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Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The primary objective of this study was to perform an updated systematic review and meta-analysis of meniscal allograft transplantation using patient reported outcome measures at final follow-up as the outcome tool. The secondary objective was to provide an up to date review of the indications, associated procedures, operative technique, rehabilitation, failures, complications, radiological outcomes, and graft healing.

Methods

Medline, Embase and CENTRAL databases, trials registries, and Web-of Science were searched for studies using pre-defined eligibility criteria. Included studies were reviewed with Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores, failures and complications pooled. Studies were also qualitatively assessed.

Results

There were 1,332 patients (1,374 knees) in 35 studies eligible for analysis. The mean follow-up was 5.1 years. Across all studies, Lysholm scores improved from 55.7 to 81.3, IKDC scores from 47.0 to 70.0, and Tegner activity scores from 3.1 to 4.7 between pre-operative and final follow-up assessments, respectively. The mean failure rate across all studies was 10.6 % at 4.8 years, and complication rate was 13.9 % at 4.7 years. There is a high risk of bias across the studies due to study design and missing outcomes.

Conclusion

Based on current evidence, meniscal allograft transplantation appears to be an effective intervention for patients with a symptomatic meniscal deficient knee. This should ideally be confirmed with a randomised controlled trial. There is not currently enough evidence to determine whether it is chondroprotective.

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References

  1. Abat F, Gelber PE, Erquicia JI, Pelfort X, Gonzalez-Lucena G, Monllau JC (2012) Suture-only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation. Am J Sports Med 40(7):1591–1596

    Article  PubMed  Google Scholar 

  2. Alentorn-Geli E, Vazquez RS, Diaz PA, Cusco X, Cugat R (2010) Arthroscopic meniscal transplants in soccer players: outcomes at 2- to 5-year follow-up. Clin J Sport Med 20(5):340–343

    Article  PubMed  Google Scholar 

  3. Baker P, Peckham A, Pupparo F, Sanborn J (1985) Review of meniscal injury and associated sports. Am J Sports Med 13:1–4

    Article  CAS  PubMed  Google Scholar 

  4. Bhosale AM, Myint P, Roberts S, Menage J, Harrison P, Ashton B, Smith T, McCall I, Richardson JB (2007) Combined autologous chondrocyte implantation and allogenic meniscus transplantation: a biological knee replacement. Knee 14(5):361–368

    Article  CAS  PubMed  Google Scholar 

  5. Binnet MS, Akan B, Kaya A (2012) Lyophilised medial meniscus transplantations in ACL-deficient knees: a 19-year follow-up. Knee Surg Sports Traumatol Arthrosc 20(1):109–113

    Article  PubMed  Google Scholar 

  6. Cameron JC, Saha S (1997) Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res 337:164–171

    Article  PubMed  Google Scholar 

  7. Carter T, Rabago M (2012) Meniscal allograft transplantation: 10 year follow-up. Arthroscopy 1:e17–e18

    Article  Google Scholar 

  8. Chalmers PN, Karas V, Sherman SL, Cole BJ (2013) Return to high-level sport after meniscal allograft transplantation. Arthroscopy 29(3):539–544

    Article  PubMed  Google Scholar 

  9. Chan AW (2012) Out of sight but not out of mind: how to search for unpublished clinical trial evidence. Br Med J 344:d8013

    Article  Google Scholar 

  10. Cole BJ, Dennis MG, Lee SJ, Nho SJ, Kalsi RS, Hayden JK, Verma NN (2006) Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Am J Sports Med 34(6):919–927

    Article  PubMed  Google Scholar 

  11. Crook TB, Ardolino A, Williams LA, Barlow IW (2009) Meniscal allograft transplantation: a review of the current literature. Ann R Coll Surg Engl 91(5):361–365

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Elattar M, Dhollander A, Verdonk R, Almqvist K, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19(2):147–157

    Article  PubMed  Google Scholar 

  13. Farr J, Rawal A, Marberry KM (2007) Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year follow-up. Am J Sports Med 35(9):1459–1466

    Article  PubMed  Google Scholar 

  14. Gomoll AH, Kang RW, Chen AL, Cole BJ (2009) Triad of cartilage restoration for unicompartmental arthritis treatment in young patients: meniscus allograft transplantation, cartilage repair and osteotomy. J Knee Surg 22(2):137–141

    Article  PubMed  Google Scholar 

  15. Gonzlez-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC (2010) Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients. Arthroscopy 26(12):1633–1640+e1214

    Article  Google Scholar 

  16. Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG (2010) Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. Am J Sports Med 38(12):2448–2455

    Article  PubMed  Google Scholar 

  17. Hambly K, Griva K (2008) IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? Am J Sports Med 36(9):1695–1704

    Article  PubMed  Google Scholar 

  18. Hardy PP, Roumazeille T, Klouche S, Rousselin B, Bongiorno V, Graveleau N, Billot N, Pansard E (2013) Arthroscopic meniscal allograft transplantation without bone blocks: evaluation with mr-arthrography. In: 9th biennial congress of the international society of arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine Toronto, Canada, 12–16 May 2013

  19. Hergan D, Thut D, Sherman O, Day MS (2011) Meniscal allograft transplantation. Arthroscopy 27(1):101–112

    Article  PubMed  Google Scholar 

  20. Higgins L, Taylor M, Park D, Ghodadra N, Marchant M, Pietrobon R, Cook C (2007) Reliability and validity of the International Knee Documentation Committee (IKDC) subjective knee form. Joint Bone Spine 74(6):594–599

    Article  PubMed  Google Scholar 

  21. Hommen JP, Applegate GR, Del Pizzo W (2007) Meniscus allograft transplantation: ten-year results of cryopreserved allografts. Arthroscopy 23(4):388–393

    Article  PubMed  Google Scholar 

  22. Hunt S, Kaplan K, Ishak C, Kummer FJ, Meislin R (2008) Bone plug versus suture fixation of the posterior horn in medial meniscal allograft transplantation: a biomechanical study. Bull NYU Hosp Jt Dis 66(1):22–26

    PubMed  Google Scholar 

  23. Huston P, Moher D (1996) Redundancy, disaggregation, and the integrity of medical research. Lancet 347(9007):1024–1026

    Article  CAS  PubMed  Google Scholar 

  24. Jang SH, Kim JG, Ha JG, Shim JC (2011) Reducing the size of the meniscal allograft decreases the percentage of extrusion after meniscal allograft transplantation. Arthroscopy 27(7):914–922

    Article  PubMed  Google Scholar 

  25. Kim J-M, Lee B-S, Kim K-H, Kim K-A, Bin S-I (2012) Results of meniscus allograft transplantation using bone fixation: 110 cases with objective evaluation. Am J Sports Med 40(5):1027–1034

    Article  PubMed  Google Scholar 

  26. Koh YG, Moon HK, Kim YC, Park YS, Jo SB, Kwon SK (2012) Comparison of medial and lateral meniscal transplantation with regard to extrusion of the allograft, and its correlation with clinical outcome. J Bone Joint Surg Br 94(B 2):190–193

    Article  PubMed  Google Scholar 

  27. LaPrade RF, Wills NJ, Spiridonov SI, Perkinson S (2010) A prospective outcomes study of meniscal allograft transplantation. Am J Sports Med 38(9):1804–1812

    Article  PubMed  Google Scholar 

  28. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100

    Article  PubMed Central  PubMed  Google Scholar 

  29. Marcacci M, Zaffagnini S, Muccioli GM, Grassi A, Bonanzinga T, Nitri M, Bondi A, Molinari M, Rimondi E (2012) Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study. Am J Sports Med 40(2):395–403

    Article  PubMed  Google Scholar 

  30. Markolf K, Mensch J, Amstutz H (1976) Stiffness and laxity of the knee: the contributions of the supporting structures. J Bone Joint Surg Am 58(A):583–594

    CAS  PubMed  Google Scholar 

  31. McDermot I, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88(B):1549–1556

    Article  Google Scholar 

  32. McDermott ID (2010) What tissue bankers should know about the use of allograft meniscus in orthopaedics. Cell Tissue Bank 11(1):75–85

    Article  PubMed  Google Scholar 

  33. McDermott ID, Lie DT, Edwards A, Bull AM, Amis AA (2008) The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures. Knee Surg Sports Traumatol Arthrosc 16(6):553–560

    Article  PubMed  Google Scholar 

  34. Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13(1):1–11

    Article  CAS  PubMed  Google Scholar 

  35. Nepple JJ, Dunn WR, Wright RW (2012) Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am 94(24):2222–2227

    Article  PubMed Central  PubMed  Google Scholar 

  36. Newman AP, Daniels AU, Burks RT (1993) Principles and decision making in meniscal surgery. Arthroscopy 9(1):33–51

    Article  CAS  PubMed  Google Scholar 

  37. Noyes F, Barber-Westin S (1995) Irradiated meniscus allografts in the human knee. A two to five year follow-up study. Orthop Trans 19:417

    Google Scholar 

  38. Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N (2011) Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull 99:89–106

    Article  PubMed  Google Scholar 

  39. Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F (2001) Meniscal allograft transplantation. Two- to eight-year results. Am J Sports Med 29(4):410–414

    CAS  PubMed  Google Scholar 

  40. Rue JPH, Yanke AB, Busam ML, McNickle AG, Cole BJ (2008) Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2-year follow-up. Am J Sports Med 36(9):1770–1778

    Article  PubMed  Google Scholar 

  41. Rueff D, Nyland J, Kocabey Y, Chang HC, Caborn DN (2006) Self-reported patient outcomes at a minimum of 5 years after allograft anterior cruciate ligament reconstruction with or without medial meniscus transplantation: an age-, sex-, and activity level-matched comparison in patients aged approximately 50 years. Arthroscopy 22(10):1053–1062

    Article  PubMed  Google Scholar 

  42. Ryu RKN, Dunbar WHV, Morse GG (2002) Meniscal allograft replacement: a 1-year to 6-year experience. Arthroscopy 18(9):989–994

    Article  PubMed  Google Scholar 

  43. Saltzman BM, Bajaj S, Salata M, Daley EL, Strauss E, Verma N, Cole BJ (2012) Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up. J Knee Surg 25(2):165–175

    Article  PubMed  Google Scholar 

  44. Seedholm B, Dowson D, Wright V (1974) Functions of the menisci: a preliminary study. J Bone Joint Surg Br 56(B):381–382

    Google Scholar 

  45. Sekiya JK, Giffin JR, Irrgang JJ, Fu FH, Harner CD (2003) Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction. Am J Sports Med 31(6):896–906

    PubMed  Google Scholar 

  46. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD (2006) Clinical outcomes following isolated lateral meniscal allograft transplantation. Arthroscopy 22(7):771–780

    Article  PubMed  Google Scholar 

  47. Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL (2000) Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients. Arthroscopy 16(4):343–347

    Article  CAS  PubMed  Google Scholar 

  48. Stone KR, Pelsis J, Surrette S, Stavely A, Walgenbach AW (2013) Meniscus allograft transplantation allows return to sporting activities. In: Arthroscopy. Toronto, pp e52–e53

  49. Stone KR, Walgenbach AW, Turek TJ, Freyer A, Hill MD (2006) Meniscus allograft survival in patients with moderate to severe unicompartmental arthritis: a 2- to 7-year follow-up. Arthroscopy 22(5):469–478

    Article  PubMed  Google Scholar 

  50. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  51. van der Wal RJP, Thomassen BJW, van Arkel ERA (2009) Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med 37(11):2134–2139

    Article  PubMed  Google Scholar 

  52. Verdonk R, Verdonk P, Almqvist KF (2009) Viable meniscal transplantation. Revista Brasileira de Medicina 66(8):37–41

    Google Scholar 

  53. Voloshin A, Wosk J (1983) Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng 5:157–161

    Article  CAS  PubMed  Google Scholar 

  54. Vundelinckx B, Bellemans J, Vanlauwe J (2010) Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sports Med 38(11):2240–2247

    Article  PubMed  Google Scholar 

  55. Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30(2):174–181

    PubMed  Google Scholar 

  56. Yoldas EA, Sekiya JK, Irrgang JJ, Fu FH, Harner CD (2003) Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 11(3):173–182

    PubMed  Google Scholar 

  57. Zhang H, Liu X, Wei Y, Hong L, Geng XS, Wang XS, Zhang J, Cheng KB, Feng H (2012) Meniscal allograft transplantation in isolated and combined surgery. Knee Surg Sports Traumatol Arthrosc 20(2):281–289

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Arthritis Research UK (Grant Number 20149).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study does not contain new patient data.

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Authors and Affiliations

  1. Clinical Sciences Research Laboratories, University of Warwick, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Nick A. Smith

  2. Western Infirmary Glasgow, Dumbarton Road, Glasgow, G11 6NT, UK

    Nicola MacKay

  3. Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Matthew Costa

  4. University Hospitals Coventry and Warwickshire, 5th floor UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Tim Spalding

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  1. Nick A. Smith
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Correspondence to Nick A. Smith.

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Smith, N.A., MacKay, N., Costa, M. et al. Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23, 270–279 (2015). https://doi.org/10.1007/s00167-014-3310-0

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  • DOI: https://doi.org/10.1007/s00167-014-3310-0

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