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Predictive Factors for Change in Patient-Reported Outcome Measures and Nonfailure Reoperations After Meniscal
Ameer A Haider1, Daniel E Fulkerson1, Tanya Boghosian1
1School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.
Background:
Meniscal allograft transplantation (MAT) has been established as a safe, effective treatment for meniscal deficiency. However, questions remain regarding pre- and perioperative factors that affect MAT outcomes.
Purpose:
To assess predictive factors for preoperative to postoperative change in Lysholm score (ΔLysholm) and nonfailure reoperations after MAT.
Study Design:
Systematic review and meta-analysis; Level of evidence, 4.
Methods:
The Ovid Medline, Embase, Scopus, and Clinicaltrials.gov databases were systematically searched for studies investigating clinical outcomes after MAT, including Lysholm scores, failure, complications, or reoperations. Study characteristics, predictive factors, and outcomes were extracted. The primary outcomes included ΔLysholm scores and nonfailure reoperations. Nonfailure reoperation was defined as any nonfailure meniscus-related procedure after primary MAT aiming to improve knee function. Failure was defined as conversion to total/unilateral knee arthroplasty, total or subtotal meniscectomy/allograft removal, or revision MAT. Relationships between predictive factors and outcomes were analyzed by meta-analysis or by weighted linear regression. Significant factors were included in a multivariable meta-regression.
Results:
Of 2347 screened titles, 154 met inclusion criteria. A total of 11,413 patients and 11,548 transplanted menisci were identified. The estimated pooled ΔLysholm score was 24.2 (SD, 6.08), and the nonfailure reoperation incidence rate was 3.36% (SD, 7.46%). No prognostic factors were significantly associated with differing ΔLysholm scores from meta-analysis. Lateral MATs had greater risk of nonfailure reoperation than medial MATs (ln[RR], -0.74; 95% CI, -1.37 to -0.108; P = .022). From multivariable regression, shorter time between meniscectomy and MAT (P = .007) and older age (P = .02) predicted less favorable cohort ΔLysholm scores. Longer intervals between injury and MAT (P = .039) and bone-bridge graft fixation for medial MAT compared with bone-plug fixation (P < .001) predicted higher risk of nonfailure reoperation.
Conclusion:
This systematic review and meta-analysis identified lateral MAT as a significant risk factor for nonfailure reoperation. Older age and shorter time interval between meniscectomy and MAT were significantly associated with less favorable ΔLysholm scores. A longer meniscal injury-MAT time interval and bone-bridge compared with bone-plug fixation technique for medial MAT were significantly associated with higher reoperation risk.
