Staged meniscal allograft transplantation as a biologic treatment of the meniscal deficient knee: A prospective case series of 26 patients with maximum 88-month follow-up

Abstract

IntroductionThe meniscal deficient knee often exists within the setting of associated pathology including instability, malalignment and chondral injury. The aim of this study was to establish the role of meniscal allograft transplantation (MAT) as part of a staged approach to treatment of the previously menisectomised knee and report: (a) primary data endpoints (pre and post-operative Knee Injury and Osteoarthritis outcome scores (KOOS), Tegner scores, satisfaction scores and graft survival), and (b) secondary endpoints:(complication/reoperation rates, and meniscal extrusion measurements as determined by MRI). Material and methodsThis prospective study included all patients that underwent arthroscopic fresh frozen allograft MAT at our institution (2010–2017) using a soft tissue fixation technique. ResultsTwenty-seven MAT procedures were performed in 26 patients (16 lateral, 11 medial). Ten patients underwent ACL reconstruction, three ACI and two osteotomy in the pre-MAT phase. Seven patients underwent ACI within the post-operative phase. Post-operative mean KOOS scores improved significantly in all subscales (p < .002) as did Tegner scores (p < .05). Graft survival was 100%, satisfaction rate 92%, and mean meniscal extrusion 3.04 mm. Post operatively, three patients required meniscal repair and a single patient, partial menisectomy of graft. Two patients underwent arthroscopic arthrolysis following MAT. ConclusionsThis series highlights the multifactorial profile of the meniscal deficient knee and the role of MAT as a safe and reliable technique in the staged and comprehensive biologic treatment available to minimise symptoms and maximise outcomes.Level of evidence: 4.