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

Wal, Robert J. P. van der; Nieuwenhuijse, Marc J; Spek, Reinier W.A.; Thomassen, Bregje J.W.; Arkel, Ewoud R.A. van; Nelissen, Rob G H H

doi:10.1007/s00167-020-06276-y

Cited by 21 publications

(31 citation statements)

References 30 publications

(43 reference statements)

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“…28,35 Reported 10-year survivorship for cryopreserved allografts range from 45% to 90.3%, although definitions of failure used in the various studies are heterogeneous. 11,31,32 When compared with survivorship across all graft preparation and surgical techniques with long-term follow-up, the present study reports higher survivorship than the 10-year survival rate of 73.5% reported by Novaretti et al 20…”

Section: Discussionsupporting

confidence: 43%

Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation With Fresh-Frozen Allografts Using the Bridge-in-Slot Technique

Wagner,

Kaiser,

Hevesi

et al. 2023

Am J Sports Med

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Background: Meniscal allograft transplantation (MAT) has been shown to provide clinical benefits in patients with symptomatic meniscal deficiency in the short term and midterm. There is, however, a paucity of data regarding long-term outcomes after MAT using fresh-frozen allografts and the bridge-in-slot technique. Purpose: To report clinical outcomes and revision rates after primary MAT with fresh-frozen allografts and the bridge-in-slot technique in a large case series of patients at a 10-year minimum follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of prospectively collected data was performed on patients undergoing primary MAT between 2001 and 2012. Lysholm, International Knee Documentation Committee subjective form, and Knee injury and Osteoarthritis Outcome Score subscales were collected preoperatively and at 1-, 2-, 5-, and minimum 10-year follow-ups. Cox proportional hazards modeling was used to identify variables associated with reoperation and failure, defined as revision MAT or conversion to arthroplasty. Reoperation was defined as a subsequent surgical intervention on the transplanted meniscus, including partial or total meniscectomy, meniscal repair, or failure as defined in the previous sentence. Results: A total of 174 patients undergoing MAT met the inclusion criteria and were followed for a mean of 12.7 ± 2.7 years (range, 10.0-21.0 years). The mean age at surgery was 28.3 ± 10.1 years. The patients were predominantly female (n = 92; 53%), and medial MAT was the most commonly performed procedure (n = 91; 52%). Concomitant procedures were performed in 115 patients (66%), with the most common procedure being osteochondral allograft transplantation (n = 59; 34%). Patients demonstrated statistically significant postoperative improvements at all time points for all patient-reported outcome measures ( P≤ .0001). A total of 65 patients (37%) underwent a meniscal reoperation at a mean time of 6.6 ± 5.5 years (range, 0.3-16.7 years) postoperatively. A total of 40 patients (23%) met the criteria for failure at a mean time of 7.3 ± 5.0 years (range, 1.0-17.4 years) after MAT, with 22 of these patients having undergone a previous meniscal reoperation. At the final follow-up, 13 patients (7%) had undergone revision MAT and 27 (15%) had converted to arthroplasty. The MAT survival rates free of meniscal reoperation and failure were 73% and 85% at 10 years and 60% and 72% at 15 years, respectively. At the time of the final follow-up, 86% of patients reported that they were satisfied with their overall postoperative condition. Conclusion: Primary MAT demonstrates efficacy and durability with high rates of patient satisfaction at a minimum 10-year follow-up. Patients should be counseled that although reoperation rates may approach 40% at 15 years, rates of overall revision MAT and conversion to arthroplasty remain low at long-term follow-up.

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Section: Discussionsupporting

confidence: 43%

Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation With Fresh-Frozen Allografts Using the Bridge-in-Slot Technique

Wagner,

Kaiser,

Hevesi

et al. 2023

Am J Sports Med

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“…Meniscal allografting, an alternative treatment for isolated lateral compartment knee pain, has shown positive results; however, outcomes and survivorship are dependent on the severity of arthritis and the age of the patient 11 . van der Wal et al reported a decline in mean KOOS ADL and Sport subscores over time, with scores of <60 between 2 and 4 years and scores of <40 by year 6 11. In our cohort of patients who were managed with lateral UKA, the KOOS ADL subscore was 91 and the KOOS Sport subscore was ≥70 at mean of 10 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…increase in progression of lateral OA 3 . Treatment options for isolated lateral compartment OA in patients <60 years of age more commonly include cartilage procedures, meniscal transplants, and femoral osteotomies [5][6][7][8][9][10] ; however, these options can be less favorable because of limited longevity, restriction of activities and sports participation 5,7,[9][10][11] , and complications such as infection, venous thromboembolism, fracture, delayed union or nonunion, and implant failure 6,8 .…”

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confidence: 99%

Isolated Lateral Tibiofemoral Compartment Osteoarthritis

Plancher

Chinnakkannu

Dotterweich

et al. 2022

Journal of Bone and Joint Surgery

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Background: Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved.Methods: All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients ( ‡60 years of age).Results: A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years.Conclusions: Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. K nee osteoarthritis (OA) is estimated to afflict 15 million individuals in the U.S., with 8.6 million having advanced symptomatic knee OA pain 1 . Persons <45 years of age make up nearly 2 million of this total, and persons between 45 and 64 years of age make up 6 million 1 . Fifty percent of these patients are known to have disease pathology that is isolated to a single, predominantly medial, compartment 2 . Lateral compartment OA, while seen in a smaller percentage of the population, is often ...

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“…However, the current knowledge of MAT survivorship is limited, the main limitation being the small cohorts studied, which rarely exceed 100 patients. 26 A few larger case series reported survival analysis and outcome, especially of the bony fixation technique. 17 , 25 The mean survival rates ranged from 11 years 24 , 28 to 16.1 years, 26 and each study proposed different criteria to define failure 18 : some definitions were based on clinical outcome and knee function alone, and others relied on a patient’s need for reoperation, although without consensus on the kind of outcomes considered to indicate failure.…”

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confidence: 99%

Survivorship and Reoperation of 324 Consecutive Isolated or Combined Arthroscopic Meniscal Allograft Transplants Using Soft Tissue Fixation

et al. 2022

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Background: Meniscal allograft transplant (MAT) is an effective treatment for relieving symptoms and improving knee function in patients who experience symptomatic unicompartmental knee pain after a previous meniscectomy. However, the literature contains a paucity of studies assessing the survival rate and prognostic factors of soft tissue MAT. Purpose: To report the survivorship of a large, single-center cohort of consecutive patients treated with arthroscopic MAT using soft tissue technique and to investigate variables that could potentially influence failures and outcomes. Study design: Case series; Level of evidence, 4. Methods: Consecutive MAT procedures totaling 364 performed in a single institution between June 2004 and April 2019 were screened and assessed for eligibility. Subjective clinical scores (Lysholm score, Tegner activity scale, and visual analog score) were collected preoperatively and at 2, 5, 7, and 10 years of follow-up. Two survival analyses were performed using Kaplan-Meier curves, with surgical failure (defined as any graft revision) and clinical failure (defined as a Lysholm score <65 points) used as endpoints. Univariate analyses were performed using reoperations, surgical failure, clinical failure, and different demographic and surgical characteristics as endpoints. Results: A total of 324 consecutive patients were evaluated at a mean follow-up 5.7 ± 3.0 years. Of these, 189 (58%) underwent an associated surgical procedure. A total of 22 patients (6.8%) were considered to have experienced surgical failure, and no predictors of surgical failure were identified based on the relevant variables. When all patients were considered, a significant improvement in all of the patient-reported outcome measures was present between the preoperative assessment and the last follow-up ( P < .001), with no significant decrease over time. Moreover, 70 (21.6%) patients were considered to have experienced clinical failure; the need for concurrent cartilage procedures (odds ratio, 0.16; P = .001) and anterior cruciate ligament (ACL) reconstruction (odds ratio, 0.40; P = .059) were predictors of failure. Finally, a lower survival rate was reported in female patients compared with male patients (49% vs 69%, respectively; P = .007) and in patients who required cartilage surgery ( P = .014). In particular, patients who required cartilage surgery showed nearly half the survival rate compared with those with required no cartilage procedures at 10-year follow-up (36.4% vs 71%, respectively; P = .029). Conclusion: Female sex and the need to combine MAT with a cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at midterm follow-up.

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

Cited by 21 publications

References 30 publications

Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation With Fresh-Frozen Allografts Using the Bridge-in-Slot Technique

Minimum 10-Year Clinical Outcomes and Survivorship of Meniscal Allograft Transplantation With Fresh-Frozen Allografts Using the Bridge-in-Slot Technique

Isolated Lateral Tibiofemoral Compartment Osteoarthritis

Survivorship and Reoperation of 324 Consecutive Isolated or Combined Arthroscopic Meniscal Allograft Transplants Using Soft Tissue Fixation

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