Summary

A meta-analysis comparing suture versus bony fixation in Meniscal Allograft Transplantation found no significant differences in clinical outcomes or complications, but highlights the need for long-term studies to assess MAT longevity and its impact on symptom recurrence and arthritic progression.

Abstract

Background

Meniscal Allograft Transplantation (MAT) replaces damaged meniscus tissue with grafts, aiming to restore knee stability and function. The method employed in the fixation of the meniscus graft, suture or bony fixation, has sparked clinical interest and ongoing discussions. The aim of this study was to compare suture fixation with bony fixation of the meniscus graft, with the focus on functional and clinical outcomes.

Methods

Meta-analyses were performed with a multi database search according to PRISMA guidelines on August 15, 2023. Data from published RCTs meeting inclusion criteria was extracted and analysed with an inverse variance statistical model.

Study Design: Meta-analysis and systematic review of randomised controlled trials; Level of evidence, 1.

Findings: A total of 4 studies were included, consisting of 139 suture-fixation and 113 bony-fixation patients. No statistical analysis could be performed for clinical outcomes due to heterogeneity of raw data, but no observable trends were observed from individual studies. Suture and bony fixation showed no statistical significant difference in the risks of infection (RR=1.52; 95% CI: 0.29-7.80, p=0.62), graft failure (RR=0.86; 95% CI: 0.19-3.78, p=0.84), graft tear (RR=1.14; 95% CI: 0.10-13.21, p=0.91), minor graft extrusion (RR=0.77; 95% CI: 0.20-2.92, p=0.70), and major graft extrusion (RR=1.20; 95% CI: 0.28-5.07, p=0.81).

Conclusion

There was no significant difference in clinical outcomes and complications between suture and bony fixation of meniscal grafts. However, the short to medium term follow-up in this meta-analysis prompts the need for studies with long term follow-up, given that MAT longevity is of paramount importance in this patient group to deter symptom recurrence and risk of arthritic progression.