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Long-term clinical outcome of open meniscal allograft transplantation
Robert Jan Peter van der Wal1, Bregje Josephina Wilhelmina Thomassen, Ewoud Rijkert Adriaan van Arkel
1Medical Center Haaglanden, Den Haag, Netherlands. rjpvanderwal@hotmail.com
Background:
Meniscal allograft transplantation is an accepted treatment for the symptomatic postmeniscectomized knee in younger patients; however, long-term data are scarce on clinical outcome.
Hypothesis:
Cryopreserved meniscal allograft transplantations can, in the long term, be a good alternative for the symptomatic postmeniscectomized knee in younger patients.
Study Design:
Case series; Level of evidence, 4.
Methods:
Sixty-three meniscal allografts (40 lateral and 23 medial) were transplanted with an open procedure in 57 patients. Clinical outcome and failure rate were evaluated at 13.8 +/- 2.8 years. Mean age at time of transplantation was 39.4 +/- 6.9 years.
Results:
Eight medial and 10 lateral allografts failed (overall failure rate, 29%). Overall Lysholm scores significantly improved from 36 +/- 18 preoperatively to 61 +/- 20 at long-term follow-up. Scores were not significantly different in the following subgroups: medial allografts, female patients, and left treated knees. All subgroups had poor scores at mean follow-up of 13.8 years, except the male patients group, which had a fair score. Short-term Lysholm scores were 79 +/- 19 at 3.1 +/- 1.5 years. All subgroups demonstrated a significant difference between short- and long-term Lysholm scores. There were no significant differences in Lysholm scores between posttransplanted survivors and posttransplanted nonsurvivors who received a total knee arthroplasty. For 2 other measures-the Knee injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee scoring system-significant decline was present between men and women only.
Conclusion:
Long-term follow-up results show that meniscal allograft transplantation is a beneficial procedure. Good improvements in clinical function and pain relief have been shown at short-term follow-up in this population. Despite the deterioration in function scores over time, there is still improvement in level of function at long-term follow-up but not at a high level. As such, meniscal allograft transplantation is a good salvage option for the treatment of degenerative arthritis of the symptomatic post-meniscectomized knee. Meniscal allograft transplantation can be used to postpone total knee arthroplasty in younger patients.