Summary

the result and clinical outcome of two stages MAT and ACL reconstruction was promising with less risk of complications.

Abstract

Purpose

The purpose of this study was to introduce a two stage approach to ACL reconstruction and meniscus allograft transplantation (MAT), using a stepwise technique where patients first undergo MAT and later undergo an ACL reconstruction and compare functional outcomes of this technique to functional outcomes of MAT alone.

Methods

Six patients (mean age, 32.05 ± 9.34; 2 female and 4 male; 6 medial meniscus) undergoing the two stage ACL reconstruction and MAT were compared with 16 patients (mean age, 36.14 ± 6.94; 10 female and 6 male; 8 lateral meniscus and 8 medial meniscus) undergoing MAT alone. Comparison was achieved using three surveys: Western Ontario and McMaster Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC), and the Tegner Lysholm Knee Scoring Scale (Lysholm) evaluated before MAT and at final follow-up.

Results

Both the two stage ACL reconstruction and MAT group and MAT only group displayed statistically significant improvement between the MAT and final follow-up using the WOMAC, IKDC, and Lysholm surveys (P <0.05). The two-stage ACL reconstruction and MAT had worse starting scores on WOMAC (70.83 ± 18.9 vs. 53.69 ± 14.20), IKDC (37.67 ± 5.13 vs. 43.19 ± 9.63), and Lysholm (24.67 ± 14.09 vs. 27.69 ± 20.64). When comparing survey scores from time point one (prior to MAT) and time point two (at final follow-up) separately, the MAT only group showed better functional outcomes for the WOMAC prior to MAT (P = 0.0317), for the WOMAC at final follow-up (P = 0.0329), and for the Lysholm at final follow-up (P = 0.0130). The IKDC survey showed no statistical significance between groups at either time point, along with the Lysholm survey prior to meniscus allograft transplantation. At final follow-up the two-stage ACL reconstruction and MAT group showed a 72% (vs. 83% - MAT only) improvement on the WOMAC, a 54% (vs. 50% - MAT only) improvement on the IKDC, and a 199% (vs. 227% - MAT only ) on the Lysholm when compared to the surveys prior to MAT.

Conclusion

Based on considerable improvement using the WOMAC, IKDC, and Lysholm functional outcome measurements between time points, that were comparable to functional outcomes for patients undergoing MAT alone, it is reasonable to conclude that the two stage ACL reconstruction and MAT is a reasonable procedure. Neither the two stage technique nor MAT alone were associated with major complication or graft failure.