Outcomes of Osteochondral Allograft Transplantation with versus without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis

摘要

Objectives: While osteochondral allograft transplantation (OAT) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, the impact of concomitant MAT on outcomes following OAT has not been assessed. The purpose of this study was to determine clinical outcomes for patients undergoing OAT with MAT compared to a matched cohort of patients undergoing isolated OAT. Methods: A review of consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. Patients who underwent OAT without concomitant MAT were compared to a matched group of patients who underwent OAT with concomitant MAT (age ± 3 years, gender, BMI ± 5 kg/m~(2), number of previous ipsilateral knee surgeries ± 1, and the presence of concomitant ligamentous surgery). The reoperation rate, failure rate, timing of reoperation, procedures performed, findings at surgery, and patient reported outcome scores were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at 2~(nd)look arthroscopy. Descriptive statistics, fisher’s exact or chi-square testing, and Mann-Whitney U testing were performed, with P<0.05 set as significant. Results: A total of 100 patients (average age 32.2±9.9 years; 52 males, 48 females) who underwent OAT (50 isolated, 50 with MAT) with an average follow-up of 4.84±2.7 years (range, 2.0-15.1) were included. These patients underwent an average of 2.6±1.2 prior surgical procedures on the ipsilateral knee prior to OAT. A total of 38 patients underwent reoperation at an average 2.4±2.2 years, with 24% (9/38) undergoing additional reoperations (range, 1-2 additional reoperations). MAT patients did not have significantly different reoperation rates (MAT: 40%; non-MAT: 36%), time to reoperation (MAT: 2.20±2.31 years; non-MAT: 2.56±2.11 years) or failure rates (14% vs. 14%) compared to non-MAT patients. Both MAT and non-MAT patients showed significant improvement in Lysholm, IKCD, KOOS, WOMAC, and SF-12 physical subscale as compared to preoperative values (P>0.05 for all for both groups). The SF-12 mental subscale was not significantly improved at final follow-up for either group. MAT patients demonstrated significantly higher SF-12 physical subscale as compared to non-MAT patients at most recent follow-up (45.81±7.42 vs 42.07±7.97, P 0.05) or defect:condyle size ratio (MAT: 0.19; non-MAT: 0.20, P>0.05). Conclusion: Patients undergoing OAT with MAT have similar survival rates, reoperation rates, and clinical outcomes compared to patients undergoing isolated OAT at an average follow-up of 5 years. This information can be used to counsel patients undergoing concomitant MAT as part of a knee joint preservation strategy.