2019 ISAKOS Biennial Congress ePoster #1038
Long-Term Survival Analysis of Meniscal Allograft Transplantation with Minimum 10-Year Follow-Up: A Systematic Review
João V. Novaretti, MD, PhD, São Paulo, SP BRAZIL
Neel K. Patel, MD, Pittsburgh, PA UNITED STATES
Jayson Lian, BA, New York, NY UNITED STATES
Ravi S. Vaswani, MD, Pittsburgh, PA UNITED STATES
Darren L. de SA, MBA(c), MD, FRCSC, Hannon, ON CANADA
Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, London, ON CANADA
Volker Musahl, MD, Pittsburgh, PA UNITED STATES
University of Pittsburgh, Pittsburgh, PA, UNITED STATES
FDA Status Not Applicable
Meniscal allograft transplantation (MAT) can yield good long-term survivorship rates, with 73.5% and 60.3% of allografts remaining functional after 10 and 15 years, respectively. Functional outcomes 10 years after MAT were fair and improved compared to pre-operative scores.
Significant heterogeneity in study population of several long-term studies has precluded a more accurate analysis of long-term results after meniscal allograft transplantation (MAT). The population in these studies is frequently composed of patients with a wide range of follow-up (from one-two years to over 10 years), thus the reported long-term outcomes of MAT may be biased by patients with shorter follow-up times.
The purpose of this systematic review was to investigate the long-term survivorship rates and functional outcomes of meniscal allograft transplantation (MAT) in patients with minimum 10-year postoperative follow-up. Based on previous MAT cases series in the literature, it was hypothesized that the survivorship rate after MAT at 10-year follow-up would be over 50% and that functional outcomes would still be improved compared to pre-operative evaluation.
Two reviewers independently searched EMBASE, MEDLINE and PubMed from database inception to January 24, 2018 for literature related to MAT according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) criteria. Inclusion criteria were: (1) all levels of evidence, (2) human studies, (3) studies published in English, (4) studies reporting outcomes after MAT (5) studies reporting survivorship rates at minimum 10-year follow-up. Exclusion criteria were: (1) review articles, (2) biomechanical/cadaveric studies, (3) studies where outcomes for the patient population of interest (patients with minimum 10-year follow-up) could not be separated from patient outcomes at shorter time points, (4) follow-up study with same patient population (in such cases, only the more recent study was included). The following key terms were used in the search: "meniscus", "meniscal", "menisci", "allograft", "transplant", and "transplantation". Data is reported in a narrative summary fashion with descriptive statistics.
Eleven studies with a total of 658 patients and 688 MATs were included. Mean age of patients was 33.1 (range 14-66) years, of which 63% were male. Mean survivorship rates were 73.5% at 10-year and 60.3% at 15-year follow-up, with two studies reporting 19 and 24-year survivorship of 50% and 15.1%, respectively. Pre- and post-operative Lysholm scores ranged from 36-60.5 and 61-75, respectively. Pre- and post-operative Tegner scores ranged from 1-3 and 2.5-4.6, respectively. Post-operative KOOS subset scores were: Pain: 61.6-76.3; Symptoms: 57.9-61.8; Function in Daily Living: 68.5-79.9; Sport and Recreation: 33.9 -49.3; Quality of Life: 37.3-45.9. Post-operative IKDC scores ranged from 46-77. Regarding surgical technique, 194 MAT bone-fixation technique (53.8%) and 165 MAT suture-only fixation techniques (46.2%) were reported. The most common type of allograft used was cryopreserved (54.5% of the allografts). The most frequent concomitant procedures performed with MAT were to address chondral (20.8% of the cases) and ligament injuries (12.4% of the cases), and realignment procedures (9.4% of the cases). The most common complications observed that were not directly related to concomitant procedures were meniscal allograft partial tears (11.1%), arthrofibrosis (3.6%) and infection (2.0%). Several criteria were used among studies to define failure of MAT, the most common parameters being removal of meniscal allograft (8/11 studies) and conversion to total knee arthroplasty (TKA) (7/11 studies).
Discussion And Conclusion
The main finding of this systematic review was that MAT can yield good long-term survivorship rates, with 73.5% and 60.3% of allografts being viable after 10 and 15 years of index procedure, respectively. Therefore, the survivorship results in this review highlights the capacity of MATs to at least serve as a "bridging procedure" for this population, helping to avoid premature joint replacement procedures while preventing long periods of debilitation and poor quality of life.
In conclusion, MAT can yield good long-term survivorship rates, with 73.5% and 60.3% of allografts remaining functional after 10 and 15 years, respectively. Functional outcomes 10 years after MAT were fair and improved compared to pre-operative scores.