The Influence of Preoperative Full-Thickness Chondral Defects on Outcomes Following Meniscal Allograft Transplantation

Abstract

Objectives:The impact of full-thickness chondral defects (FTD) on outcomes after meniscus allograft transplantation (MAT) remains unknown. The purpose of this study was to determine the impact of FTD on outcomes following MAT.Methods:Patients undergoing MAT between 9/1997-3/2013 with minimum two-year follow-up were identified and split into two groups based upon presence or absence of FTD identified intra-operatively: No defect (“ND’, Outerbridge Grade 0/I) or FTD (Outerbridge Grade IV). All FTD were treated with cartilage restoration procedures (microfracture, osteochondral allo/autograft, DeNovo or autologous chondrocyte implantation). Reoperations, failures (revision MAT or conversion to arthroplasty), and patient-reported outcomes (PROs) were reported at six-months, one-year, two-years and final follow-up. Inter-group comparisons were made using unpaired student t-tests.Results:A total of 91 patients - 22 with ND and 69 with a FTD were identified and followed for a mean 4.48 and 3.84 years, respectively. There were no significant between-group differences in age, body mass index (BMI), or number of prior surgeries. One complication occurred in the FTD group (1.3%), and no complications in the ND group. There were no significant differences in number of subsequent surgeries or failures. Comparison of the cohorts found no differences in PROs preoperatively. At 6-months postoperative, significantly greater values were reported in the FTD cohort for KOOS-Pain and KOOS-ADL and greater values for the ND cohort for WOMAC-Function and WOMAC-Total. At 1-year postoperative, significantly greater values were reported for the ND cohort for KOOS-Symptoms and KOOS-QOL, but at 2-years postoperative and final follow-up, no further significant differences in any PROs were present. At final follow-up, the ND and FTD cohorts reported significant improvements in the majority of PRO categories, with a greater number of PRO subscales demonstrating significance in the FTD group (Figure 1; Table 1).Conclusion:FTD when treated at the time of MAT have no significant influence on outcome following MAT, including PROs, failures or reoperations. Clinicians performing MAT in meniscus deficient patients with full-thickness chondral defects should counsel their patients that if these defects are treated concomitantly with MAT that they can expect similar outcomes to patients without full-thickness chondral defects at long-term follow-up.Table 1:Chage from Preoperative to Final Follow-up in Patient Reported OutcomesPRO“No defect” (grade 0/1 defects)“Full-thickness defect” (grade 4 defects)P ValueLysholm14.8±14.421.1±19.80.410IKDC15.3±1424.2±23.10.301KOOS Pain13.6±13.417.6±17.10.549 Symptoms11.3±1215.2±19.30.530 ADL10.1±9.417.3±17.40.279 Sports8.3±1228.0±28.20.153 QOL20.5±22.623.1±26.60.783WOMAC Pain-1.7±2.1-2.7±3.20.389 Stiffness-0.9±1.4-1.1±2.30.806 Function-6.9±6.4-11.8±11.80.278 Total-9.9±9.2-14.8±15.40.420Overall Knee Function2.3±2.73.1±3.00.402Symptom Rate2.9±0.91.1±1.90.173SF-12 Physical5.2±8.32.5±6.90.395SF-12 Mental0.8±9.70.5±8.70.741PRO = patient reported outcome; IKDC = International Knee Documentation Committee; KOOS = Knee Injury and Osteoarthritis Outcome Score; ADL = activities of daily living; QOL = quality of life; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index; SF-12 = Short Form-12