Survival analysis of human meniscal transplantations

Abstract

We describe a prospective survival analysis of 63 consecutive meniscal allografts transplanted into 57 patients. The lateral meniscus was transplanted in 34, the medial meniscus in 17, and both menisci (combined) in the same knee in six. For survival analysis we used persistent pain or mechanical damage as clinical criteria of failure. A total of 13 allografts failed (5 lateral, 7 medial, 1 medial and lateral). A significant negative correlation (p = 0.003) was found between rupture of the anterior cruciate ligament (ACL) and successful meniscal transplantation. A significant difference (p = 0.004) in the clinical results was found between lateral and medial meniscal transplants. The cumulative survival rate of the lateral, medial and combined allografts in the same knee, based on the life-table method and the Kaplan-Meier calculation, was 76%, 50% and 67%, respectively. The survival of medial meniscal allografts may improve when reconstruction of the ACL is carried out at the same time as meniscal transplantation in an ACL-deficient knee.

Transplantation of Viable Meniscal Allograft

“…In their study, the Lysholm score and arthroscopic findings were used to define clinical failures of cryopreserved allografts fixed with a comparable soft-tissue technique. The greater survival time and rate for the medial allografts in our series compared with those in other reports 27 can be attributed to the lower number of anterior cruciate-deficient knees in our series. Increased anterior tibial translation due to deficiency of the anterior cruciate ligament is known to induce higher stress on the medial meniscus and therefore can induce secondary graft detachment and failure 27 .…”

“…The greater survival time and rate for the medial allografts in our series compared with those in other reports 27 can be attributed to the lower number of anterior cruciate-deficient knees in our series. Increased anterior tibial translation due to deficiency of the anterior cruciate ligament is known to induce higher stress on the medial meniscus and therefore can induce secondary graft detachment and failure 27 . We performed a survival analysis on twenty cases of isolated medial allograft transplantation and forty-nine cases of isolated lateral allograft transplantation.…”

“…The mean survival times and cumulative survival rates were comparable between the lateral and medial allografts. In contrast, van Arkel and de Boer noted a considerable difference between these two types of grafts in their series, in which the mean survival times were 9.25 and 5.75 years for the lateral and medial allografts, respectively, and the survival rates were 76.54% at ten years for the lateral allografts and 50.6% at nine years for the medial allografts 27 . In their study, the Lysholm score and arthroscopic findings were used to define clinical failures of cryopreserved allografts fixed with a comparable soft-tissue technique.…”

“…However, it cannot be concluded that a high tibial osteotomy should be performed in association with medial meniscal transplantation in a limb with normal axial alignment. Rather, it can be concluded that transplantation of a medial meniscal allograft in a varus-aligned knee should be combined with a high tibial osteotomy since varus malalignment is an absolute contraindication to transplantation of a medial meniscal allograft 5,18,[25][26][27][28] . Overall, twenty-one of the 100 viable allografts in our study failed at a mean of 5.4 ± 3.3 years.…”

Meniscal Allograft Transplantation: Where are we Standing?

“…Many studies found significant improvements after MAT in the International Knee Documentation Committee (IKDC) [11,14,15,17,18,20], with percentages between 70 to 90% of nearly normal or normal values [21][22][23]. MAT has provided most patients with pain relief, adequate return to sports, and excellent satisfaction [6][7][8][9]10,11,14,15,17,18,21,[24][25][26][27]. In general, quality of life has even improved after MAT [28], with physical and mental component summary values above those for the matched U.S. population [22,23].…”