Review Article

Meniscal allograft transplantation: a meta-analysis

¹ Faculty of Medicine, Ghent University, De Pintelaan 185, B9000 Gent, Belgium
² Antwerp Orthopaedic Center, AZ Monica Hospitals, Harmoniestraat 68, B2018 Antwerp, Belgium
³ Department of Orthopaedic Surgery, Antwerp University Hospital, Wilrijkstraat, 2650 Edegem, Belgium
⁴ Department of Orthopaedic Surgery, Campus Erasme, University Libre de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium

^* Corresponding author: manolito.debruycker@gmail.com

Received: 28 October 2016
Accepted: 28 February 2017

Abstract

Purpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation). Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed.

Study design: Meta-analysis.

Methods: An online database search was performed using following search string: “meniscal allograft transplantation” and “outcome”. A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed.

Results: The subjective and objective results of 2977 patients (3157 allografts) were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS) scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI) of the patient shows a slightly negative correlation with the outcome of MAT.

Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all pathologies including alignment, stability, meniscal abnormality and cartilage degeneration. It requires possibly combined but appropriate action in that order.