Meniscal allograft with or without osteotomy: a 15-year follow-up study

Abstract

Purpose: To assess survivorship of meniscal allografts and the benefit of concomitant osteotomy.

Methods: A retrospective review was performed of all patients who had meniscal allograft surgery ± osteotomy. Fresh frozen meniscal allograft was sutured in place using an onlay technique. Osteotomies were performed in patients with malalignment. We recorded any further intervention required. Survivorship was assessed defining failure as being scheduled or having received a total knee arthroplasty (TKA).

Results: Mean age was 40 years. Primary diagnosis was degeneration after previous meniscal injury. Eighty-six allografts were performed, 43 of the medial meniscus and 41 of the lateral meniscus. One patient had implantation of both medial and lateral menisci. Simultaneous osteotomy was performed in 53 patients. Seven patients underwent simultaneous anterior cruciate ligament reconstruction. Mean follow-up was 180 months. At the time of writing, 61 allografts (71%) remain in situ with adequate function. Fifteen allografts required arthroscopy and meniscal debridement at a mean of 68 months postop. Twenty-four allografts (28%) went on to degenerate and required TKA at a mean of 149 months postop. There was no significant difference in the survival for isolated allograft ± osteotomy of either the medial meniscus, lateral meniscus or patients requiring arthroscopic intervention (n.s.).

Conclusions: Meniscal allograft is a viable solution to meniscal loss in the young patient. Survivorship is good, providing a mean of 12.4 years prior to TKA in those requiring conversion with 71% of allografts still in situ at a mean of 15 years post-surgery.

Level of evidence: Therapeutic, retrospective, Level IV.