Arthroscopic Meniscal Allograft Transplantation Research Articles

Significant improvements in clinical outcome measures and patient satisfaction after combined all-arthroscopic meniscal allograft transplantation and autologous chondrocyte implantation: A single-centre longitudinal study.

The optimal treatment approach for the complex pathology of meniscal insufficiency and coexisting full-thickness cartilage defects remains unclear. The purpose of this study was to evaluate the viability, safety, and efficacy of this combined surgical approach at medium-term follow-up. This is a single-centre longitudinal study with blinded outcome assessment. All consecutive patients treated with combined all-arthroscopic meniscal allograft transplantation (MAT) with bone bridge fixation and ACI using chondrospheres at our institution between 2001 and 2021 were eligible for inclusion. Twenty patients with an average follow-up of 72.6 ± 34.4 months were included in the statistical analysis. Clinical outcomes were assessed pre- and postoperatively using the IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and Visual Analog Scale (VAS) for patient satisfaction. Failure and reoperation rates were assessed, and cartilage regeneration tissue was evaluated on postoperative MRI. IKDC scores significantly improved from 52.1 ± 16.9 to 68.5 ± 16.3 (p = 0.003). Lysholm scores improved from 61.5 ± 21.7 to 78.5 ± 12.9 (p = 0.004). Tegner scores improved from 3.5 (1-4) to 4.0 (2-6) (p = 0.014). KOOS scores improved significantly across all subcategories, except 'symptoms', where improvements did not reach statistical significance. VAS for overall patient satisfaction showed improvements but did not reach statistical significance. The combined procedure was successful in 17 patients (85%). Eight patients had to undergo reoperation (40%), comprising mostly small, arthroscopic procedures. Seven reoperations were directly attributable to meniscal allograft transplantation (46.7%). Postoperative Magnetic Resonance Observation of Cartilage Repair Tissue scores were 68.9 ± 16.8 (n = 14). Combined arthroscopic MAT and autologous chondrocyte implantation (ACI) is a viable, safe, and effective treatment approach for younger patients with meniscal insufficiency and coexisting full-thickness cartilage damage, where alternative treatment options are limited. The combined surgical procedure achieved significant improvements in clinical outcome measures and patient satisfaction with acceptable failure and high arthroscopic reoperation rates. MAT is the limiting part of this combined procedure, with most failures and reoperations being attributable to MAT, as opposed to ACI. Level III.

Meniscal allograft transplantation in The Netherlands: long-term survival, patient-reported outcomes, and their association with preoperative complaints and interventions

PurposeEvaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee.MethodsA prospective consecutive study of 109 consecutive patients who had an arthroscopic meniscal allograft transplantation (MAT) between 1999 and 2017 by a single surgeon. Patients were assessed with KOOS scores, preoperative and after a minimal follow-up of 2 years. Furthermore, two anchor questions (whether expectations were met and overall satisfaction, on a five-point Likert scale) were asked. Additionally, prior interventions to MAT were evaluated.ResultsPrior to MAT, patients had undergone an average of 2.8 (range 1–14) of surgical procedures of the knee. Overall, mean allograft survival was 16.1 years (95% CI 14.8–17.5 years). Higher age at surgery was associated with lower MAT survival: hazard ratio for MAT failure was 1.19 per year increase (95% CI 1.04 to 1.36, p = 0.009). At 4.5 years (IQR, 2–9) of follow-up, all KOOS score were still improved compared to baseline. Age below 35 years, simultaneous anterior cruciate ligament reconstruction and number of knee surgeries before MAT were associated with lower KOOS scores. Overall patient expectations and overall satisfaction after MAT were not associated with preoperative patient characteristics nor with the number or kind of preoperative interventions.ConclusionMeniscal allograft transplantation has a good overall survival with a clinically relevant improvement. Both meniscal allograft survival and PRO were associated with age. PRO was lower in patients younger than 35 years at time of MAT and meniscal allograft survival was worse in patients older than 50 years. PRO was associated with preoperative patient characteristics and number of surgical procedures prior to MAT. All patients reported improved postoperative satisfaction and met expectations after MAT, both independent of the preoperative history of knee interventions.Level of evidenceLevel III.Trial registration Medical ethical review board (METC) number: 17–104 (7 August 2017).Dutch Trial Register (NTR) number: NTR6630 (4 July 2017).

Return to Work Following Arthroscopic Meniscal Allograft Transplantation.

Evaluate the ability of patients to return to work (RTW) following arthroscopic meniscal allograft transplantation (MAT) for meniscal deficiency. Consecutive patients undergoing MAT were retrospectively reviewed at a minimum of 2 years postoperatively. Patients completed a subjective work questionnaire, Visual Analogue Scale for pain, Single Assessment Numerical Evaluation, and satisfaction. Forty-seven patients who were employed within 3 years prior to surgery (average age: 30.2 ± 6.9 years) were contacted at an average of 3.5 ± 0.9 years postoperatively. Forty-six patients (97.8%) returned to work by 2.7 ± 2.6 months postoperatively, and 44 patients (93.6%) returned to the same level of occupational intensity. Patients who held sedentary, light, medium, or high intensity occupations were able to RTW at a rate of 100.0%, 100.0%, 88.9%, and 85.7% (P = 0.4) by 1.1 ± 1.0 months, 2.5 ± 2.5 months, 3.5 ± 3.2 months, and 4.3 ± 2.8 months (P = 0.3) postoperatively. Thirty-eight patients (80.9%) were at least somewhat satisfied, and 43 patients (91.5%) would still have the operation if presented the opportunity. No patient underwent revision MAT or conversion to arthroplasty. In patients with painful meniscal deficiency, MAT provides a high rate of RTW (97.8%) by 2.7 ± 2.6 months postoperatively. However, some patients may be unable to return to their previous level of occupational intensity. Although statistically insignificant, patients with higher intensity occupations may have a lower rate and longer duration until RTW than those with less physically demanding occupations. Information regarding RTW is imperative for appropriately managing postoperative expectations.

Return to Sport and Patient Satisfaction After Meniscal Allograft Transplantation

To investigate patient return to sport and satisfaction after meniscal allograft transplantation (MAT). Patients undergoing MAT using a bone bridge technique between 2013 and 2015 with minimum 2-year follow-up were retrospectively reviewed. They completed a survey regarding return to sport, satisfaction, and subsequent surgery in addition to patient-reported outcome measures. Of 117 patients, 87 (74.4%) were available at an average follow-up of 3.64 years (range, 2.01-5.13 years). The mean age at the time of surgery was 28.99 ± 8.26 years. Lateral MAT was performed in 44 cases (50.6%); medial MAT, 42 (48.3%); and combined medial and lateral MAT, 1 (1.1%). Concomitant procedures were performed in 72 patients (82.7%) including cartilage restoration (n= 65, 74.7%), realignment (n= 9, 10.3%), and anterior cruciate ligament reconstruction (n= 9, 10.3%). Patients experienced significant improvement in the Lysholm score (P < .001), International Knee Documentation Committee score (P < .001), Knee Injury and Osteoarthritis Outcome Score (KOOS)-Quality of Life (P < .001), KOOS-Activities of Daily Living (ADL) (P < .001), KOOS-Pain (P < .001), KOOS-Sports (P= .001), KOOS-Symptoms (P= .003), Short Form 12 physical score (P < .001), and Veterans Rand-12 physical score (P < .001). Reoperation was performed in 26 patients (29.9%); failure occurred in 12 patients (13.8%; total knee arthroplasty in 1, unicompartmental arthroplasty in 2, and total meniscectomy in 9). Overall, 77.0% of patients were satisfied with their outcome. Prior to MAT, 82 patients (94.3%) participated in sporting activities; 62 patients (75.6%) returned to at least one sport at 12.58 ± 6.20 months postoperatively, with 30 (48.4%) reaching their preoperative level of intensity and 72 (87.8%) discontinuing at least one of their preoperative sports. The most common reasons for sports discontinuation postoperatively were prevention of further damage (73.6%), pain with activity (51.4%), fear of further injury (48.6%), surgeon recommendation (33.3%), and swelling with activity (30.6%). Patients were satisfied with their sports participation at a rate of 62.1%. In a complex patient population undergoing arthroscopic MAT, 75.6% of patients were able to return to at least one sport at an average of 12.58 ± 6.20 months postoperatively. The level of sport declined, with 93.5% of patients restricting involvement to recreational sports after MAT and 48.4% returning to their preoperative level of activity intensity. In addition, 87.8% of patients reported discontinuing a sport in which they had participated preoperatively. The most common reasons for decreasing level of sport were prevention of further damage, pain or swelling with sports, and fear of further injury. The reoperation rate after MAT was 29.9%. Most patients were satisfied with the outcome of surgery, with 77.0% satisfied in general and 62.1% satisfied with their ability to play sports. Level IV, retrospective case series.

Patient Satisfaction and Return to Sports after Meniscal Allograft Transplantation

Objectives: To investigate the ability of patients to return to sport following arthroscopic meniscal allograft transplantation (MAT). Methods: Patients undergoing arthroscopic MAT between 2013 and 2015 were retrospectively reviewed. Patients completed an outcome survey regarding return to sports in addition to patient reported outcome measures. Subsequent surgery and failure (total meniscectomy, revision MAT, or total or partial knee arthroplasty) were also evaluated. Results: Of 117 MAT performed, 87 patients (74.4%) were available at average 3.6 year follow-up. The average age at time of surgery was 29.0+/-8.3. All 84 patients underwent prior ipsilateral knee surgery with an average of 3.5+/-2.1 prior procedures. MAT was lateral in 44 cases (50.6%), medial in 42 cases (48.3%), and combined medial and lateral in one case (1.1%). Concomitant procedures were performed in 72 patients (82.7%) including cartilage restoration (65, 74.7%), realignment (9, 10.3%), and ACL reconstruction (9, 10.3%). Patients experienced significant improvement compared to preoperative Lysholm, IKDC, KOOS, WOMAC, and SF-12 physical scores (p &lt; 0.001). Within three years prior to MAT, 82 patients (94.3%) reported participation in sporting activities. Due to knee symptoms, 62 patients (75.6%) discontinued at least one sport prior to MAT. Of the 82 patients participating in sports preoperatively, 62 patients (75.6%) returned to at least one sport at an average of 12.3 months after MAT. Rates of return to specific sports were highest for light weight lifting, yoga, swimming, and cycling and all RTS rates are shown in Table 1. The percentage of patients participating in sports above the recreational level declined significantly (46.0% prior to symptoms versus 8.2% after MAT, p &lt; 0.001). The most common reasons for decreasing level of sport postoperatively were: to prevent further damage (73.6%), pain or swelling with sports (51.4%), fear of further injury (48.6%), surgeon recommendation (33.3%), and decision to pursue other activities (11.1%). Patients reported being satisfied with their ability to participate in sports at a rate of 63.2%, and 78.8% reported they would still undergo MAT with the benefit of hindsight. Reoperation was performed in 26 patients (29.9%) with 12 patients experiencing failure (13.7%; 1 TKA, 2 UKA, 9 total meniscectomy). Conclusion: In a complex patient population undergoing arthroscopic MAT, 75.6% of patients were able to return to at least one sport at an average of 12.3 months postoperatively. Level of sport declined compared to baseline, with most patients restricting involvement to recreational sports after MAT. The most common reasons for decreasing level of sport were: to prevent further damage, pain or swelling with sports, and fear of further injury. [Table: see text]

Open Meniscal Allograft Transplantation With Transosseous Suture Fixation of the Meniscal Body Significantly Decreases Meniscal Extrusion Rate Compared With Arthroscopic Technique

To assess and compare meniscal extrusion rates after lateral "bridge-in-slot" meniscal allograft transplantation (MAT) with arthroscopic versus open insertion. In this review of prospectively collected data, we analyzed data from patients who underwent arthroscopic or open lateral MAT. Patients who underwent concomitant distal femoral osteotomy, for whom 1-year postoperative magnetic resonance imaging was unavailable, or who underwent open lateral MAT without the use of transosseous sutures were excluded. Meniscal extrusion in the included patients was assessed by 2 independent examiners by measuring the absolute value and the relative percentage of extrusion on 1.5-T magnetic resonance images at 1-year follow-up. The number of MATs with radial displacement larger or smaller than 3mm was determined. A total of 20 patients met the inclusion criteria, of whom 10 underwent arthroscopic and 10 underwent open lateral MAT. No statistically significant differences were found in baseline demographic data. Absolute meniscal extrusion was similar between the groups (P= .091). A significantly larger relative percentage of extrusion (arthroscopic MAT, 31 ± 27mm; open MAT, 10 ± 29mm; 95% confidence interval, -0.4 to -0.02 mm; P= .03) and a significantly higher extrusion rate were found in patients treated with arthroscopic MAT than in those treated with open MAT (>3mm in 5 patients [50%] with arthroscopic MAT and 0 patients with open MAT, P= .01). This study identified similar absolute extrusion and significantly lower postoperative lateral meniscal extrusion rates after open MAT compared with arthroscopic MAT. Transosseous fixation of the meniscal body appears protective against meniscal extrusion after MAT. Level III, case-control study.

Meniscal Allograft Transplantation With Soft Tissue in Bone Socket Fixation: Arthroscopic Technique With Technical Pearls

Meniscal allograft transplantation may slow the progression of degenerative changes in the meniscus-deficient knee. The current literature suggests patients can experience good early to mid-term satisfaction and patient-reported outcomes with reasonable expectations of return to work. More ambitious applications in athletes have also shown good results although long-term data are lacking. Traditionally, meniscal allograft transplantation has been considered an open procedure with incorporation of bone blocks from the allograft source. However, as arthroscopic techniques have advanced, it has become possible to perform this procedure through a predominantly arthroscopic approach while securing the soft tissue graft in bone tunnels. The current demonstration provides this background and technical pearls for success in arthroscopic meniscal allograft transplantation.

Concomitant Arthroscopic Meniscal Allograft Transplantation and Anterior Cruciate Ligament Reconstruction

In recent decades, arthroscopic meniscal allograft transplantation (MAT) has been refined as a robust option for the treatment of evolving unicompartmental tibiofemoral arthrosis in the setting of meniscal deficiency. It is imperative that the MAT be performed in a knee with anatomic stability and alignment to reduce aberrant biomechanical forces experienced by the allograft tissue to maintain its durability. Thus, in an anterior cruciate ligament (ACL)–deficient knee, ACL reconstruction (ACLR) must be performed to restore the stable knee environment for the MAT to succeed. Although these operations can be performed in staged fashion, a single-stage procedure with concomitant MAT and ACLR is an option. Its performance is technically demanding and requires careful consideration as to the intraoperative setup, incisions, graft options, surgical tools, and procedural order to properly secure the transplanted meniscal allograft and restore a functional, anatomic ACL. We present our preferred technique for concomitant arthroscopic MAT and ACLR, as well as some potential pitfalls and pearls to avoid pitfalls.

Is Sport Activity Possible After Arthroscopic Meniscal Allograft Transplantation?

Background: Meniscal allograft transplantation (MAT) has produced good to excellent results in the general population; however, few investigations have examined MAT in athletes and sport-related outcomes. Purpose: To report midterm clinical outcomes of MAT and the rate of return to sport in a physically active population. Study Design: Case series; Level of evidence, 4. Methods: The study included all physically active patients who underwent arthroscopic MAT without bone plugs and had a minimum of 2 years of follow-up at a single institution. Clinical evaluation was performed with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Tegner activity scale, and a 0- to 100-point subjective scale for knee function and satisfaction. Outcomes evaluated included ability to return to sport, time to return to sport, level of sport activity upon return compared with preinjury level, and level of decrease in sport participation or reasons for not returning to sport participation. Comparisons were made between patients who did or did not return to sport and between patients who returned to the same level or a decreased level. Regression analysis was performed to determine the variables affecting the outcomes. Results: Eighty-nine patients, whose mean ± SD age at surgery was 38.5 ± 11.2 years, were evaluated to a mean follow-up of 4.2 ± 1.9 years. Total KOOS improved from a mean ± SD of 39.5 ± 18.5 preoperatively to 84.7 ± 14.8 at the latest follow-up (P < .001). The Tegner score improved significantly from a median of 2 (interquartile range [IQR], 1-4) preoperatively to a median of 4 (IQR, 3-6) at the latest follow-up (P < .001), although it did not reach the preinjury level of 6 (IQR, 5-7) (P < .001). Older age at surgery was correlated with the worst clinical results. Sixty-six patients (74%) were able to return to sport after 8.6 ± 4.1 months. Forty-four (49%) returned to the same level as preinjury. Patients who did not return to sport activity and those who reduced their activity level at follow-up had inferior subjective outcomes compared with those who returned to sport and those who returned to their preinjury levels, respectively. Only 11 patients (12%) underwent a surgical procedure during the follow-up period. Conclusion: Arthroscopic MAT without bone plugs improved knee function and reduced pain, allowing sport resumption in 74% of patients and return to the preinjury activity level in 49% of patients at midterm follow-up. Of all the demographic and surgical variables, only age at surgery seemed to affect outcomes.

Arthroscopic Meniscal Transplantation Technique

The meniscus provide several important mechanical functions in the knee joint. Following menisectomy the tibiofemoral contact area decreases while the contact forces increase. Meniscal allograft transplantation (MAT) offers the potential to restore partial load-bearing, decrease symptoms, and provide chondroprotective effect. Ideal patient for MAT should have normal alignment, stable knee, abscence of cartilage damage and has less than 50 years-old. Several open and arthroscopic MAT techniques have been described. The succesful of MAT is to use a minimal invasive technique without sacrificing the precise anatomic reconstruction of the original meniscofemoaral and meniscotibial relationships. Anatatomical position, appropriate sizing of the graft, and fixation method are crucial key points to have good results. In general there are three fixation methods: soft tissue fixation, suture fixation through transoseous tunnels, and bone plugs press-fit fixation. However, inferior biomechanical and contact pressure have been reported with soft tissue and transosseous tunnels compared with the bone block technique.

Arthroscopic meniscal allograft transplantation with two tibia tunnels without bone plugs: evaluation of healing on MR arthrography and functional outcomes

Meniscal allograft transplantation seems to be a valid therapeutic option to restore the knee function and limit the development of osteoarthritis after menisectomy. No surgical technique has been shown to provide better results than others. The main objective of this study was to assess graft healing after arthroscopic meniscal allograft transplantation without bone plugs. This retrospective study included all patients who underwent arthroscopic meniscal allograft transplantation during 2005-2010. The meniscal horns were fixed through two tibia tunnels without bone plugs. The primary endpoint was graft healing according to Henning's criteria on MR arthrography (MRA) at 6-month follow-up. The secondary endpoints were the KOOS questionnaire, the IKDC score, measurement of the joint space and meniscal extrusion on both MRA at 6-month and MRI at last follow-up. The series included 22 patients, mean age 37 ± 7.5 years. The allograft was lateral in 20 cases and medial in 2 cases. The mean follow-up was 4.4 ± 1.6 years with one lost to follow-up. MR arthrography was performed in 14/21 patients at 6-months of follow-up: 8/14 (57.1%) had total graft healing, 2/14 (14.3%) partial healing and 4/14 (28.6%) no healing. At final follow-up, all functional scores had significantly improved. The average pre- and post-operative joint space thickness was similar. MRI showed meniscal extrusion in 75% of patients. The meniscal allograft transplantation without bone plugs effectively treats painful and functional sequellae of meniscectomies. The graft healed in most patients at 6-month follow-up. The long-term clinical relevance of meniscal extrusion has to be evaluated. Retrospective study, Level IV.

Arthroscopic meniscal allograft transplantation without bone plugs

Partial or total meniscectomy are common procedures performed at Orthopedic Surgery departments. Despite providing a great relief of pain, it has been related to early onset knee osteoarthritis. Meniscal allograft transplantation has been proposed as an alternative to meniscectomy. The purposes of this study were to describe an arthroscopic meniscal allograft transplantation without bone plugs technique and to report the preliminary results. All meniscal allograft transplantations performed between 2001 and 2006 were approached for eligibility, and a total of 35 patients (involving 37 menisci) were finally engaged in the study. Patients were excluded if they had ipsilateral knee ligament reconstruction or cartilage repair surgery before meniscal transplantation or other knee surgeries after the meniscal transplantation. Scores on Lysholm, Subjective IKDC Form, and Visual Analogue Scale (VAS) scale for pain were obtained at a mean follow-up of 38.6 months and compared to pre-operative data. Data on chondral lesions were obtained during the arthroscopic procedure and through imaging (radiographs and MRI) studies pre-operatively. Two graft failures out of 59 transplants (3.4%) were found. Daily life accidents were responsible for all graft failures. Significant improvements for Lysholm, Subjective IKDC Form, and VAS for pain scores following the meniscal allograft transplantation were found (P < 0.0001). Controlling for chondral lesion, there was no significant interactions for Lysholm (n.s.), Subjective IKDC Form (n.s.), and VAS for pain scores (n.s.). This study demonstrated that an arthroscopic meniscal allograft transplantation without bone plugs improved knee function and symptoms after a total meniscectomy. Improvements were observed independently of the degree of chondral lesion.