Meniscal allograft transplantation: a meta-analysis

Abstract

Purpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation). Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed. Study design: Meta-analysis. Methods: An online database search was performed using following search string: “meniscal allograft transplantation” and “outcome”. A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed. Results: The subjective and objective results of 2977 patients (3157 allografts) were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS) scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI) of the patient shows a slightly negative correlation with the outcome of MAT. Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all pathologies including alignment, stability, meniscal abnormality and cartilage degeneration. It requires possibly combined but appropriate action in that order.

Meniscal allograft transplantation in The Netherlands: long-term survival, patient-reported outcomes, and their association with preoperative complaints and interventions

“…Not only the surgical technique has been improved by the arthroscopic MAT, but also indications, patient selection, and postoperative rehabilitation have been improved during 30 years of clinical experience. Short- and long-term outcomes of both open and arthroscopic MAT have shown positive results in terms of pain relief and functional improvement [ 3 , 25 ].…”

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

“…42 Age has been associated with reduced graft survivorship 26,34,46 and some authors consider it a negative prognostic factor. 3 On the other hand, no studies showed an association with BMI.…”

“…We also identified areas in which there is need for more and better quality evidence, specifically concerning the role of preoperative chondral damage, sport level, time from meniscectomy, and smoking status, whose impact on clinical outcome is still controversial. Several systematic reviews and meta-analyses have been published in the last decade about MAT; these, however, were mostly introductory in their nature, [7][8][9][10][11][12] focused primarily on outcomes in general, 2,3,13,14 or evaluated one single predictor in detail, such as laterality, 15 the impact of concomitant procedures, 16 or the type of graft fixation. 17 Other reviewers considered particular aspects, such as the chondroprotective role of MAT 5 or the feasibility of sports activity after recovery.…”

“…Cryopreservation seems to partially preserve donor chondrocyte viability, while it has been suggested that deep freezing has a negative impact on connective cells in the donor meniscus. 11 That said, some authors reported no differences in terms of outcomes between cryopreserved and fresh-frozen MAT 3,26 ; therefore, the higher cost of cryopreservation should be considered. 11 Interestingly, we found that fresh-frozen MAT was associated with better postoperative Lysholm's scores as well as lower failure rates, and these findings are in agreement with those of Rosso et al 7 However, data on cryopreserved allografts were limited, and studies had very long-term follow-up times, which might have considerably impacted the results of the analysis.…”

“…Generally, MAT is performed when patients become symptomatic; while the role of a "prophylactic MAT" as a preventive measure is still controversial. 3 Jang et al 28 published the first study that separately compared the outcome of patients with immediate and delayed MAT, reporting better subjective results, chondroprotection, and preservation of muscle strength with immediate MAT. Similarly, Zaffagnini et al 41 found the time from meniscectomy to index surgery to have a predictive role in determining postoperative subjective scores.…”