Summary

This study assessed the long-term outcomes of meniscus allografts in patients older than 50 years of age and found that meniscus transplants in combination with other arthroscopic knee treatments delay knee arthroplasty, improve knee symptoms of pain and improve function in a population over 50 years who are otherwise candidates for knee arthroplasty.

Abstract

Introduction

Although progression from meniscus injury to knee arthroplasty is complex, a critical stage exists between 50 and 70 years of age. One topic of investigation often overlooked is the utility of meniscus allografts in combination with other arthroscopic procedures to delay knee arthroplasty for patients in this age range. The purpuse of this study was to assess the ability of meniscus allografts in combination with other procedures to delay knee arthroplasty in patients older than 50 years of age.

Methods

108 meniscus allograft transplants (MATs) using the arthroscopic three tunnel technique between 1997 and 2019 in patients over 50 years of age and told to have a knee arthroplasty were reviewed. Patient ages ranged from 50 to 69 years of age (mean 55.8). 86 of 108 (79%) patients met eligibility for this case series report. Inclusion criteria were patients told to consider a knee arthroplasty with pain in a meniscectomized compartment with preservation of some joint space by standing AP and PA flexion x-ray. Exclusion criteria was defined as failure to comply with rehabilitation protocol or failure to complete baseline and follow-up research questionnaires. 74 of 86 (86%) patients had Grade III or IV arthritis documented by Outerbridge findings on X-ray and direct observation. 44 of 86 (51%) patients underwent concomitant cartilage repair with the articular cartilage paste graft technique previously reported. International Knee Documentation Committee (IKDC) and Visual Analogue Pain Scale (VAS) were obtained longitudinally throughout the post-operative period. Time from meniscus transplantation to knee arthroplasty was measured with failure of the surgical procedure defined as progression to arthroplasty, no improvement in pain scores, or increased pain.

Results

Over the follow-up range of 2 to 25 years, 41 of 86 (47.6%) patients progressed to revision by arthroplasty, at a mean time of 8.5 years. 68 of 89 (76%) meniscus transplants in patients over 50 delayed joint arthroplasty by a minimum of 8.2 years (8.2-20.6). At the time of reporting, 41 of 86 (47.6%) patients had intact meniscus transplants. Significant improvements (p<0.05) were observed in both pain and function as assessed by VAS and IKDC. These significant improvements were sustained through ten years post-operatively, correlated to a mean age of 65.8 years of age.

Discussion

Meniscus allografts in combination with other arthroscopic knee treatments delay knee arthroplasty, improve knee symptoms of pain and improve function in a population over 50 years who are otherwise candidates for knee arthroplasty. The individual contribution of the meniscus separate from the concomitant procedures cannot be defined.