Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Meniscal allograft transplant (MAT) is considered an effective procedure for reducing pain and improving knee function. Nevertheless, the current knowledge regarding the results of MAT is limited to short- to mid-term follow-up studies, especially for arthroscopic techniques. </jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p> To evaluate the long-term clinical outcomes, reoperations, and failures with a minimum follow-up of 10 years after fresh-frozen MAT performed arthroscopically with soft tissue fixation. </jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p> Case series; Level of evidence, 4. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A total of 46 patients (age, 36.6 ± 10.6 years; 36 male, 10 female) who underwent medial MAT (n = 27) or lateral MAT (n = 19) with a minimum 10-year follow-up were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, and Tegner score. Surgical failure was defined as the need for partial or total graft removal (meniscectomy or knee replacement), and clinical failure was defined as the need for partial or total graft removal in addition to a poor Lysholm score (&lt;65 points) at final follow-up. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS) for MAT. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 10-year survival and clinical data were available for 38 patients. Because 6 meniscectomies were required, the rate of survival free from surgical failure was 91% at 5 years and 86% at 10 years. Lower survival was reported in lateral MAT (73%) compared with medial MAT (96%). Because a further 4 patients had poor Lysholm scores, the rate of survival free from surgical and clinical failure was 87% at 5 years and 70% at 10 years. The average Lysholm score at final follow-up was 82 ± 20, and 60% to 82% of patients achieved PASS of the various KOOS subscales. The Tegner score and the KOOS Sport score significantly decreased from mid-term to long-term evaluation ( P &lt; .001 and P &lt; .05, respectively). Other KOOS subscales and the Lysholm score remained stable at long-term evaluation. No significant differences were found between isolated MAT or combined MAT regarding subjective scores, surgical failures, or clinical failures. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Up to 10 years after surgery, 86% of fresh-frozen MATs with soft tissue fixation were still in situ, and satisfactory clinical results were present for about 70% of patients. Decline of clinical outcomes from midterm to long term was noted only in sports-related scores. A higher number of overall reoperations was noted in female patients, whereas a higher risk of failure was present in the patients with lateral MAT. </jats:p></jats:sec>

Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis

“…Of those, the articles with the greatest sample sizes [ 45 , 47 , 49 ] were included. Consequently, 44 articles were included in this review [ 8 , 10 , 32 , 34 , 36 , 42 , 45 , 47 , 49 , 51 – 85 ] and were assessed for methodological quality (Fig. 1 ).…”

“…Secondly, we pooled studies with different follow-ups (6 months to 20 years) in the analyses. Several studies show that the time from primary reconstruction to subsequent C-ACL injury is often 3–4 years [ 8 , 52 , 73 ], indicating that studies with a follow-up of less than 3 years may not be able to capture all C-ACL injuries and consequently the results from such studies should be interpreted with caution. Our sensitivity analysis also showed that lower age (as a continuous variable) was no longer a risk factor for C-ACL injury if studies with a follow-up of ≤ 2 years were excluded, whereas there were no differences in the result for other risk factors.…”

“…Indeed, many ACL-injured individuals never return to their pre-injury activity level [ 7 ]. Additionally, the risk of sustaining a subsequent contra-lateral ACL (C-ACL) injury is high and has even been reported to be significantly higher than suffering a new injury to the ipsi-lateral knee [ 8 , 9 ]. A systematic review with meta-analysis from 2016 calculated the overall C-ACL injury rate to be around 8%, and even higher (12%) in younger individuals involved in sports at an elite level [ 9 ].…”

Association Between Meniscal Allograft Tears and Early Surgical Meniscal Allograft Failure

“…18,20 Surgical meniscal allograft failure was defined as the need for subtotal or total meniscal allograft resection, meniscal allograft repair, revision MAT, or conversion to unicompartmental or total knee arthroplasty. 10 Central meniscal allograft tears were left in situ or treated via arthroscopic debridement (resection of no more than one-third of the allograft width) and were not considered a surgical meniscal allograft failure. Peripheral meniscal allograft tears that required partial resection (more than one-third of the allograft width) or total resection of the meniscal allograft were considered as surgical meniscal allograft failure.…”

“…In contrast, clinical meniscal allograft failure is defined as a postoperative Lysholm score \65 points. 10,21,37,44 Risk factors associated with surgical meniscal allograft failure include older patient age and presence of articular cartilage lesions at the time of MAT, lateral MAT, subsequent operative procedures, nonanatomic placement of the meniscal allograft root, and undersized meniscal allografts. 3,10,16,[20][21][22]37 Moreover, 1 study reported extensive meniscal allograft tears as the primary cause of surgical meniscal allograft failure, requiring subsequent graft removal.…”