2015 ISAKOS Biennial Congress ePoster #1626
Is Meniscal Allograft Transplantation Chondroprotective? A Systematic Review of Radiological Outcomes
Nick Anthony Smith, MSc, MRCS, BMBS, BMedSci, Solihull, West Midlands UNITED KINGDOM
Benjamin Parkinson, FRACS(Orth), Coventry UNITED KINGDOM
Tim Spalding, FRCS(Orth), Coventry and London UNITED KINGDOM
University of Warwick, Coventry, Warwickshire, UNITED KINGDOM
FDA Status Not Applicable
Summary: This systematic review systematically appraised 38 studies that had reported radiological measures of osteoarthritis progression or meniscal integrity following meniscal allograft transplantation, finding some evidence of chondroprotection.
Meniscal allograft transplantation has been shown to improve patient reported outcomes in the short and medium term. Meniscectomy results in a high risk of osteoarthritis and it is often stated that meniscal allograft transplantation is likely to be chondroprotective. However, to date, there is little evidence to support this hypothesis. The primary aim of this systematic review is to provide the best current answer to this question by identifying and appraising studies that have assessed the progression of osteoarthritis following meniscal allograft transplantation. The secondary aim is to identify and appraise radiological measures of meniscal integrity.
The databases of Medline, Embase and CENTRAL were searched using pre-defined eligibility criteria. The study protocol was published prior to the searches being performed in order to reduce the risk of bias. Clinical studies on human participants undergoing meniscal allograft transplantation with a minimum follow up of 6 months were included. The primary outcome measure was any radiological osteoarthritis progression measure, including joint space width change, Kellgren and Lawrence classification, Fairbank criteria, IKDC radiological scores and Yulish grading. Secondary outcomes included meniscal size, shape, healing, extrusion and signal intensity.
Thirty-eight studies with 1056 allografts were included. The total weighted mean joint space loss was 0.03mm at 4.5 years across 11 studies. Other radiological classification systems were reported in small numbers and with variable progression rates. Meniscal extrusion was present in nearly all cases, but was not associated with poor clinical or other radiological outcomes. Meniscal healing rates were high, although the size, shape and signal intensity was commonly altered from that of the native meniscus. The quality of the included studies was low, with a high risk of bias.
There is some evidence to support the hypothesis that meniscal allograft transplantation is chondroprotective. However it could not universally prevent degenerative changes in the knee. These findings are supported by biomechanical and animal model studies, but the strength of findings are limited by the generally low quality of included studies. A randomised controlled trial would be the best study design to test this hypothesis, which is currently in progress.