Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis

Abstract

Background: Meniscal allograft transplant (MAT) is an important treatment option for young patients with deficient menisci; however, there is a lack of consensus on the optimal method of allograft fixation. Hypothesis: The various methods of MAT fixation have measurable and significant differences in outcomes. Study Design: Meta-analysis; Level of evidence, 4. Methods: A single-arm meta-analysis of studies reporting graft failure, reoperations, and other clinical outcomes after MAT was performed. Studies were stratified by suture-only, bone plug, and bone bridge fixation methods. Proportionate rates of failure and reoperation for each fixation technique were pooled with a mixed-effects model, after which reconstruction of relative risks with confidence intervals was performed using the Katz logarithmic method. Results: A total of 2604 patients underwent MAT. Weighted mean follow-up was 4.3 years (95% CI, 3.2-5.6 years). During this follow-up period, graft failure rates were 6.2% (95% CI, 3.2%-11.6%) for bone plug fixation, 6.9% (95% CI, 4.5%-10.3%) for suture-only fixation, and 9.3% (95% CI, 6.2%-13.9%) for bone bridge fixation. Transplanted menisci secured using bone plugs displayed a lower risk of failure compared with menisci secured via bone bridges (RR = 0.97; 95% CI, 0.94-0.99; P = .02). Risks of failure were not significantly different when comparing suture fixation to bone bridge (RR = 1.02; 95% CI, 0.99-1.06; P = .12) and bone plugs (RR = 0.99; 95% CI, 0.96-1.02; P = .64). Allografts secured using bone plugs were at a lower risk of requiring reoperations compared with those secured using sutures (RR = 0.91; 95% CI, 0.87-0.95; P < .001), whereas allografts secured using bone bridges had a higher risk of reoperation when compared with those secured using either sutures (RR = 1.28; 95% CI, 1.19-1.38; P < .001) or bone plugs (RR = 1.41; 95% CI, 1.32-1.51; P < .001). Improvements in Lysholm and International Knee Documentation Committee scores were comparable among the different groups. Conclusion: This meta-analysis demonstrates that bone plug fixation of transplanted meniscal allografts carries a lower risk of failure than the bone bridge method and has a lower risk of requiring subsequent operations than both suture-only and bone bridge methods of fixation. This suggests that the technique used in the fixation of a transplanted meniscal allograft is an important factor in the clinical outcomes of patients receiving MATs.

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

“…The present study reported survival rates of 94% at 5 years and 89% at 10 years, rates that are comparable with other large case series that involved bone plug fixation techniques. 12 , 17 This finding contrasts the results of a recent meta-analysis by Ow et al, 21 who found a lower reoperation rate with the bone plug fixation technique. Interestingly, those investigators did not specify whether the reoperations were related to the MAT procedure, and the rate of second surgery was not weighted based on the percentage of concurrent procedures.…”

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“…Similarly, the rates of reoperation were the lowest in the bone plug group (5.2%), followed by the suture-only group (13.4%) and the bone bridge group (32.6%). There were no significant differences in MRI-assessed graft extrusion between groups 10 .…”

“…The ideal surgical technique for securing meniscal allografts remains controversial. In a meta-analysis of 36 studies, Ow et al 10 assessed the outcomes of meniscal allograft transplantation in 2,604 patients by comparing sutures only (24.7%), bone plugs (43.5%), or bone blocks (31.6%) for fixation. Graft failure, defined as requiring revision meniscal allograft transplantation, conversion to joint arthroplasty, or allograft removal, was the lowest in the bone plug group (6.2%), followed by the suture-only group (6.9%), and was the greatest in the bone bridge group (9.3%).…”

Fully Guided Synthetic Osteochondral Resurfacing of a Large Stifle OCD Lesion Using a Patient-Specific Implant and Drill Guides

“…Future applications should investigate transosseous suture fixation, bone anchors or bone plug fixation, which seems to be the most efficient fixation method. 25,26 At the 18-month radiographic follow-up, stable fixation of the PSI with evidence of bony incorporation was present. Previous studies in a sheep model using similar implants showed bone-to-implant contact already at 6 months.…”

“…Future applications should investigate transosseous suture fixation, bone anchors or bone plug fixation, which seems to be the most efficient fixation method. 25 26…”