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Bone bridge technique for lateral meniscal allograft transplantation: no difference in clinical outcome compared to the soft tissue technique

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There is considerable debate regarding the optimal method of fixation for lateral meniscus allograft transplantation (MAT), with bone bridge techniques technically harder but allowing maintenance of root attachments, while soft tissue techniques are potentially more challenging for healing. The aim of this study was to compare the clinical results of the bone bridge and soft tissue techniques for lateral MAT in terms of failure, re-operation rate, complications and patient reported outcomes.

Methods

Retrospective analysis of prospectively collected data for patients undergoing primary lateral MAT with a minimum of 12-month follow-up. Patients following surgery utilising the bone bridge technique (BB) were compared with historical control patients who underwent MAT with the soft tissue technique (ST). Outcome was assessed by failure rate, defined as removal or revision of the meniscus transplant, survivorship by Kaplan–Meir analysis, re-operation rates, and other adverse event. Patient-reported outcome measures (PROMs) were compared using data at the 2-year point or 1 year if not reached 2 years.

Results

One-hundred and twelve patients following lateral meniscal transplants were included, 31 in the BB group and 81 in the ST historical control group, with no differences in demographics between both groups. Median follow-up for the BB group was 18 (12–43) months compared to 46 (15–62) months for the ST group. There were 3 failures (9.6%) in the BB group v 2 (2.4%) in the ST group (n.s.) with a mean time to failure of 9 months in both groups. 9 patients (29%) required a re-operation (all cause) in the BB group v 24 patients (29.6%) in the ST group (n.s). There was no difference in complications between both groups. There was significant improvement (p < 0.0001) in all PROMs (Tegner, IKDC, KOOS and Lysholm) between baseline and 2-year follow-up for both groups but no between-group differences.

Conclusion

Lateral MAT has a high success rate for symptomatic meniscal deficiency with significant benefits irrespective of the fixation technique. There is no advantage in performing the more technically demanding BB technique over ST fixation.

Level of evidence

Level 2.

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Data availability

Data is available as required.

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Acknowledgements

We acknowledge the UHCW Meniscal Transplant service

Funding

No additional funding was required.

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Authors and Affiliations

  1. University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK

    Rahul Bhattacharyya, Nicole Bausch, Adam Pilarski, Peter Thompson, Andrew Metcalfe & Tim Spalding

  2. Frimley Park Hospital NHS Trust, Frimley, Surrey, UK

    Harry Krishnan

  3. Tallaght University Hospital, Dublin, Ireland

    Niall McGoldrick

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  1. Rahul Bhattacharyya
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Contributions

RB—study design, data collection, analysis, writing, editing and approval of manuscript. HK—data collection, approval of manuscript. NB—data collection, approval of manuscript. NMG—data collection, approval of manuscript. AP—data analysis, approval of manuscript. PT—data analysis, approval of manuscript. AM—data analysis, approval of manuscript. TS—study design, data analysis, editing and approval of manuscript.

Corresponding author

Correspondence to Rahul Bhattacharyya.

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Conflict of interest

One of the authors (TS) is a named consultant for CONMED (USA) for teaching and surgical techniques. No relation to any instruments used in this paper. Another author (AM) has non-commercial research funding and unrelated research support. All the other authors have no conflict of interest.

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Approved by the Research and Development Department at University Hospital Coventry and Warwickshire NHS Trust.

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Bhattacharyya, R., Krishnan, H., Bausch, N. et al. Bone bridge technique for lateral meniscal allograft transplantation: no difference in clinical outcome compared to the soft tissue technique. Knee Surg Sports Traumatol Arthrosc 31, 4162–4170 (2023). https://doi.org/10.1007/s00167-023-07443-7

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