Summary

The objective and subjective results of the present study indicate that combined all-arthroscopic meniscal allograft transplantation with bone-bridge and autologous chondrocyte implantation using chondrospheres is a safe and valid option for the treatment of patients with combined meniscal insufficiency and chondral lesions.

Abstract

Purpose

Meniscectomy has detrimental effects on the knee joint. Meniscal allograft transplantation (MAT) is a salvage procedure to improve function, as well as counteract accelerated articular degeneration. However, it is still unclear whether MAT should be performed in patients with concomitant chondral damage. The purpose of this study was to evaluate clinical outcomes, patient satisfaction, and magnetic resonance imaging after combined MAT and ipsicompartmental autologous chondrocyte implantation (ACI) using chondrospheres in patients with severe meniscal insufficiency and high-grade chondral defects to assess its viability as a biological alternative to arthroplasty. Our hypotheses were that this combined approach would be able to significantly improve outcome measures at a low failure rate even with coexisting chondral damage, and that cartilage lesions should therefore not be a contraindication for MAT.

Methods

This study constitutes a retrospective single-surgeon clinical follow-up study (level of evidence IV). We identified 23 consecutive patients who underwent combined arthroscopic MAT with bone bridge and arthroscopic ACI between 2010 and 2018 and matched the eligibility criteria. The following outcome measures were prospectively obtained both pre- and postoperatively: International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, MOCART score, and visual analog scale for patient satisfaction. The IKDC subjective score was the primary outcome measure and a p value < 0.05 was considered significant. Arithmetic mean and standard deviation were calculated for complete datasets. Pre- and postoperative values were compared with paired t tests.

Results

Twenty-one patients (91.3%) were available for follow-up (13 male, 8 female), including 16 lateral and 5 medial MATs. The mean age was 30.8 ± 9.8 years. The mean chondral defect size was 4.5 ± 2.7 cm2. A kissing lesion was present in 33% of patients. The mean follow-up was 58.2 ± 27.4 months. All clinical outcome measures showed statistically significant improvements. IKDC subjective scores improved from 51.3 ± 16.8 to 73.2 ± 14.1 (p < 0.001). Lysholm scores improved from 61.4 ± 22.1 to 82.3 ± 10.5 (p < 0.001). Visual analog scale for patient satisfaction improved from 2.8 ± 2.3 to 7.5 ± 2.2 (p < 0.001). All KOOS subcategories, KOOS total, and Tegner activity scale also showed statistically significant improvements (p = 0.011). The overall transplant survival rate was 90.5% at final follow-up, with MAT accounting for 100% of failure events. No failures of ACI were observed in our cohort. The most common cause for reoperation was re-suturing of the meniscal allograft, with an overall reoperation rate of 38.1%. The mean MOCART score was 67.5 ± 15.2 and presence of a kissing lesion was indicative of worse postoperative outcomes in our cohort.

Conclusions

These results support the emerging hypothesis that combined MAT and ACI using chondrospheres is a viable and safe option for the treatment of patients with meniscal insufficiency and concomitant chondral damage capable of improving function, reducing symptoms, and increasing patient satisfaction, at acceptable failure and reoperation rates. This indicated that chondral damage should not be a contraindication for MAT.