Summary

Arthroscopic Meniscal Allograft Transplantation significantly improved clinical outcomes, enabling 71% of patients to resume sports within two years postoperatively, with 75% returning to their pre-injury sports activities, and meniscal extrusion showing no impact on clinical outcomes at midterm follow-up.

Abstract

Introduction

Meniscal Allograft Transplantation (MAT) has shown good to excellent results in up to 85% of cases, with survival rates reaching 95% at 15 years of follow-up. However, data on returning to sports after MAT remains sparse. While some authors reported a 50% return to sports after MAT, others noted rates as high as 92%. Moreover, controversy still exists on whether a return to preinjury sports and high-impact activity levels can be achieved. Another concern after MAT is postoperative meniscal extrusion due to its high incidence, reaching 98% in some series. This study investigates the return to sport, clinical outcomes after MAT, and their correlation with meniscal extrusion.

Methods

We conducted a retrospective analysis of 34 patients who underwent MAT, with or without concomitant procedures, between 2014 and 2021. Pre and postoperative sports participation, and return to sports at the last follow-up were evaluated. The pre and postoperative pain was analysed using the Visual Analog Scale (VAS). Clinical outcomes were assessed using the IKDC and Lysholm questionnaires. The Likert postoperative subjective satisfaction scale and the Range of Joint Mobility (ROM) were determined at the last control. Post-surgical complications were analysed. Meniscal extrusion was evaluated at 6 months postoperatively with a Magnetic Resonance Image (MRI).

Results

Twenty-one men and 7 women with a mean age of 34 years were included. Eighteen MAT were lateral and 10 were medial. The mean follow-up was 4.34 years. Soccer was the most frequently performed activity (64.3%; n=18). Twenty patients (71%) returned to sports at 24 months postoperatively. Of these patients, 75% (n=15) returned to doing the same sport they did before surgery and 46% at the same level. Sport abandonment was due to personal reasons (n=3), being afraid of further damage (n=3) and due to pain during sports (n=2).
The average pre and postoperative pain was 7.96 (±1.07) and 3.14 (±1.92) respectively. IKDC and Lysholm scores improved from 40.78 (±11.72) and 51.17 (±12.91) preoperatively to 70.07 (±12.09) and 78.39 (±15.14) after surgery.
According to the Likert scale, 71% of the patients felt “satisfied” or “very satisfied” with the outcomes. There were 7 postoperative complications (25%): 4 arthrofibrosis and 3 transplant failures that required new arthroscopic surgery. All patients achieved complete ROM at the final follow-up. The incidence of meniscal extrusion was 78.6% (n=22). Medial MAT was associated with more meniscal extrusion than Lateral MAT (p<0.01). Nevertheless, there were no statistically significant differences in clinical outcomes between extruded and non-extruded menisci.

Conclusion

Arthroscopic MAT surgery improved clinical outcomes and allowed sport resumption in 71% of the patients at 2 years postoperatively. Of these patients, 75% returned to the same sporting activities. Meniscal extrusion didn´t seem to interfere with clinical outcomes. This study could provide valuable guidance for managing patient´s expectations regarding sports participation and outcomes after MAT.