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What is 'success' after meniscal allograft transplantation?
Author(s):
Searle H. (United Kingdom)
Searle H. (United Kingdom)
Affiliations:
ESSKA Academy. Searle H. May 9, 2018; 209756; P14-1094 Topic: Arthroscopic Surgery
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Abstract
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Objectives: A retrospective outcomes study to explore the definition of success after meniscal allograft transplantation (MAT) using both surgical and patient reported-outcomes, to better inform surgeons, patients and healthcare providers alike.

MAT can be a useful option for treating premature knee degeneration after previous meniscal loss in patients younger than fifty years old, who are too young for traditional arthroplasty. Many outcome studies have been published showing MAT reduces symptoms and improves function, but different outcome measures and definitions of success are used, making it difficult to compare studies.

Methods: 60 patients who underwent MAT between 2008 and 2014 from one surgeon's cohort were identified. Fresh-frozen, non-irradiated grafts were sized-matched from one provider and fixed arthroscopically using transosseusous bone tunnels and peripheral capsular sutures. With no MAT-specific measure to assess patient outcomes, six validated measures for knee pathologies were incorporated into an online self-administered questionnaire (KOOS, IKDC, VAS, SF-12, Lysholm and Tegner Before & After MAT). Patient satisfaction with the procedure and questions around sport were also included to ascertain their relevance in defining success. Common to other MAT studies, surgical failure was defined as removal of most or all of the graft, revision allograft, or conversion to arthroplasty. Clinical failure was defined as a Lysholm score of <65. The overall complication rate was also calculated.

Results: 43 (72%) patients responded with a mean follow-up of 3 (±1.9) years. 19/43 (44%) had Outerbridge cartilage damage of Grade III or IV and 31/43 (72%) required additional concomitant procedures. Four (9.3%) patients were classified as surgical failures and nine (21%) as clinical failures. Three of the four surgical failures were also clinical failures. Whilst 32 (74%) patients would undergo MAT again, only one of the surgical failure patients and two of the clinical failure patients stated that they would not. Despite all patients being advised to avoid heavy joint-loading activities for good after their surgery, 20% expected to be able to do more sport, with 40% dissatisfied with their sporting levels.

Conclusions: Overall, the short-term findings in this patient cohort were encouraging, and in-keeping with the published literature. However, this study highlights the fact that the definition of success/failure may be inadequate, since nearly all those classified as failures stated that they would be happy to have the procedure again. Patient satisfaction with sporting levels also appears to be a potential concern for this challenging population. The percentage failure rate varies considerably depending on the definition used; therefore, we would suggest that a standardised definition of surgical failure and a MAT-specific outcomes measure is required: possibly the Western Ontario Meniscal Evaluation Tool (WOMET).

Keywords:
Meniscal allograft transplantation; outcomes; PROMs
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