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Securing Transplanted Meniscal Allografts Using Bone Plugs Results In Lower Risks Of Graft Failure


Zachariah Gene Wing Ow, MBBS (Candidate)
SINGAPORE

Securing Transplanted Meniscal Allografts Using Bone Plugs Results In Lower Risks Of Graft Failure

Zachariah Gene Wing Ow, MBBS (Candidate), SINGAPORE Chin Kai Cheong, MBBS (Candidate), SINGAPORE Hao Han Hai, MBBS (Candidate), SINGAPORE Cheng Han Ng, MBBS (Candidate), SINGAPORE Dean Wang, MD, UNITED STATES Aaron J. Krych, MD, UNITED STATES Daniel Saris, MD, PhD, Prof., UNITED STATES Keng Lin Francis Wong, MMed(Orth), MCI (NUS), FRCSEd (Orth), FAMS, PhD, SINGAPORE Heng An Lin, MBBS, FRCSEd(Orth), SINGAPORE

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SINGAPORE

2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Meniscus Medial Lateral

Diagnosis / Condition

Tears

Treatment / Technique

Transplantation Allograft

Sports Medicine

Epidemiology Evidence Based Medicine

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Summary: We performed a meta-analysis comparing the three most predominantly utilized methods of fixation for transplanted meniscal allografts, namely suture-only, bone plug and bone bridge fixation. Bone plug fixated allografts showed decreased risks of graft failure and reoperations.

Background

Meniscus allograft transplantation (MAT) is an important treatment option for young patients with deficient menisci; however, there lacks a consensus on the optimal method of allograft fixation.

Methods

Single-arm meta-analysis of studies reporting graft failure, reoperations and other clinical outcomes following MAT was performed. Studies were stratified by method of fixation, namely suture-only, bone plug and bone bridge techniques. Proportionate rates of failure and reoperation for each fixation technique were pooled with a generalized linear mixed effects model, following which, reconstruction of relative risks with confidence intervals was performed using the Katz-logarithmic method.

Results

A total of 2604 patients underwent MATs. Graft failure rates were noted to be 6.2% (CI: 3.2% to 11.6%) for bone plug fixated allografts, 6.9% (CI: 4.5% to 10.3%) for suture-only fixation, and 9.3% (CI: 6.2% to 13.9%) for the bone bridge group. Transplanted menisci secured using bone plugs as compared to bone bridges displayed a lower risk of graft failure (RR = 0.97; 95% CI: 0.94-0.99; p=0.02), however, risks of failure were neither significantly different when comparing bone bridge to suture fixation (RR = 1.02; 95% CI: 0.99-1.06; p=0.12), nor between bone plug and suture fixation methods (RR = 0.99; 95% CI: 0.96-1.02; p=0.64). Meta-regression was performed for studies reporting failure in the suture-only fixation group, with failure rates being regressed against the meniscus laterality. Patients receiving a medial meniscus allograft transplant, secured by suture fixation, was associated with an increased risk of graft failure (ß = 3.01; SE = 1.27; p=0.02). In terms of the risk of reoperation following MAT procedures, allografts secured using bone plugs were at a lower risk of requiring reoperations as compared to those secured using sutures (RR = 0.91; 95% CI: 0.87-0.95; p<0.0001), while those fixated using bone bridges were observed to have a higher risk of necessitating reoperations when compared to allografts fixated using either sutures (RR = 1.28; 95% CI: 1.19-1.38; p<0.001), or bone plugs (RR = 1.41; 95% CI: 1.32-1.51; p<0.0001).

Conclusion

Transplanted meniscal allografts secured using bone plugs show a lower risk of graft failure as compared to the bone bridge technique, as well as lower risks of needing reoperations than both bone bridge, and suture-only fixation. Hence, with these risk estimates, a case can be made for the use of bone-plug techniques when securing meniscal allograft transplants.

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