Frank McCormick, MC USNR, Holy Cross Orthopedic Institute, 5597 Dixie Hwy, Ft Lauderdale, FL 33334, USA.
Am J Sports Med. 2014 Apr;42(4):892-7. doi: 10.1177/0363546513520115. Epub 2014 Feb 14.
Meniscal allograft transplantation (MAT) is a treatment option for knee pain in young patients with meniscal deficiency in the setting of intact articular surfaces, ligamentous stability, and normal alignment. It is being performed with increasing frequency, and the need for reoperations is not uncommon. A mean survival rate of allografts and indications for reoperations would be helpful information when counseling patients regarding the procedure. Purpose/
The purpose of this study was to quantify survival for MAT and report findings at reoperation. The hypothesis was that the reoperation rate would be frequent and that the most common secondary surgery would be arthroscopic debridement.
Case series; Level of evidence, 4.
A retrospective review of a prospectively collected database of patients who underwent MAT from 2003 to 2011 was conducted; all surgeries were performed by a single surgeon. The reoperation rate, timing of reoperation, procedure performed at reoperation, and findings at surgery, including the status of the meniscal and articular cartilage, were reviewed. Survival was defined as a lack of revision MAT or knee arthroplasty. Descriptive statistics, log-rank testing, cross-tabulation, and χ2 testing were analyzed, with an α value of .05 set as significant.
Of 200 patients who underwent MAT during the study period, 172 patients (86%; mean age, 34.3 ± 10.3 years) were evaluated at a mean of 59 months (range, 24-118 months) with a minimum 2-year follow-up. Forty-one percent of MATs were isolated, while 60% were performed with concomitant procedures. Sixty-four patients (32%) returned to the operating room after their index procedure. Arthroscopic debridement was performed in 59% (38/64) of these patients. The mean time to subsequent surgery was 21 months (range, 2-107 months), with 73% occurring within 2 years. Eight of 172 patients (4.7%) went on to require revision MAT or total knee replacement. Patients requiring secondary surgery within 2 years had an odds ratio of 8.4 (95% CI, 1.6-43.4) for future arthroplasty or MAT revision (P = .007).
In this series, there was a 32% reoperation rate for MAT, with simple arthroscopic debridement being the most common surgical treatment (59%), and a 95% allograft survival rate at a mean of 5 years. Those requiring additional surgery still benefited, having an 88% allograft survival rate, but were at an increased risk of failure. Patients requiring secondary surgery within 2 years had an odds ratio of 8.4 for future arthroplasty or MAT revision.
半月板同种异体移植（MAT）是治疗年轻患者半月板缺失的一种方法，这些患者的关节面完整、韧带稳定且关节排列正常。随着该手术的应用越来越频繁，再次手术的需求也并不少见。当向患者提供该手术的咨询服务时，同种异体移植物的平均存活率和再次手术的适应证等信息将非常有帮助。目的：
本研究的目的是量化 MAT 的存活率，并报告再次手术的结果。我们的假设是再次手术的发生率较高，最常见的二次手术是关节镜下清创术。
病例系列研究；证据等级，4 级。
对 2003 年至 2011 年期间接受 MAT 的患者前瞻性收集数据库进行回顾性分析；所有手术均由一位外科医生完成。分析再次手术率、再次手术时间、再次手术时的手术方式以及手术时的发现，包括半月板和关节软骨的状态。定义无翻修 MAT 或膝关节置换术为存活率。采用描述性统计、对数秩检验、交叉表和卡方检验进行分析，以α值为 0.05 为显著差异。
在研究期间，200 名患者接受了 MAT，其中 172 名（86%；平均年龄 34.3±10.3 岁）在平均 59 个月（24-118 个月）的时间内接受了评估，且最低随访时间为 2 年。41%的 MAT 为孤立性，60%的 MAT 与其他手术联合进行。64 名患者（32%）在其首次手术后返回手术室。在这些患者中，59%（38/64）接受了关节镜下清创术。再次手术的平均时间为 21 个月（2-107 个月），73%发生在 2 年内。8 名患者（4.7%）需要进行翻修 MAT 或全膝关节置换术。在 2 年内需要再次手术的患者，未来关节置换或 MAT 翻修的比值比为 8.4（95%CI，1.6-43.4）（P=0.007）。
在本系列中，MAT 的再次手术率为 32%，最常见的手术治疗方法是单纯关节镜下清创术（59%），平均 5 年的同种异体移植物存活率为 95%。需要进一步手术的患者仍能受益，同种异体移植物的存活率为 88%，但失败风险增加。在 2 年内需要再次手术的患者，未来关节置换或 MAT 翻修的比值比为 8.4。
