Brisbane Orthopaedic and Sports Medicine Centre, Level 6 Brisbane Private Hospital, 259 Wickham Terrace, Brisbane, QLD, Australia.
Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1900-1907. doi: 10.1007/s00167-019-05398-2. Epub 2019 Feb 14.
To assess mid-term survivorship of meniscal allograft transplantation (MAT) and determine the effect that pre-operative meniscal sizing has upon functional outcome and mechanical survivorship.
A prospectively collected database of patients receiving MAT from 2001 to 2017 was analysed. Data include demographics; sizing measurements, complications, further surgery, and patient-reported outcome measures (PROMs). Allografts were fresh frozen, non-irradiated, and sized using the Pollard technique.
Seventy-three MATs were performed in 67 patients; mean age at MAT was 34 years (range 14-52 years). 56% were male and 62% were medial. The mean follow-up was 75 months (6.25 years). Mechanical survival at 5 and 10 years was 96% and 89.4%, respectively. There were statistically significant improvements in all PROMs; mean Lysholm score improved by 17.5 points [95% confidence interval (CI) 22.2-12.9, p < 0.001]; mean IKDC score improved significantly by 13.3 points (CI 19.3-7.4, p < 0.001); mean OKS improved by 5.6 points (CI 9.2-2.2, p < 0.002); and the median Tegner improved by 1 point. Forty-one MATs (56%) were undersized for width (range 1-11 mm). Seven MATs (10%) were undersized for length (range 1-4 mm). There was no statistically significant difference in mechanical survivorship or clinical outcomes between undersized, matched, or oversized grafts overall; however, sub-group analysis demonstrated increased failure when allografts were undersized by more than 5 mm in width.
MAT is an effective treatment to improve function and alleviate pain with excellent survivorship in this series. Accepting an allograft that is more than 5 mm smaller in width than pre-operative templating increases the likelihood of clinical and mechanical failure. We, therefore, urge surgeons to be familiar with the measuring process used by their individual tissue bank provider to avoid graft-host mismatch that could affect outcome.
评估半月板同种异体移植（MAT）的中期存活率，并确定术前半月板尺寸对功能结果和机械存活率的影响。
分析了 2001 年至 2017 年间接受 MAT 的患者的前瞻性数据库。数据包括人口统计学资料；尺寸测量、并发症、进一步手术和患者报告的结果测量（PROMs）。同种异体移植物为新鲜冷冻、未辐照，并采用 Pollard 技术进行尺寸测量。
67 名患者共进行了 73 例 MAT，MAT 时的平均年龄为 34 岁（14-52 岁）。56%为男性，62%为内侧。平均随访时间为 75 个月（6.25 年）。5 年和 10 年的机械存活率分别为 96%和 89.4%。所有 PROMs 均有统计学显著改善；Lysholm 评分平均提高 17.5 分[95%置信区间（CI）22.2-12.9，p<0.001]；IKDC 评分显著提高 13.3 分（CI 19.3-7.4，p<0.001）；OKS 平均提高 5.6 分（CI 9.2-2.2，p<0.002）；Tegner 中位数提高 1 分。41 例（56%）MAT 宽度尺寸偏小（1-11mm）。7 例（10%）MAT 长度尺寸偏小（1-4mm）。总体而言，在机械存活率或临床结果方面，尺寸偏小、匹配或偏大的移植物之间无统计学显著差异；然而，亚组分析表明，当同种异体移植物宽度比术前模板小 5mm 以上时，失败的可能性增加。
在本系列中，MAT 是一种有效治疗方法，可改善功能并缓解疼痛，具有良好的存活率。接受比术前模板小 5mm 以上的同种异体移植物会增加临床和机械失败的可能性。因此，我们敦促外科医生熟悉其所在组织库供应商使用的测量过程，以避免移植物-宿主不匹配，从而影响结果。
