Comparison of medial versus lateral meniscus allograft transplantation. Literature review and meta-analysis

Abstract

Objectives: To perform a literature review and meta-analysis evaluating the effectiveness of medial and lateral meniscus allograft transplantation (MAT).

Methods: The literature review and meta-analysis were conducted between August and October 2015 in the People's Hospital of China Three Gorges University, Yi Chang, China. A systematic search was performed in the Medline and EMBASE databases, and the Cochrane Library for relevant literature published through October 2015. The outcomes of the included studies were analyzed in terms of the Lysholm Score, International Knee Documentation Committee (IKDC) Score, Knee Injury And Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), Tegner Activity Score, MRI results, and failure rates. An adapted version of the Newcastle-Ottawa Scale was used for the methodological quality assessment in the meta-analyses.

Results: The literature review identified 12 observational studies, including 7 retrospective studies, 4 prospective studies, and the nature of one study was not reported. Significant differences in the outcomes of the lateral MAT group and the medial MAT group were observed in the IKDC scores, KOOS pain values, KOOS activities of daily living (ADL) values, and the absolute and relative extrusions observed on MRI, which suggested that the lateral MAT patients experienced superior clinical benefits compared with the medial MAT patients. However, significant differences between the lateral MAT group and the medial MAT group were not observed with regards to the Lysholm Scores, KOOS symptom values, KOOS sports and recreations values, KOOS quality of life (QOL) values, Tegner Activity Scores, VAS for pain values, and failure rates.

Conclusion: The analysis results indicated that lateral MAT provides superior clinical outcomes compared with medial MAT according to the KOOS and IKDC scores. In addition, greater graft extrusion was observed in the medial group on MRI. Although significant differences were not detected between the 2 groups, the medial MAT patients were more prone to failure compared with the lateral MAT patients.

Figure 1

Flow diagram of the literature search included in the study.

Figure 2

Meta-analysis of the lysholm score A) IKDC value, B) Tegner activity score, C) and VAS for pain D) between the medial and lateral MAT groups. CI - confidence interval, SD - standard deviation, MAT - meniscus allograft transplantation, IKDC - International knee documentation committee, VAS - visual analog scale.

Figure 3

Meta-analysis of the KOOS Pain (A), KOOS Symptoms (B), KOOS ADL (C), KOOS S&R (D), and KOOS QOL (E) between the medial and lateral MAT groups. CI, confidence interval; SD, standard deviation; MAT, meniscus allograft transplantation; KOOS, Knee Injury and Osteoarthritis Outcome Score; ADL, Activities of Daily Living; S&R, Sports and Recreation; and QOL, Quality of Life.

Figure 4

Meta-analysis of the absolute extrusion observed on MRI and A) relative extrusion observed on MRI B) between the medial MAT and lateral MAT groups. CI - confidence interval, SD - standard deviation, and MAT - meniscus allograft transplantation.

Figure 5

Meta-analysis of the failure rates between the medial and lateral MAT groups. CI - confidence interval, SD - standard deviation, and MAT - meniscus allograft transplantation.

Figure 6

Funnel plot of the lysholm score. MD - mean difference, SE - standard error