Meniscal Allograft Transplantation: The Effect of Cartilage Status on Survivorship and Clinical Outcome

Mahmoud, Ahmed; Young, James K.; Bullock-Saxton, Joanne; Myers, Peter

doi:10.1016/j.arthro.2018.01.010

Cited by 48 publications

(76 citation statements)

References 21 publications

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“…It has previously been shown that if left untreated, patients who have Outerbridge class III or IV cartilage lesions are at an increased risk of MAT failure. 31 In contrast, patients who receive cartilage restoration therapy for such lesions in combination with MAT show similar midterm outcomes to those who receive MAT in isolation. 32 In addition, it has been suggested that realignment osteotomies be performed in patients with malalignment, 33 although more evidence is needed to verify the effects of osteotomies on the clinical outcomes of MAT.…”

Section: Discussionmentioning

confidence: 99%

Return to Sport and Outcomes After Concomitant Lateral Meniscal Allograft Transplant and Distal Femoral Varus Osteotomy

Puzzitiello

Liu

Garcia³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Discussionmentioning

confidence: 99%

Return to Sport and Outcomes After Concomitant Lateral Meniscal Allograft Transplant and Distal Femoral Varus Osteotomy

Puzzitiello

Liu

Garcia³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…For example, age is investigated in all models as a continuous variable, an ordinal categorized variable (younger than 35, 35–50, and older than 50), and a dichotomized variable (younger than 35, 35, and older). Regarding age, the dichotomized variable was chosen for modelling purpose and its clinical relevance [ 12 ]. Model assumptions were checked and models were adjusted accordingly.…”

Section: Methodsmentioning

confidence: 99%

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

Wal

Nieuwenhuijse

Spek

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Evaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee. Methods A prospective consecutive study of 109 consecutive patients who had an arthroscopic meniscal allograft transplantation (MAT) between 1999 and 2017 by a single surgeon. Patients were assessed with KOOS scores, preoperative and after a minimal follow-up of 2 years. Furthermore, two anchor questions (whether expectations were met and overall satisfaction, on a five-point Likert scale) were asked. Additionally, prior interventions to MAT were evaluated. Results Prior to MAT, patients had undergone an average of 2.8 (range 1–14) of surgical procedures of the knee. Overall, mean allograft survival was 16.1 years (95% CI 14.8–17.5 years). Higher age at surgery was associated with lower MAT survival: hazard ratio for MAT failure was 1.19 per year increase (95% CI 1.04 to 1.36, p = 0.009). At 4.5 years (IQR, 2–9) of follow-up, all KOOS score were still improved compared to baseline. Age below 35 years, simultaneous anterior cruciate ligament reconstruction and number of knee surgeries before MAT were associated with lower KOOS scores. Overall patient expectations and overall satisfaction after MAT were not associated with preoperative patient characteristics nor with the number or kind of preoperative interventions. Conclusion Meniscal allograft transplantation has a good overall survival with a clinically relevant improvement. Both meniscal allograft survival and PRO were associated with age. PRO was lower in patients younger than 35 years at time of MAT and meniscal allograft survival was worse in patients older than 50 years. PRO was associated with preoperative patient characteristics and number of surgical procedures prior to MAT. All patients reported improved postoperative satisfaction and met expectations after MAT, both independent of the preoperative history of knee interventions. Level of evidence Level III. Trial registration Medical ethical review board (METC) number: 17–104 (7 August 2017). Dutch Trial Register (NTR) number: NTR6630 (4 July 2017).

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“…44,53,73,74 However, with the advent of modern chondral restoration procedures, an increasing number of surgeons have extended the indications to patients with advanced chondral defects, such as those with an OCS IV or IRCS > 3, and several recent studies demonstrated that these patients can expect comparable functional results. 33,36,38,40,43,46,52,55 Interestingly, some authors have observed that patients with greater chondral damage did not report worse clinical outcome compared with those with lower chondral damage even though their grafts seemed to fail earlier. Kempshall et al 40 divided patients into two subgroups, those with IRCS 3b and those with IRCS > 3b; the groups had comparable PROMs but a difference of 1.1 years in survivorship in favor of the group with lesser chondral damage was noted.…”

Section: Discussionmentioning

confidence: 99%

“…Five studies 26,36,42,47,57 compared the outcome of MAT in relation to the knee affected (right vs. left). No studies reported any significant difference in terms of clinical scores or survivorship.…”

Section: Sidementioning

confidence: 99%

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

et al. 2019

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This systematic review investigates factors associated with outcomes after meniscal allograft transplantation (MAT). The PubMed, Scopus, and Cochrane Central Register databases were used to search relevant articles in April 2018. Studies that evaluated at least one association between a factor and outcomes were extracted. Of 3,381 titles, 52 studies were finally analyzed. Data about predictors, patient-reported outcome scores (PROMs), and failure rates were extracted for quantitative and qualitative analysis. A total of 3,382 patients and 3,460 transplants were identified. Thirty different predictors were reported in the current MAT literature, 18 of which by at least two studies. Subgroup analysis showed that lateral MAT had higher postoperative values than medial MAT in Lysholm's (p = 0.0102) and International Knee Documentation Committee (IKDC; p = 0.0056) scores. Soft tissue fixation showed higher postoperative IKDC scores than bone fixation (p = 0.0008). Fresh frozen allografts had higher Lysholm's scores (p < 0.0001) and showed significantly lower failure rates (p < 0.0001) than cryopreserved allografts. Age (p < 0.015, β = 0.80), sex (p < 0.034, β = − 8.52), and body mass index (BMI; p < 0.014, β = −4.87) demonstrated an association with PROMs in the regression model. Qualitative analysis found moderate evidence that a higher number of previous procedures in the same knee are an independent predictor of transplant failure. Conflicting evidence was found with regard to chondral damage, time from meniscectomy, smoke, sport level, worker's compensation status, and preoperative Lysholm's score as predictors of outcomes. Our review suggests that the ideal candidate to undergo MAT may be a young male of normal weight with no previous knee surgeries, treated with a lateral isolated procedure. However, MAT is associated with good outcomes in the majority of patients with many of the PROMs requiring further study to determine their direct effects on long-term outcomes. This study is a systematic review and reflects level of evidence IV.

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Meniscal Allograft Transplantation: The Effect of Cartilage Status on Survivorship and Clinical Outcome

Cited by 48 publications

References 21 publications

Return to Sport and Outcomes After Concomitant Lateral Meniscal Allograft Transplant and Distal Femoral Varus Osteotomy

Return to Sport and Outcomes After Concomitant Lateral Meniscal Allograft Transplant and Distal Femoral Varus Osteotomy

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

Predictors of Meniscal Allograft Transplantation Outcome: A Systematic Review

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