Summary

Factors such as age, sex and laterality of transplant should be strongly considered when conducting surgical planning for patients eligible for MAT to better understand risks and potential outcomes of the procedure.

Abstract

Introduction

Meniscus insufficiency in young patients occurs following recurrent or irreparable tears. In such cases, meniscus allograft transplantation (MAT) is performed to protect joint integrity and prevent subsequent acceleration of arthritic changes. There is limited information on the outcomes of such procedures in an adolescent and young adult population. The purpose of this study was to retrospectively examine patients who underwent MAT at a single children’s hospital and describe their baseline characteristics and outcomes.

Methods

We performed a retrospective chart review for all patients who underwent primary MAT at a single children’s hospital between 2015 and 2022. Demographic information and surgical characteristics of all eligible patients were included. The primary outcomes were presence of postoperative complications, reoperation, and graft failure. A logistic regression analysis was performed considering age, sex, affected compartment, discoid meniscus, malalignment, chondral lesion, and concomitant procedure, as risk factors for postoperative complications and re-operation. A subgroup analysis was performed considering only patients who were 18 years old or younger.

Results

Forty-eight primary MAT in 47 patients were included in this study. The mean age at time of surgery was 17.15 years, and 54% were females. Half of cases had knee sports related injuries, and 31% had a discoid meniscus. Malalignment was documented in 7 patients (15%). Chondral lesions were found in 30 patients (63%), 90% of chondral lesions were found in the same compartment in which the MAT was performed. Concomitant procedures were performed in 20 patients (42%). Postoperative complications were reported in 26 patients (54%). Re-operation was reported in 13 patients (27%), with mean time to re-operation of 286.92 days. Logistic regression analysis showed that female sex and concomitant procedures significantly increased the risk of postoperative complications, and older age, female sex and lateral MAT significantly increased the risk of re-operation. Subgroup analysis of 33 patients aged =18 years at the time of surgery revealed similar findings to those reported in the full patient analysis.

Conclusion

The MAT is an efficient procedure aimed to help preserve joint integrity and can improve function and symptoms in patients with meniscal insufficiency, but it is not without complications. More than 50% of patients in our cohort experienced postoperative complications and 27% required re-operation. Individuals of the female sex with concomitant procedures undergoing MAT have increased risk for postoperative complications. Further, increased age, female sex and lateral MAT also significantly increased the risk of re-operation. These factors should be strongly considered when conducting surgical planning for patients eligible for MAT to better understand risks and potential outcomes of the procedure.