Summary

The female sex and the need to combine MAT with cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at a mid-term follow-up.

Abstract

Introduction

Meniscus allograft transplantation (MAT) is an effective treatment for relieving symptoms and improving knee functions in patients who experience symptomatic unicompartmental knee pain following a previous meniscectomy. However, in the literature there is a paucity of studies assessing the survival rate and prognostic factors of soft-tissue MAT. The present study aimed to report the survivorship of a large single-center cohort of consecutive patients treated with arthroscopic MAT using soft tissue technique and investigate variables that could potentially influence failures and outcomes.

Methods

364 consecutive MAT performed in a single Institution between June 2004 and April 2019 were screened and assessed for eligibility. Subjective clinical scores (Lysholm score, Tegner Activity Scale and VAS) were collected pre-operatively and at 2 years, 5 years, 7 years and 10 years follow-up. Two survival analyses were performed using the Kaplan–Meier curves with (SF) surgical failure and (CF) clinical failure as endpoints. In addition, univariate analyses were performed using reoperations, surgical failure and clinical failure as endpoints, and different demographic and surgical characteristics as endpoints.

Results

324 consecutive patients were evaluated at a mean follow-up 5.7 ± 3.0 years. Of them, 189 (58%) underwent an associated surgical procedure. A total of 22 patients (6.8%) were considered Surgical Failures. A significant improvement of all the PROMs was present between the pre-operative status and the last follow-up (p<0.001) with no significant decrease over time. Moreover, 70 (21.6%) patients were considered Clinical Failure: the need for concomitant Cartilage procedures (OR=0.16, p=0.001) or ACL reconstruction (OR=0.40; p=0.059) were predictors of failure. Finally, a lower survival rate was reported in Females (p=0.007) and in patients who required cartilage surgery (p=0.014). In particular, the latter group showed nearly half the survival rate with respect to those with no cartilage procedures at 10-year follow-up (36.4% vs. 71%, p=0.029).

Discussion And Conclusion

The female sex and the need to combine MAT with cartilage procedure or ACL reconstruction could result in an increased rate of clinical failure at a mid-term follow-up. The present study results help the surgeon correctly set patients’ expectations regarding MAT survival and clinical failures. In particular females and patients with focal cartilage defects have nearly half the survival rate at long-term follow-up.