽

Cited By ~ 7

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.

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