Outcomes Of Meniscal Allograft Transplantation Research Articles

Outcome comparison of meniscal allograft transplantation (MAT) and meniscal scaffold implantation (MSI): A systematic review.

Although numerous studies have reported successful clinical outcomes of Meniscal allograft transplantation (MAT) or Meniscal scaffold implantation (MSI), the difference between the outcome of MAT and MSI remains unclear. To compare the overall outcomes and survival rates of MAT and MSI, aiming to provide comprehensive evidence for determining the optimal treatment strategy for meniscal defects. A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of MAT or MSI were included according to the inclusion and exclusion criteria. The Lysholm score was chosen as the primary outcome measure, while secondary outcomes encompassed Patient-reported Outcome Measures (PROMs), Return to Sports (RTS) rates, survival rates, and complication rates. The outcomes were stratified into two groups: MAT group and MSI group, followed by statistical comparison (P<0.05). The quality of the included studies was assessed by the Cochrane Risk of Bias 2 (RoB2) assessment tool for randomized controlled trials (RCTs) and the Coleman Methodology Score (CMS) for non-randomized controlled trials. A total of 3932 patients (2859 MAT, 1073 MSI) in 83 studies (51 MAT, 32 MSI) had the overall significant improvement in all clinical scores. The group MSI had higher Lysholm score of both preoperative (P=0.002) and postoperative (P<0.001) than group MAT; however, the mean improvements were similar between the two groups (P=0.105). Additionally, MSI had higher improvements of IKDC (P<0.001), KOOS symptom (P=0.010), KOOS pain (P=0.036), and KOOS ADL (P=0.004) than MAT. Interestingly, MAT had higher preoperative (P=0.018) and less postoperative VAS pain (P=0.006), which was more improved in MAT (P<0.001). Compared with MAT, MSI had higher 10-year survival rate (P=0.034), similar mid-term survival rate MAT (P=0.964), and lower complication rate (P<0.001). Both MAT and MSI could have good clinical outcomes after surgery with the similar improvement in Lysholm score. MSI had higher 10-year survival rate and less complications than MAT. IV, systematic review.

Meniscal allograft transplantation improves patient-reported outcomes in both minimal and moderate knee osteoarthritis at 1 and 2 years postoperatively

PurposeSevere cartilage damage and advanced knee osteoarthritis (OA) might be associated with poor outcomes of meniscal allograft transplantation (MAT). The purpose of this prospective follow-up study was to explore MAT survivorship and patient satisfaction among young patients with symptomatic meniscal deficiency and radiological OA of different Kellgren–Lawrence (K–L) grades.MethodsThirty-five consecutive MAT patients were prospectively followed up for 2 years. The lateral meniscus was replaced in 29 patients and the medial meniscus in 6 patients. Outcomes were assessed using the KOOS4 composite score, KOOS subscales, Lysholm knee score, and OA K–L grade progression from weight-bearing knee radiographs. For the outcome analysis, patients were categorized into two groups: 19 in Group A (K–L classification 0–1) and 16 in Group B (K–L classification 2).ResultsIn terms of KOOS4 and Lysholm scores, the patients showed a clinically significant improvement from baseline to the 1-year follow-up (22.2 points, 95% CI 16.6–27.8 for KOOS4 and 16.8 points, 95% CI 8.9–24.6 for Lysholm), and the improvement remained at 2 years (20.6 points, 95% CI 13.2–28.1 for KOOS4 and 21.5, 95% CI 12.5–30.7 for Lysholm). At the 6-month follow-up, this improvement was not yet observed. Minor between-group differences were observed in the KOOS4 and Lysholm scores for the K–L 0–1 and K–L 2 OA groups, but the estimates were imprecise with wide confidence intervals. A clinically relevant difference between these two study groups could not be found at any timepoint. The reoperation rate was higher in the K–L 2 group than in the K–L 0–1 group (31% vs. 11%).ConclusionsMAT yielded improved patient-reported outcomes and subjective satisfaction at 1 and 2 years postoperatively. The differences from baseline exceeded the minimal clinically important difference (MCID) at all timepoints. The severity of cartilage damage and knee OA in terms of the K–L grade at the time of surgery did not affect the KOOS and Lysholm scores after the MAT procedure. Knee OA progression in terms of K–L grade worsening was not observed in any patients.Level of evidenceIII.

MENISCAL ALLOGRAFT TRANSPLANTATION COMBINED WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A SYSTEMATIC REVIEW.

To evaluate the clinical and functional outcomes of meniscal allograft transplantation (MAT) with anterior cruciate ligament reconstruction (ACLR) in a single surgical stage through a systematic review of the currently available evidence. A systematic search of the PubMed and Google Scholar databases, with no publication date limit, until December 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Follow-up studies and case series published in English involving patients undergoing a combination of ACLR and MAT were included. The quality of these studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. A systematic review of the International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores was conducted. Seven studies involving 154 patients were included. The mean follow-up was 5,3 years. The mean age at the time of the surgery was of 35.3 years. All studies used the Lysholm Knee score, IKDC score or Tegner activity score to measure clinical outcomes post-operatively and the mean improvements were 26.7, 24.7, and 1.8 respectively. The rate to return to sport was 75.5 %. No intra-operative complications were reported. The post-operative complication rate was 11.6%. MAT combined with ACLR procedure showed good clinical results up to an average of 5 years of follow-up. More studies need to be conducted that can better understand the long-term effects of this combined procedure.

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Clinical Outcomes of Meniscal Allograft Transplantation With Respect to the Minimal Clinically Important Difference

Background: Arthroscopic-assisted meniscal allograft transplantation (MAT) has become a viable and effective treatment option for young active patients with postmeniscectomy pain. The minimal clinically important difference (MCID) of patient-reported outcome measures (PROMs) is imperative to evaluate the clinical significance of surgical interventions and inform clinical practice guidelines in orthopaedic surgery. Purpose: To perform a systematic review of clinical outcome studies of patients undergoing MAT and compare postoperative improvement with established MCID thresholds. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Web of Science, and Cochrane Library databases. A meta-analysis was performed using data obtained from studies reporting patient-reported outcomes. Subgroup analysis was performed on patients undergoing isolated lateral MAT using fresh-frozen grafts. Weighted mean postoperative improvements in the International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale for pain (VAS pain) were calculated and compared with MCID values to determine if they met the MCID threshold. Results: A total of 35 studies were identified, including 1658 unique patients. Weighted mean postoperative score improvements exceeded MCID thresholds for the VAS pain, IKDC, and Lysholm. Subgroup analysis of patients undergoing isolated lateral fresh-frozen MAT demonstrated postoperative improvements exceeding the MCID for the Lysholm and VAS pain. Conclusion: Evaluating postoperative PROMs with respect to the MCID is crucial to evaluate the effect of MAT on functional improvement. The results of the present meta-analysis suggest that postoperative improvements after MAT are clinically meaningful as reflected by PROMs exceeding the MCID threshold for the IKDC, Lysholm, and VAS pain.

Do Outcomes of Meniscal Allograft Transplantation Differ Based on Age and Sex? A Comparative Group Analysis

To analyze the effect of patient age, sex, and associated preoperative factors on patient-reported outcome (PRO) measures and graft survival following primary meniscal allograft transplantation (MAT). A prospectively collected database was retrospectively reviewed to identify patients who underwent primary MAT with a minimum of 2 years of follow up between 1999 and 2017. Demographic, intraoperative, and postoperative outcome data were collected for each patient. Postoperative outcomes were stratified based on age and sex, and comparative statistical analysis was performed between sexes, both >40 and <40. A total of 238 patients underwent primary MAT during the study period, of which 212 patients (mean age, 28.5 ± 9.0 years; range, 15.01-53.67 years) met the inclusion criteria with a mean follow-up of 5.1 ± 3.4 years (range 2.0-15.9 years). At final follow-up, patients ≥40 and <40 years of age demonstrated statistically significant improvements in nearly all PRO scores (P < .05 for both groups). There were no significant differences between either group for achievement of minimal clinically important difference for International Knee Documentation Committee (P= .48) or Knee Injury and Osteoarthritis Outcome Score symptoms (P= .76). Because of insufficient numbers, a statistically significant difference could not be demonstrated in reoperation rate (≥40: 1.49 ± 1.77 years, <40: 1.87 ± 1.98 years, P= .591), failure rate (≥40: 7/32 [21.9%], <40: 19/180 [10.6%], P= .072), or complication rate (≥40: 2/32 [6.3%], <40: 12/180 [6.7%], P= .930) based on age. Both sexes showed a significant improvement in PROs, whereas female patients were more likely to undergo revision surgery (P= .033), with no significant differences based on time to reoperation, failure, or complication rates. PROs similarly improved following MAT in both patients aged ≥40 and those <40 at final follow-up with no significant differences in minimal clinically important difference achievement rate, complication rate, reoperation rate, time to reoperation, or failure rate between groups. Female patients may be more likely to undergo revision surgery after MAT. III; therapeutic retrospective comparison study.

Does Age Itself Have an Adverse Effect on Survivorship of Meniscal Allograft Transplantation? A Cartilage Status and Time From Previous Meniscectomy–Matched Cohort Study

Background: The aging process is accompanied by several conditions that could affect the outcome of meniscal allograft transplantation (MAT). These conditions have made it difficult for clinicians to determine the effect of chronologic age on survivorship after MAT. Hypothesis: Advanced age does not have an adverse effect on survivorship of MAT when controlling for age-related factors, such as cartilage status and time from previous meniscectomy. Study Design: Cohort study; Level of evidence, 3. Methods: The records of 264 consecutive patients who underwent primary medial or lateral MAT were reviewed. To check whether there was a difference in MAT survivorship according to age, a cutoff value was calculated from a time-dependent receiver operating characteristic curve. Survival rates, as well as clinical improvement as determined using the Lysholm score, were compared between groups divided by the cutoff value. Patients were matched for cartilage status and elapsed time from previous meniscectomy. Differences in survivorship and clinical outcomes were assessed between the matched groups. Results: A time-dependent receiver operating characteristic curve showed that the difference in MAT survivorship was maximized with a cutoff age of 43 years. Kaplan-Meier analysis showed a significant difference in MAT survivorship between the older and younger groups (log-rank test, P = .01). However, after matching for cartilage status and time from previous meniscectomy, which left 56 patients per group, there was no significant difference in MAT survivorship (log-rank test, P = .10) between the groups. Regarding clinical outcomes, the mean Lysholm scores were not significantly different between the older and younger groups (P = .19, before matching; P = .39, after matching). Conclusion: MAT survivorship was more affected by age-related prognostic factors, such as cartilage status and time from previous meniscectomy, than age itself. Clinical outcomes did not show differences according to age, either.

Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study.

The purpose of this study was to analyze the effect of obesity and other clinical factors on the outcome of meniscal allograft transplantation (MAT) with transosseous fixation. A retrospective cohort study was performed on patients who underwent a MAT between 2002 and 2017. All the participants had a minimum follow-up period of 24 months. The variables assessed were age at the time of the transplant, side, sex, transplanted meniscus (lateral/medial), body mass index (BMI), smoking status, and previous surgeries. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) test outcomes, and patient satisfaction were recorded. Image assessment was performed using plain standing X-rays and a follow-up magnetic resonance imaging scan. Thirty-five patients fulfilled the inclusion criteria. The mean follow-up time was of 75.7 standard deviation (SD) 43.4 months. Patients with a BMI ≥ 30 underwent medial meniscal transplants (88.9 vs. 42.3%, p = 0.022, respectively) more frequently. Obese patients had a significantly lower IKDC (48.6 SD 19.9 vs. 61.7 SD 13.1, p = 0.038, power: 57.5%) and Lysholm (60.3 SD 19.2 vs. 79.4 SD 14.3, p = 0.004, power: 88.7%) scores compared with nonobese patients. The satisfaction and Tegner scores were also lower in obese patients (55.6 vs. 80.7%, p = 0.136, and 2.8 SD 1.0 vs. 4.0 SD 1.9, p = 0.104, respectively); however, these differences were not statistically significant. Obese patients had higher rates of meniscal transplant failure compared with nonobese patients (adjusted hazard ratio: 11.8 [95% confidence interval: 1.5-91.4]). No differences were observed between obese and nonobese patients regarding age, sex, side, smoking status, and follow-up time. In this study, a BMI ≥ 30 kg/m2 resulted in higher MAT failure rates. Nonobese patients had better knee functional results compared with obese individuals.

The International Knee Documentation Committee Score Indicates Midterm Patient Satisfaction with Outcomes after Meniscal Allograft Transplantation.

Background:This study aimed to identify the factors associated with patient satisfaction with the outcome of meniscal allograft transplantation (MAT).Materials and Methods:Patients treated with MAT from March 2006 to May 2009 were asked to complete a five-point Likert scale regarding satisfaction with the outcome of MAT, in addition to the following subjective outcome evaluation forms: the International Knee Documentation Committee (IKDC) subjective forms, Knee Society Score knee and function forms, and Lysholm Knee Scoring Scale. We collected radiologic data using X-ray and magnetic resonance imaging and assessed isokinetic muscle strength test using the Biodex System 3. We investigated whether these parameters were significantly associated with patient satisfaction. Statistical analysis was computed using univariate and multivariable logistic regression.Results:Among the 130 patients who underwent MAT, 49 participated in the interview and were included in this study. The mean followup period was 50.4 months. Mean patient age was 40 (±9) years; 33 were male and 16 were female (33%). The lateral meniscus was transplanted in 13 (27%) patients, while the medial meniscus was involved in 36 (73%) patients. On univariate analysis, sex and isokinetic extension strength deficit at 60° and 180° as well as the IKDC, Knee Society, and Lysholm scores showed significant association with patient satisfaction regarding the outcome. On multivariable logistic regression, only the IKDC score showed a significant association, with P = 0.04.Conclusions:The study results support the importance of patient-reported subjective outcomes in terms of patient satisfaction following a surgical procedure. Regarding MAT, the IKDC outcome score reflects patient satisfaction.Level of evidence:Level III.

Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up

ObjectiveTo evaluate the clinical and radiologic outcomes of meniscal allograft transplantation (MAT) using a modified bone plug technique.MethodsWe conducted a retrospective single-center study of 73 patients who underwent MAT between January 2007 and December 2013. The International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score, visual analogue scale (VAS), and physical examinations were retrospectively reviewed to measure clinical outcomes after MAT, and questionnaires regarding activity and factors were analyzed. Magnetic resonance imaging (MRI) was used to assess the cartilage status and meniscal extrusion.ResultsThe mean follow-up was 37 months for 61 patients (65 knees), and 12 patients were lost to follow-up. The mean meniscal extrusion was 3.39 ± 0.90 mm, the relative percentage of extrusion (RPE) was 34.82% ± 12.71%, and arthrosis progression was observed in 8 of 61 cases (13.1%). The mean results for VAS, IKDC, and Lysholm scores were significantly improved after MAT (P < 0.05), but there were no significant differences in the range of motion or Tegner score (P > 0.05). Thirty-eight (62.3%) patients were able to return to their previous level of activity, and 23 (37.7%) patients reached a mean 76.7% of the previous level of activity. Of the 23 patients reporting a decrease in activity, 10 reported a fear of reinjury as the primary factor limiting activity. The patient satisfaction rate in the study was 78.7%.ConclusionOur modified bone plug method with anatomical meniscal root reinsertion was an effective surgical method, and the majority of active patients with meniscal disorders returned to preinjury levels of activity.

Clinical Outcomes of Meniscal Allograft Transplantation With or Without Other Procedures: A Systematic Review and Meta-analysis

Background: While additional procedures correcting accompanying pathological conditions can improve the clinical outcomes of meniscal allograft transplantation (MAT), whether those outcomes are comparable or poorer than those of isolated MAT has yet to be clarified. Purpose: To evaluate whether there is a difference in clinical outcomes between isolated MAT and MAT combined with other procedures (combined MAT). Study Design: Meta-analysis and systematic review. Methods: For the comparison of clinical outcomes between isolated MAT and combined MAT, the authors searched MEDLINE, Embase, and the Cochrane Library. Studies that separately reported the clinical outcomes of isolated MAT and combined MAT were included. Clinical outcomes were evaluated in terms of patient-reported outcomes (PROs) and complication, reoperation, survivorship, and failure rates. We conducted a meta-analysis of the PROs that were used in more than 3 studies. Results: A total of 24 studies were included in this study. In the meta-analysis, no significant differences in Lysholm scores (95% CI, –5.92 to 1.55; P = .25), Tegner activity scores (95% CI, –0.54 to 0.22; P = .41), International Knee Documentation Committee subjective scores (95% CI, –5.67 to 3.37; P = .62), and visual analog scale scores (95% CI, –0.15 to 0.94; P = .16) were observed between isolated MAT and combined MAT. For PROs that were not included in the meta-analysis, most studies reported no significant difference between the 2 groups. As for the survivorship and failure rates, studies showed varying outcomes. Four studies reported that additional procedures did not affect MAT failure or survivorship. However, 3 studies reported that ligament surgery, realignment osteotomy, and osteochondral autograft transfer were risk factors of failure. One study reported that the medial MAT group in which high tibial osteotomy was performed showed a higher survival rate than the isolated medial MAT group. Conclusion: Overall, there seems to be no significant difference between the postoperative PROs in terms of isolated MAT and combined MAT. However, more data are required to verify the effects of osteotomy and cartilage procedures on the clinical outcomes of MAT. We could not draw conclusions about the differences in complication, reoperation, survivorship, and failure rates between the 2 groups because we did not obtain sufficient data.

Survivorship of Meniscal Allograft Transplantation in an Athletic Patient Population

Background: There are limited data evaluating the clinical outcomes of meniscal allograft transplantation (MAT) in physically active cohorts. Purpose: To determine the survivorship, complication rates, and functional outcomes of MAT in an active military population. Study Design: Case series; Level of evidence, 4. Methods: All military patients undergoing MAT between 2007 and 2013 were identified from the Military Health System. Previous/concomitant procedures, perioperative complications, reoperation rate, revision, and initiation of medical discharge for persistent knee disability were recorded. Univariate analysis was performed to identify associations between patient-based and surgical variables on selected endpoints. Results: A total of 230 MATs (227 patients; 228 knees) were identified; the mean patient age was 27.2 years (range, 18-46 years), and the cohort was predominately male (89%). Approximately half (51%) of the patients had undergone prior, nonmeniscal knee procedures. Medial MATs were performed in 160 (69%) cases, and isolated MATs were most common (60%). A total of 51 complications occurred in 46 (21.1%) patients, including a secondary tear or extrusion (9%). At a mean clinical follow-up of 2.14 years, 10 (4.4%) patients required secondary meniscal debridement, while 1 (0.4%) patient required revision MAT and 2 (0.9%) patients underwent total knee arthroplasty. After MAT, 50 (22%) patients underwent knee-related military discharge at a mean of 2.49 years postoperatively. Tobacco use (P = .028) was associated with significantly increased risk of failure, and operation by fellowship-trained surgeons trended toward significance as a protective factor (P = .078). Furthermore, high-volume surgeons (≥1 MAT/year; range, 9-35) had significantly reduced rates of failure (P = .046). Conclusion: While reporting low reoperation and revision rates, this investigation indicates that 22% of patients with MAT were unable to return to military duty due to persistent knee limitations at short-term follow-up. Increased surgical experience may decrease rates of failure after MAT. Careful patient selection and referral to subspecialty-trained, higher-volume surgeons should be considered to optimize clinical outcomes after MAT.

Outcomes of Meniscal Allograft Transplantation in the Pediatric Athlete

Objectives:Meniscal allograft transplantation (MAT) has a successful clinical track record in adults. The results of MAT in children have not been reported. The goal of this study was to report the results of MAT with minimum 2-year follow-up in this unique population.Methods:After IRB approval, all patients under the age of 16 undergoing MAT between 1999 and 2011 and having > 2 year clinical follow-up were identified from a prospectively collected database. Demographic data including age, height, weight, BMI and prior surgery were collected. Functional outcome scores were collected pre-operatively and at 6 months, 1 year, 2 years and final follow up. Differences between scores at each time point were compared using a mixed model repeated measures ANOVA. All re-operations were documented.Results:17 patients met inclusion criteria. Mean age was 14.9 +/- 1.4 years (range 11 - 16). 10/17 patients had undergone prior knee surgery. 59% were female and 41% were male. The average BMI was 23.4 +/- 5.9. Concomitant procedures included 7 ACI, 1 ACI biopsy and one ACL reconstruction. All patients were available for follow-up at an average of 38 +/- 30 months (range 24 - 122). Surgery resulted in significant improvements in KOOS pain, KOOS ADL, KOOS sport and KOOS QOL scores (Figure 1). Similar improvements were seen in Lysholm, IKDC subjective, WOMAC pain, WOMAC function, and SF-12 physical scores. 3/17 (18%) patients underwent subsequent surgical intervention, however only one (6%) required a graft meniscectomy. One patient required a plica excision, and the other a combined ACL reconstruction and ACI. No complications were found in this population.Conclusion:MAT results in predictable improvements in functional outcomes in the pediatric athlete. Most of these improvements were sustained at an average follow up of 38 months. The meniscal re-operation rate was low (6%) and no complications were reported.

Restoration of the anatomic position during a meniscal allograft transplantation using pre-existing landmarks.

Accurate sizing and positioning of a meniscal allograft is an important factor for successful outcomes of meniscal allograft transplantation. The objectives of this study were (1) to search a proper rotational landmark, (2) to determine the sagittal slope of meniscus, and, thus (3) to determine the meniscal positioning. A total of 121 consecutive patients who underwent magnetic resonance imaging in the 3months prior to the beginning of the study were selected. To assess the meniscal rotation, rotation 0° line of the meniscus was defined as a line connecting the center of the anterior and the posterior horn of the medial and lateral meniscus, respectively. At this level, four possible reference lines were compared: Akagi line, line perpendicular to the largest mediolateral dimension (LMLD), line between the medial border of the patellar tendon and the apex of the medial tibial spine (PTMS), and line between the lateral border of the patellar tendon and the apex of the lateral tibial spine. To assess the meniscal slope, the slope of the insertional area, meniscal and bony slopes at the mid-plateau area were compared. Akagi line was significantly different with a true meniscal rotation (line connecting between centers of the anterior and posterior horns) in both medial and lateral meniscus (p<0.01 and p<0.01). LMLD was significantly different in the lateral meniscus (p<0.01), however, no statistical difference was observed in the medial meniscus (n.s.). PTMS was not different in the medial meniscus (n.s.), however, it was different in the lateral meniscus (p<0.01). On the medial side, significant statistical difference was observed between insertional and bony slope (p<0.01) and between meniscal and bony slope (p<0.01). On the lateral side, comparison of three slopes showed significant statistical differences (p<0.01-p=0.03). Line between patellar tendon and tibial spine was a good reference line for a meniscal rotation in the medial meniscus. Among previously introduced reference lines, LMLD showed approximity with a true meniscal rotation. The slope between tibial insertion and mid-portion was significantly different in the lateral meniscus.

Reducing the Size of the Meniscal Allograft Decreases the Percentage of Extrusion After Meniscal Allograft Transplantation

The purpose was to evaluate the amount of extrusion and clinical and radiographic outcomes of meniscal allograft transplantation (MAT) after use of a modified Pollard method to measure the size of the meniscus. We analyzed 36 patients who underwent MAT between September 2002 and June 2008. Eighteen patients had preoperative allograft sizing by the conventional Pollard sizing method, and the other 18 had the size measured by our modified method, reducing the total size of the graft by 5% from the Pollard method. The mean follow-up period was 31.4 months (range, 24 to 36 months). We compared the absolute amount of extrusion and the relative percentage of extrusion between the 2 groups. We also compared the Lysholm knee score, amount of joint space narrowing on radiographs, and Kellgren-Lawrence grade. The absolute amount of extrusion did not differ significantly between the 2 groups. However, the mean relative percentage of extrusion was lower in the modified Pollard group (P = .037). The mean Lysholm knee score increased in all patients, but there was no significant difference between the 2 groups. There was no significant difference in terms of radiographic outcomes. Reducing the graft size by 5% from the Pollard method decreases the percentage of meniscal extrusion after MAT without any adverse outcome clinically or radiographically. Level III, retrospective comparative study.

Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials

since the first meniscal allograft transplantation in 1984, thousands of patients with postmeniscectomy symptoms have been treated by allograft replacement. This study aims the collection, presentation and meta-analysis of published trials reporting outcomes of meniscal allograft transplantation to establish its safety and reproducibility. a literature search was conducted and the abstracts of all English-language trials with a more than 6 months' clinical, radiological and/or histological follow-up in human subjects were reviewed. Forty-four trials representing 1,136 grafts in 1,068 patients were analyzed. To assess the methodological quality of the collected data, original and modified Coleman methodology scores were determined for all included papers. the outcomes of 678 medial and 458 lateral grafts in 613 male, 265 female and 190 nondefined patients with a mean age of 34.8 years were presented. The outcome was assessed using 12 scoring systems, 4 imaging modalities, second-look arthroscopy and/or histological analysis. Whatever the follow-up period and the scoring system used, patients continuously showed clinical improvement. The average original Coleman scores were 45.9 ± 8.4 (range 25-59). The average modified Coleman scores were 43.7 ± 9.1 (range 24-62). all studies reported a continuously satisfactory outcome with restoration of working capacity in these active patients. The complication and failure rates are considered acceptable by all authors. Salvage procedures included osteotomy and arthroplasty without secondary difficulties. Meniscal allograft transplantation can be considered as safe and reliable for the treatment of refractory postmeniscectomy symptoms in selected patients. IV.