Prospective Evaluation Of Meniscal Allograft Transplantation Revision: A Minimum Of 2-year Follow-up

摘要

Objectives: Meniscus transplantation (MTx) demonstrates improved clinical outcomes up to 10 years postoperatively in patient with symptomatic meniscal deficiency; however, a subset of patients develop recurrent symptoms secondary to re-injury or meniscus degeneration.In selected patients we have performed revision MTx (RMTx) for clinical failure after primary MTx, herein we report the outcomes of this procedure. Methods: A retrospective review of prospectively collected data on a consecutive series of patients who underwent RMTx by the senior author was performed. The pre-operative and more recent follow-up data for the following scoring systems were analyzed for significance using pairwise comparisons: Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score, Short Form quality of life score (SF-12), and visual analogue scale for satisfaction. Radiographs were obtained pre-operatively and at final follow-up. Results: Eleven patients met inclusion criteria, of which three were lost to follow up. The remaining patients included three males five females with a mean age of 31.6±10.2 years with five lateral and three medial menisci involved. The average time to revision from the index procedure was 3.45±2.52years (1.2-9 years). Mean follow up after RMTx was 3.83±1.3 years (2-5.85 year). Three patients (two lateral and one median menisci) described a new traumatic event that incited their symptoms. On average there was 0.20±1.0 mm of joint space narrowing in the affected compartment at final follow-up as compared to pre-operatively. Concomitant procedures included ACL reconstruction, revision OA graft, distal femoral osteotomy, and high tibial osteotomy. One patient progressed to arthroplasty, otherwise there were no re-operations. Six were mostly satisfied, two were completely satisfied, and subjective satisfaction was 7.6 on a ten-point scale. Seven of eight reported that they would have surgery again. All validated outcome measures were unchanged except for symptom rate which was significantly improved (p=0.011). Conclusion: RMTx is a reasonable option for select patients that are young and active, planning to continue an active lifestyle.