2015 ISAKOS Biennial Congress ePoster #1621
Meniscal Allograft Transplantation: A Systematic Review of Patient Reported Outcomes
Nick Anthony Smith, MSc, MRCS, BMBS, BMedSci, Solihull, West Midlands UNITED KINGDOM
Ioannis Pengas, MBChB, MRCS, MPhil, MD, FRCS (T&O), Truro, Cornwall UNITED KINGDOM
Tim Spalding, FRCS(Orth), Coventry and London UNITED KINGDOM
University of Warwick, Coventry, West Midlands, UNITED KINGDOM
FDA Status Not Applicable
Summary: This systematic review reports the results of patient reported outcome measures following meniscal allograft transplantation, showing a consistent improvement in the medium term.
Meniscal allograft transplantation has now been performed for over 30 years in humans. There have been a number of potentially significant changes to the intervention over the years, with a possible associated change in clinical outcome for patients. The primary objective of this study was to provide an up-to-date systematic review of the literature, with pooling of patient reported outcome measures in patients undergoing meniscal allograft transplantation. The secondary objective was to identify recent trend changes in meniscal allograft transplantation by reviewing the indications, associated procedures, operative technique, rehabilitation, failures, complications, radiological outcomes and graft healing.
Published and unpublished studies were identified using the databases of Medline, Embase and CENTRAL, as well as trials registries and the Web of Science. Pre-defined eligibility criteria were used and the study protocol was published prior to performing the searches, in order to reduce the risk of bias. Lysholm, IKDC and Tegner scores, as well as failures and complications were pooled from included studies. All eligible studies were also qualitatively assessed to identify trend changes to the intervention.
There were 1332 patients in 35 studies, with a mean follow up of 5.1 years. There were no randomised controlled trials. Across all studies Lysholm scores improved from 55.7 to 81.3, IKDC scores from 47.0 to 70.0 and Tegner activity scores from 3.1 to 4.7 between pre-operative and final follow up assessments respectively. The mean failure rate across all studies was 10.6% at 4.8 years and complication rate was 13.9% at 4.7 years. There was a trend change from the use of cryopreserved allografts to fresh frozen allografts. Bone block or bone bridge fixation remains the most common method of root fixation, but an all suture technique is also commonly performed.
The most important finding is that there were clinically relevant improvements in all mean patient reported outcome measures at final follow up. This study suggests that meniscal allograft transplantation is a reasonable treatment option for the symptomatic relief of compartmental knee pain in patients with a history of total or subtotal meniscectomy. This should ideally be confirmed with a randomised controlled trial.