Higher survivorship following meniscal allograft transplantation in less worn knees justifies earlier referral for symptomatic patients: experience from 240 patients

Abstract

Purpose: To analyse the clinical outcome and survivorship of meniscal allograft transplantation (MAT), performed in a single unit, specifically to assess the impact of concomitant operations and the influence of articular cartilage lesions on outcome.

Method: A prospective case series analysis of 240 patients undergoing MAT with follow-up greater than 12 months (range 1-10 years) was performed. Group A represented patients with good chondral surfaces (ICRS 0-3A); Group B had good chondral surfaces with concomitant realignment osteotomy. Group C had good chondral surfaces with ACL reconstruction performed at the same time. Groups D and E had bare bone on one or both surfaces respectively. Kaplan-Meier survivorship and PROMS including Lysholm, KOOS, Tegner, and IKDC subjective scores were analysed.

Results: Overall survivorship was 96.7% at 1 year, 87% at 5 years and 82.2% at 7 years. Groups A-C (knees without significant chondral damage) had significantly improved survivorship (95% at 5 years) compared to Groups D, E (full-thickness chondral wear) with 77% survivorship at 5 years. Survivorship and PROMS were equivalent between Groups A-C. Groups D and E had similar PROMS to Group A, but did have a higher failure rate. Overall 27% required further operative intervention.

Conclusions: Meniscal transplantation is clinically effective in treating patients with symptomatic meniscal deficiency. Where indicated, the addition of osteotomy or ACL reconstruction achieves results similar to patients undergoing simple meniscal transplantation in stable and normally aligned knees. Survivorship is lower in patients with full-thickness chondral loss and future treatments should, therefore, be directed at improving success in this at-risk group. The results support encouragement for earlier referral of symptomatic patients to a specialist meniscal reconstruction centre before a significant chondral damage is sustained.

Level of evidence: III.

Keywords: Allograft; Meniscal; Meniscus transplantation; Outcome; Survivorship; Transplant.