Summary

A Systematic review and meta-analysis that evaluates the return to sports rate and time following meniscal allograft transplantation.

Abstract

Introduction

Despite the increase in the use of meniscal allograft transplantation (MAT), controversy still exists regarding the standardized rate and time to return to sports following MAT. The primary aim of this study was to evaluate the return to sports rate and time following (MAT). The secondary outcomes were the level of return to sports, patient-reported outcomes, reoperations, and failures following MAT.

Methods

PubMed, Web of Science, and Embase were searched in June 2020. Eligibility criteria included clinical studies reporting the return to sport rate following MAT with at least 12-month follow-up.

The baseline data items that were collected included: the authors’ surnames, study year, level of evidence, age, sex, number of patients, mean body mass index, laterality (medial or lateral meniscus), activity level, concomitant procedures, follow-up time points. Outcome measures collected were return to sports, the level of return to sports, discontinuation of sports, reoperations, failures, Tegner, Lysholm, subjective international knee documentation committee score, the Western Ontario and McMaster Universities Osteoarthritis Index, Short-form 12, and the Knee Injury and Osteoarthritis Outcome Score.

The quality assessment of the included studies was performed with the use of the National Institutes of Health assessment tool of pre-post uncontrolled studies.

The quantitative synthesis was performed with the use of OpenMetaAnalyst software. The outcomes were estimated with the use of 95% confidence interval (CI). The mean difference (MD) was used for estimating the continuous outcomes. Proportions were utilized for dichotomous outcomes. The outcomes were pooled through using random-effects meta-analysis with the use of the DerSimonian-Laird method.

Results

A total of 14 case series were included with 670 patients. Regarding the qualitative assessment, four studies had a good overall rating., 4 had a moderate overall rating, and 6 had a poor overall rating.

The overall return to sport rate was 76.6% at a mean time of 11.34 months. Of those who returned to play, 62% were able to return to play the same pre-injury level, 34% at a lower level, and 16% at a higher level. Additionally, 39% of patients discontinued at least one sport.

The postoperative Tegner activity score did not return to pre-injury levels. Furthermore, there was a notable improvement in patient-reported functional outcomes that were beyond the minimal clinically important difference.

The total reoperation rate following MAT was 32.2% (148 out of 627 knees). The total failure rate was 19.2% (129 out of 670 knees), which entailed both clinical and surgical failures. The surgical failures consisted of revision MAT, allograft meniscectomy, knee arthroplasty, and failures due to infection. The clinical failures were reported as persistent knee disability leading to discontinuation of sport or work.

Conclusion

This study highlights important findings that should be discussed with patients to tailor their expectations regarding the MAT outcomes. The return to sport rate was 76.6% at a mean follow-up of 11.3 months. Moreover, two-thirds of patients were able to return at the same pre-injury level with clinically significant improvement in all functional outcome measures.