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

2017 ◽  
Vol 46 (5) ◽  
pp. 1243-1250 ◽  
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.

Influence of Varus Alignment on Survivorship After Lateral Meniscal Allograft Transplantation

2020 ◽  
Vol 48 (6) ◽  
pp. 1374-1378 ◽  
Author(s):  
Ju-Ho Song ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Chang-Rack Lee
Keyword(s):  
Survival Analysis ◽  
Clinical Outcomes ◽  
Graft Survival ◽  
Survival Rates ◽  
Lysholm Score ◽  
Varus Alignment ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
And Cartilage

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.

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.

Prospective Long-Term Evaluation of Meniscal Allograft Transplantation Procedure: A Minimum of 7-Year Follow-Up

2012 ◽  
Vol 25 (02) ◽  
pp. 165-176 ◽  
Author(s):  
Bryan Saltzman ◽  
Sarvottam Bajaj ◽  
Michael Salata ◽  
Erika Daley ◽  
Eric Strauss ◽  
...  
Keyword(s):  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Term Evaluation

International Meniscus Reconstruction Experts Forum (IMREF) 2015 Consensus Statement on the Practice of Meniscal Allograft Transplantation

2016 ◽  
Vol 45 (5) ◽  
pp. 1195-1205 ◽  
Author(s):  
Alan Getgood ◽  
Robert F. LaPrade ◽  
Peter Verdonk ◽  
Wayne Gersoff ◽  
Brian Cole ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Consensus Statement ◽  
Opinion Leaders ◽  
Long Term Results ◽  
Meniscal Allograft Transplantation ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Symptomatic Knee ◽  
Key Opinion Leaders

Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes.

Long-term Outcomes of Meniscal Allograft Transplantation With and Without Extrusion: Mean 12.3-Year Follow-up Study

2019 ◽  
Vol 47 (4) ◽  
pp. 815-821 ◽  
Author(s):  
Sang-Min Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Chang-Rack Lee ◽  
...  
Keyword(s):  
Joint Space Width ◽  
Long Term Effects ◽  
Meniscal Allograft Transplantation ◽  
Level Of Evidence ◽  
Time Points ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Long Term Follow Up

Background: Meniscal allograft transplantation (MAT) is a widely performed surgical technique used to reconstruct meniscal deficiencies after meniscectomy. However, the long-term effects of extrusion on clinical and radiologic outcomes are unclear. Hypothesis: In long-term follow-up, extrusion after MAT would show poorer outcomes than nonextrusion and would lead to faster progression of arthritic changes. Study Design: Cohort study; Level of evidence, 3. Methods: Forty-five MAT cases (lateral, n = 36; medial meniscal, n = 9) with a minimum 8-year follow-up period were selected. The mean follow-up period was 12.3 years (range, 8.0-19.6 years). Data were collected on patients’ sex, age, surgical side, and mechanical axis deviation. Patients were categorized into 2 groups: extrusion (≥3 mm) and nonextrusion (<3 mm). Categories were based on extrusion length measured via magnetic resonance imaging taken 1 year after surgery. Joint space width (JSW) on the affected and contralateral sides was measured on bilateral weightbearing posterior-anterior radiographs at 45° of flexion at 3 time points (preoperative, 4-6 years postoperative, and >8 years postoperative). Differences of the measured and relative JSW values between the groups and differences at different time points were analyzed. The Lysholm score was used to evaluate clinical function. Results: Mean ± SD extrusion was 3.07 ± 0.82 mm. The extrusion and nonextrusion groups were composed of 19 (42.2%) and 26 (57.8%) patients, respectively. Analysis of JSW showed a difference in relative JSW between the groups at >8 years ( P = .017). At the point of transition from 4 to 6 years to >8 years, the differences in absolute JSW values were −1.25 ± 0.78 mm (extrusion group) and −0.58 ± 0.66 mm (nonextrusion group; P < .001). Relative JSW values also differed between groups (extrusion group, −0.22 ± 0.13; nonextrusion group, −0.04 ± 0.18; P < .001). No differences were observed in the Lysholm scores between the groups at each time point. Conclusion: Long-term follow-up after MAT revealed a greater decrease in JSW in the extrusion group than in the nonextrusion group. However, no significant differences in clinical outcomes were observed.

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.

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