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Meniscal allograft transplantation, anterior cruciate ligament reconstruction, and valgus high tibial osteotomy for meniscal-deficient, unstable, and varus knees: surgical technique and clinical outcomes

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Abstract

Purpose

The aim of this study was to determine the clinical and functional outcome of a salvage surgical approach with the combined procedures meniscal allograft transplantation (MAT), anterior cruciate ligament reconstruction (ACLR), and high tibial osteotomy (HTO), in a cohort of patients treated for complex knee lesions evaluated up to a mid-term follow-up.

Methods

Eight patients (38.8 ± 4.6 years, 88% males) were treated arthroscopically with MAT without bone plugs combined with primary or revision ACLR and HTO and evaluated at basal, at a minimum of two years (short follow-up), and at a mean follow-up of 5.1 years (mid-term follow-up) with the VAS score for pain, Lysholm score, IKDC subjective score, WOMAC Osteoarthritis index, and Tegner score. Physical examination (Lachman and pivot-shift tests, arthrometer assessment) and radiographic evaluation (pre- and post-operative x-rays) were obtained. Complications and failures were also recorded.

Results

A statistically significant improvement was observed from baseline to five years in all clinical scores. In particular, the IKDC subjective score improved from 33.3 ± 20.7 to 73.1 ± 18.4 at short follow-up (p < 0.05), up to 78.3 ± 9.8 at the final follow-up (p < 0.05). A similar trend was demonstrated with the Lysholm, VAS, WOMAC, and Tegner score, even though only one patient reached the pre-injury activity level. Two patients had a worsening of the Kellgren-Lawrence (KL) grade from preoperative (grade 1) to final follow-up (grade 2). No major complications and surgical failures were documented.

Conclusion

The combined procedure of MAT, ACLR, and HTO presents few complications and failures and showed to be a valid option to reduce pain, recover knee function, and slow down the osteoarthritis process even in complex patients, with good and stable results up to a mid-term follow-up.

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Acknowledgements

Special thanks go to Mrs. Silvia Bassini for her contribution to the realization of the surgical technique illustrations.

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Contributions

S.Z. and A.G. contributed to the study conception and design. Material preparation, data collection, and analysis were performed by I.R., G.D.F., and A.G. The first draft of the manuscript was written by I.R. and G.D.F. The review and the editing were performed by S.Z., A.G., and G.F. All the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Iacopo Romandini.

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This study was performed in line with the principles of the Declaration of Helsinki and approved by the Local Ethics Committee.

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Conflicts of interest

Stefano Zaffagnini has received institutional support from Fidia Farmaceutici, Cartiheal, IGEA Clinical Biophysics, Biomet, and Kensey Nash; grant support from I+; and royalties from Springer outside the submitted work. The other authors declare no conflict of interest.

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Zaffagnini, S., Romandini, I., Filardo, G. et al. Meniscal allograft transplantation, anterior cruciate ligament reconstruction, and valgus high tibial osteotomy for meniscal-deficient, unstable, and varus knees: surgical technique and clinical outcomes. International Orthopaedics (SICOT) 47, 2523–2535 (2023). https://doi.org/10.1007/s00264-023-05846-2

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