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Good clinical outcomes can be expected after meniscal allograft transplantation at 15 years of follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to evaluate graft survivorship and report the functional and radiographic results of Meniscal allograft transplantation (MAT) throughout a minimum 15-year follow-up period.

Methods

Fifty-one patients that had undergone an isolated MAT procedure during the period studied were included. The results were assessed with the Lysholm and Tegner scores as well as the Visual Analog Scale. Magnetic resonance imaging and a complete radiographic series were carried out to determine the degree of meniscal extrusion and joint space narrowing. A comparison was made between the radiological findings of the last follow-up, the 5-year mid-term follow-up and those from the preoperative period.

Results

Thirty-eight patients were available for the final follow-up. The mean follow-up was 17.4 years. There were 23 (60.5%) medial menisci and 15 lateral menisci (39.4%). Meniscal extrusion increased from the 29.7% ± 14.9 obtained at the 5-year follow-up to the 72.5% ± 22.5 seen at the end of the follow-up (p = 0.0001). The joint space distance was almost unchanged from the initial evaluation (3.3 ± 1.5 mm) to the 5-year follow-up measurement (3.1 ± 1.7 mm, n.s.). However, it did decrease at the last follow-up (1.9 ± 1.5 mm, p < 0.05). The functional outcomes improved from the preoperative period to the mid-term follow-up and later worsened at the final follow-up. The mean preoperative Lysholm score at the initial follow-up was 61.5 ± 9.6, 86.9 ± 10.9 for the 5-year evaluation and stood at 77.4 ± 11.5 (p = 0.0001) at the final follow-up. Regarding the Tegner score, those pre-operative scores were compared to the ones at the last follow-up (median: 3; range 0–6 vs. 5.5; 3–6, respectively; p = 0.0001). The VAS went down from 6.6 ± 1.7 at the initial evaluation to 2.5 ± 1.9 at the final follow-up (p = 0.0001). The joint-space width remained unchanged from the initial evaluation (3.35 ± 1.5 mm) up to the 5-year follow-up measurement (3.1 ± 1.7 mm, n.s.). However, this joint-space distance had decreased by the last evaluation in the long-term follow-up (1.9 ± 1.4 mm, p < 0.05). Five patients (13.1%) presented with a MAT failure at 5 years, which was followed by extirpation of the meniscal graft. At the final follow-up, a total of 16 patients (42.1%) presented with a failure. At that time, there were 4 more MAT removals and seven patients that required a total knee replacement. The mean time to failure of the meniscal graft was 206.2 months ± 13.4 (18.0 years).

Conclusions

Meniscal allograft transplantation produces good functional results at a minimum 15-year follow-up. However, degenerative arthritis in the affected compartment progressed during that period.

Level of evidence

III.

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Acknowledgements

This work was carried out within the framework of the PhD program in Surgery and Morphological Sciences of the Universitat Autonoma de Barcelona (U.A.B.), as part of the thesis from a compendium of publications of the second author of the study. The authors thank Mr. Eric Goode for his help in correcting the manuscript.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain

    Raúl Torres-Claramunt, Simone Perelli & Joan Carles Monllau

  2. Knee Unit, Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Raúl Torres-Claramunt, Simone Perelli & Joan Carles Monllau

  3. Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León (U.A.N.L.), Av. Francisco I. Madero and Av. Dr. Eduardo Aguirre Pequeño, s/n, Col. Mitras Centro, CP 66460, Monterrey, Nuevo León, Mexico

    Rodolfo Morales-Avalos

  4. Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González”, Universidad Autònoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, Mexico

    Rodolfo Morales-Avalos & José Ramón Padilla-Medina

Authors
  1. Raúl Torres-Claramunt
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  2. Rodolfo Morales-Avalos
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  3. Simone Perelli
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Contributions

RT-C: Conception of the research question, acquisition and analysis of the data, writing of a part of the manuscript and approval of its definitive version. RM-A: Conception of the research idea, protocol design and drafting, obtaining, analyzing and interpreting the data, drafting of the manuscript and approval of its definitive version as well as an agreement with the other authors that all doubts or aspects of the manuscript were meticulously reviewed before being sent to publication. SP: Design and conception of the study, realization of the translation, realization of the statistical analysis, writing of part of the manuscript, search of literature, analysis and interpretation of the data, support of the definitive version of the manuscript. JRPM: Acquisition and analysis of data, intellectual advisor in the area of human anatomy, wrote part of the manuscript and gave approval of its definitive version. JCM: One of the two main investigators of the study, editing of the manuscript before its definitive version, orthopedic adviser, proposal of the idea, proposal of the clinical relevance of the study, implementation of the protocol methodology, interpretation of results, approval of the definitive version, writing off part of the manuscript.

Corresponding author

Correspondence to Rodolfo Morales-Avalos.

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Conflict of interest

Each author certifies that neither he/she or any member of his/her immediate family receives funding from or has any commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his/her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Ethical approval

The present protocol was approved by the Institutional Review Board and the Research Ethics Committee of the Hospital Universitari Dexeus, affiliated to Universitat Autonoma de Barcelona with registration number: 10/090/1129.

Informed Consent

Signed by all the patients in the study.

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Torres-Claramunt, R., Morales-Avalos, R., Perelli, S. et al. Good clinical outcomes can be expected after meniscal allograft transplantation at 15 years of follow-up. Knee Surg Sports Traumatol Arthrosc 31, 272–278 (2023). https://doi.org/10.1007/s00167-022-07106-z

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