2017 ISAKOS Biennial Congress ePoster #1320

 

Arthroscopic Meniscal Allograft Transplantation Without Bone Plugs: Survival Analysis of 147 Patients

Stefano Zaffagnini, MD, Prof., Bologna ITALY
Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, Bologna ITALY
Alberto Grassi, PhD, Bologna ITALY
Tommaso Bonanzinga, MD, PhD, Rozzano, milano ITALY
Federico Raggi, MD, Bologna ITALY
Tommaso Roberti di Sarsina, MD, Bologna ITALY
Giuseppe Carbone, MD, Bologna ITALY
Alice Bondi, MD, Bologna ITALY
Maria P. Neri, Bologna ITALY
Maurilio Marcacci, MD, Milano, Milano ITALY

Istituto Ortopedico Rizzoli, Bologna, BO, ITALY

FDA Status Not Applicable

Summary

The purpose of this study was to present the results of a survival analysis of our first 147 arthroscopic MAT procedures. The study underlined how in patients with already degenerative changes the MAT should be intended as a way to postpone knee arthroplasty.

Abstract

Introduction

Few medium-term or long-term reports on meniscal allograft transplantation (MAT) are available. The purpose of this study was to present the results of a survival analysis of our first 147 arthroscopic MAT procedures. Study Design and Level of evidence: Therapeutic study, Level IV; retrospective case series of prospectively collected data.

Methods

147 patients (117 males; 30 females) underwent arthroscopic MAT without bone plugs (82 medial MAT, 65 lateral MAT) according to Marcacci et al. [1] They were retrospectively reviewed at a mean of 4.0±1.9 years follow-up. Mean age at surgery was 40.9±11.2 (range 16.7-68.8) years; 70 patients (48%) underwent combined procedures (anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, high tibial osteotomy, distal femoral osteotomy or cartilage treatment). Survival analysis was performed using two endpoints: surgical failure (revision procedure with direct relation to MAT) and clinical failure (revision procedure or Lysholm score =poor” <65).

Results

There was a significant (P < .05) and clinically relevant decrease in the VAS and increase in KOOS and Lysholm from preoperative mean score to postoperative mean score.?Seven (5%) patients (2 medial, 5 lateral) experienced surgical failure (4 meniscetomies, 1 lateral graft peripheral suture, 1 lateral MAT revision, 1 unicompartmental knee arthroplasty). The mean overall survival rate at 2, 4, 6, 8 and 10 years was respectively 96.3%, 95.5%, 95.5%, 83.5% and 83.5%, while survival time was 9.7 years (CI 9.1 - 10.3).
Sixteen (11%) patients (10 medial, 6 lateral) were considered clinical failures. The mean overall survival rate at 2, 4, 6, 8 and 10 years was 95%, 83.9%, 78.8%, 48.2% and 48.2%, while survival time was 8 years (CI 7.1 - 8.8). No statistically significant differences in failures and survival rate were present between medial and lateral MAT, isolated or combined MAT, patients >50 or <50 years old and patients with body mass index 25.

Discussion

Arthroscopic transplantation of a fresh-frozen meniscal allograft without bone plugs can significantly relieve pain and improve function of the knee joint. Survival analysis showed that this beneficial effect remained in approximately 80% of the patients at six years, based on both surgical and clinical failure criteria. However, clinical outcomes start to decline from eight years onward.
This declination could be related to late surgical procedure performed and open the discussion on the early intervention indication after meniscectomy. In patients with already degenerative changes the MAT should be intended as a way to postpone knee arthroplasty.
References:
[1] Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, et al. Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study. Am J Sports Med. 2012;40(2):395-403.