Low 5-year failure rate found for meniscal allograft transplantation

However, researchers found second-look arthroscopy with debridement was common.

Issue: July 2014

Recently presented research shows a high overall survival rate at 5 years for meniscal allograft transplantation and a 32% reoperation rate, with most operating room returns occurring for arthroscopic debridement.

“You can counsel your patients to expect a low failure rate overall at a mean 5 years of follow-up, but there is a relatively high reoperation rate. This is important to counsel patients at the time of the index surgery regarding the potential need for a second-look arthroscopy and debridement within the first 2 years after their [meniscal allograft transplantation] MAT,” Rachel M. Frank, MD, said during her presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “Subsequent surgery within the first 2 years was much more likely to predict ultimate failure within the follow-up period than not undergoing subsequent surgery, but that overall, 95% of these allografts survived at 5 years,” she said.

Of the 32% of patients who had subsequent surgery — defined as any surgical procedure on the operative knee, which included manipulation under anesthesia — 59% underwent arthroscopic debridement. The average length of time until subsequent surgery was at 21 months, with 40% of patients returning to the operating room (OR) within the first year.

This arthroscopic image is of a 20-year-old
woman undergoing a left knee medial
meniscus allograft transplantation.

Image: Frank RM

“Eighty-eight percent of patients who returned to the OR still had what we would consider a successful outcome,” Frank said, noting these patients were not considered failures, which was defined by revision MAT or subsequent arthroplasty.

Overall, there were eight failures. The researchers discovered patients who required subsequent surgery within the first 2 years had an 8.4 times higher risk for failure.

“Close personal surveillance is warranted, especially in the first 2 years, because the rate of subsequent surgery goes down after those 2 years,” Frank said. After the initial 2-year period had passed, the likelihood of returning to surgery decreases sharply, according to Frank.

For the study, Frank and her colleagues reviewed data from the senior author, Brian J. Cole, MD, MBA, Section Head of the Rush Cartilage Restoration Center in Chicago. The data analyzed consisted of a consecutive series of isolated or concomitant MAT procedures performed from 2003 to 2011. Among the 200 patients, 172 were successfully contacted at a mean 5 years.

At the time of operation, the patients had an average body mass index of 25 and 60% underwent concomitant procedures. The researchers excluded patients with diffuse grade 3 or 4 articular cartilage changes on the femoral or tibial side, while those with focal cartilage lesions treated with cartilage repair procedures (i.e., osteochondral allografts) were included in the dataset. – by Katie Pfaff

Reference:

Frank RM. Paper #457. Presented at the: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014. New Orleans.

For more information:

Rachel M. Frank, MD, can be reached at the Division of Sports Medicine, Department of Orthopaedics, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL 60612; email: rmfrank3@gmail.com.
Disclosure: Frank has no relevant disclosures.