Effect of ICRS Lesion Grade on Graft Survival After Medial Meniscal Allograft Transplantation: MRI-Based Objective Evaluation

Abstract

Background: Data are lacking regarding the survival rate after medial meniscal allograft transplantation (MAT) alone. Furthermore, little information is available about prognostic factors for graft survival that affect the outcomes of medial MAT. Purpose: To investigate the prognostic factors and survival rate of allograft after medial MAT. Study Design: Case-control study; Level of evidence, 3. Methods: The records of 78 consecutive patients who underwent primary medial MAT between 1996 and 2018 were reviewed. Kaplan-Meier survival analysis was performed to analyze the anatomic and clinical survival rates. Anatomic failure was defined as a tear covering >50% of the allograft or unstable peripheral rim. Clinical failure was considered Lysholm score <65 or need for additional surgery such as meniscal repair, revision MAT, realignment osteotomy, and meniscectomy for >50% of the allograft. Patient factors affecting anatomic and clinical failure were analyzed. Results: The mean follow-up period was 6.9 ± 5.3 years (range, 2-21 years). Anatomic failure was noted in 19 patients (24.4%), and none of these patients had a persistent poor Lysholm score of <65; of these, 2 patients who underwent meniscal repair also had clinical failure. Clinical failure was noted in 7 patients (9.0%); 4 patients had Lysholm score <65, 2 patients underwent meniscal repair, and 1 patient underwent realignment osteotomy. The estimated 10-year anatomic and clinical survival rates were 73.89% and 87.90%, respectively. Anatomic survival was significantly associated with only high-grade International Cartilage Regeneration & Joint Preservation (ICRS) lesion (ICRS grade 3 or 4) (hazard ratio, 3.171; 95% CI, 1.124-8.944; P = .029). However, the clinical survival rate was not significantly associated with any factors. Patients with low-grade ICRS lesion (ICRS grade 0, 1, or 2) showed a higher estimated 10-year anatomic survival rate compared with patients with high-grade ICRS lesions (87.6% vs 63.3%, respectively; P = .022). Conclusion: Low-grade ICRS lesion was associated with higher anatomic survival rate after medial MAT. In patients with high-grade ICRS lesions, the clinical outcome might be good; however, the status of an allograft might be poor. The surgeon should be aware of this and explain to the patient that close observation is necessary.

Survivorship of 157 Arthroscopic Meniscal Allograft Transplants Using Bone Fixation at a Mean of 7 Years and Prognostic Factors Analysis

“…56 Fourth, the Lysholm score was only collected at the final follow-up as a commonly used parameter for subjective outcome of MAT. 26,48,84 Therefore, it cannot be compared with a preoperative score. However, the KOOS and IKDC score were collected at 2 time points, and a correlation between scores has previously been reported.…”

“…16 Graft survival rates ranging from 60% to 86% after 10 and 15 years have been reported, indicating lasting ingrowth of the graft and stable treatment results. 27,51,54,72 However, current evidence of long-term allograft survivorship and function is limited due to small study sizes rarely exceeding 100 patients, 25,48,75 unstandardized definitions of clinical and anatomic failure, and heterogeneous study cohorts. 75,77 Furthermore, relevant information such as preoperative Kellgren-Lawrence or To ¨nnis grade, preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade, tibial slope, and leg alignment are often underreported, impeding interpretation of presented data.…”

“…11,26,37 Previous studies have identified generalized degenerative arthritis as a prognostic factor for poor allograft function and survival, leading to exclusion of these patients in a variety of studies. 26,48,55,63,73,79 However, recent evidence suggests that even in knees with severe focal chondral damage, MAT can be an effective treatment, leading to improved clinical scores and decreased pain, especially when combined with cartilage procedures. 1,4,22,45,68 However, the potential chondroprotective capability of MAT, and therefore its role as a preventive procedure in the asymptomatic knee, remains controversial.…”

Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation

“…Most patients in the medial MAT group had concomitant surgery, and ligament surgery was performed in two-thirds of the cases with accompanying ACL tears. However, concomitant surgery does not decrease the survival rate [17,19]. In addition, when ACL reconstruction and medial MAT are performed together, stability is rather increased [3,24,34].…”

“…Meniscal allograft transplantation (MAT) is an established effective treatment for relieving pain in patients who underwent meniscectomy with a 10‐year survival rate ranging from 73 to 86% [6, 10, 19, 27, 29]. Despite such a high mid‐to‐long‐term survival rate, it occurs occasionally for early postoperative failure [7, 31].…”