IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy.
IRCCS Istituto Ortopedico Rizzoli, Centro di Ricerca Applicata e Traslazionale, Bologna, Italy.
Am J Sports Med. 2020 Aug;48(10):2360-2369. doi: 10.1177/0363546520932923. Epub 2020 Jul 6.
Meniscal allograft transplant (MAT) is considered an effective procedure for reducing pain and improving knee function. Nevertheless, the current knowledge regarding the results of MAT is limited to short- to mid-term follow-up studies, especially for arthroscopic techniques.
To evaluate the long-term clinical outcomes, reoperations, and failures with a minimum follow-up of 10 years after fresh-frozen MAT performed arthroscopically with soft tissue fixation.
Case series; Level of evidence, 4.
A total of 46 patients (age, 36.6 ± 10.6 years; 36 male, 10 female) who underwent medial MAT (n = 27) or lateral MAT (n = 19) with a minimum 10-year follow-up were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, and Tegner score. Surgical failure was defined as the need for partial or total graft removal (meniscectomy or knee replacement), and clinical failure was defined as the need for partial or total graft removal in addition to a poor Lysholm score (<65 points) at final follow-up. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS) for MAT.
10-year survival and clinical data were available for 38 patients. Because 6 meniscectomies were required, the rate of survival free from surgical failure was 91% at 5 years and 86% at 10 years. Lower survival was reported in lateral MAT (73%) compared with medial MAT (96%). Because a further 4 patients had poor Lysholm scores, the rate of survival free from surgical and clinical failure was 87% at 5 years and 70% at 10 years. The average Lysholm score at final follow-up was 82 ± 20, and 60% to 82% of patients achieved PASS of the various KOOS subscales. The Tegner score and the KOOS Sport score significantly decreased from mid-term to long-term evaluation ( < .001 and < .05, respectively). Other KOOS subscales and the Lysholm score remained stable at long-term evaluation. No significant differences were found between isolated MAT or combined MAT regarding subjective scores, surgical failures, or clinical failures.
Up to 10 years after surgery, 86% of fresh-frozen MATs with soft tissue fixation were still in situ, and satisfactory clinical results were present for about 70% of patients. Decline of clinical outcomes from midterm to long term was noted only in sports-related scores. A higher number of overall reoperations was noted in female patients, whereas a higher risk of failure was present in the patients with lateral MAT.
半月板同种异体移植（MAT）被认为是一种有效减少疼痛和改善膝关节功能的方法。然而，目前关于 MAT 结果的知识仅限于短期至中期随访研究，特别是对于关节镜技术。
评估新鲜冷冻 MAT 进行关节镜下软组织固定后至少 10 年的长期临床结果、再次手术和失败率。
病例系列；证据水平，4 级。
共评估了 46 例（年龄 36.6±10.6 岁；36 名男性，10 名女性）接受内侧 MAT（n=27）或外侧 MAT（n=19）的患者，随访时间至少 10 年，采用 Lysholm 评分、膝关节损伤和骨关节炎结果评分（KOOS）、疼痛视觉模拟评分和 Tegner 评分进行评估。手术失败定义为需要部分或全部移植物切除（半月板切除术或膝关节置换术），临床失败定义为需要部分或全部移植物切除以及最终随访时 Lysholm 评分<65 分。采用 Kaplan-Meier 曲线进行生存分析，根据 MAT 的患者可接受症状状态（PASS）分析临床评分。
38 例患者获得 10 年的生存和临床数据。由于需要进行 6 次半月板切除术，5 年时无手术失败生存率为 91%，10 年时为 86%。外侧 MAT 的生存率较低（73%），而内侧 MAT 为 96%。由于另外 4 例患者 Lysholm 评分较差，5 年和 10 年时无手术和临床失败生存率分别为 87%和 70%。最终随访时的平均 Lysholm 评分为 82±20，60%至 82%的患者在各种 KOOS 子量表中达到 PASS。Tegner 评分和 KOOS 运动评分从中期到长期评估显著下降（<0.001 和<0.05，分别）。其他 KOOS 子量表和 Lysholm 评分在长期评估中保持稳定。单独 MAT 或联合 MAT 的主观评分、手术失败率或临床失败率之间无显著差异。
手术 10 年后，有 86%的新鲜冷冻 MAT 用软组织固定仍在位，约 70%的患者有满意的临床效果。从中期到长期，仅在与运动相关的评分中观察到临床结果的下降。女性患者的总体再手术次数较多，而外侧 MAT 患者的失败风险较高。
