Kunze Kyle N, Davie Ryann A, Ramkumar Prem Narayan, Chahla Jorge, Nwachukwu Benedict U, Williams Riley J
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Long Beach Orthopaedic Institute, Long Beach, California, USA.
Orthop J Sports Med. 2023 Jun 1;11(6):23259671231160296. doi: 10.1177/23259671231160296. eCollection 2023 Jun.
Graft failure after meniscal allograft transplantation (MAT) may necessitate revision surgery or conversion to arthroplasty. A comprehensive understanding of the risk factors for failure after MAT of the knee may facilitate more informed shared decision-making discussions before surgery and help determine whether MAT should be performed based on patient risk.
To perform a systematic review and meta-analysis of risk factors associated with graft failure after MAT of the knee.
Systematic review; Level of evidence, 4.
The PubMed, OVID/Medline, and Cochrane databases were queried in October 2021. Data pertaining to study characteristics and risk factors associated with failure after MAT were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MAT graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs. Qualitative analysis was performed to describe risk factors that were variably reported.
In total, 17 studies including 2184 patients were included. The overall pooled prevalence of failure at the latest follow-up was 17.8% (range, 3.3%-81.0%). In 10 studies reporting 5-year failure rates, the pooled prevalence of failure was 10.9% (range, 4.7%-23%). In 4 studies reporting 10-year failure rates, the pooled prevalence was 22.7% (range, 8.1%-55.0%). A total of 39 risk factors were identified, although raw data presented in a manner amenable to meta-analysis only allowed for 3 to be explored quantitatively. There was strong evidence to support that an International Cartilage Regeneration & Joint Preservation Society grade >3a (OR, 5.32; 95% CI, 2.75-10.31; < .001) was a significant risk factor for failure after MAT. There was no statistically significant evidence to incontrovertibly support that patient sex (OR, 2.16; 95% CI, 0.83-5.64; = .12) or MAT laterality (OR, 1.11; 95% CI, 0.38-3.28; = .85) was associated with increased risk of failure after MAT.
Based on the studies reviewed, there was strong evidence to suggest that degree of cartilage damage at the time of MAT is associated with graft failure; however, the evidence was inconclusive on whether laterality or patient sex is associated with graft failure.
半月板同种异体移植（MAT）后移植物失败可能需要翻修手术或转换为关节成形术。全面了解膝关节MAT后失败的风险因素可能有助于在手术前进行更明智的共同决策讨论，并有助于根据患者风险确定是否应进行MAT。
对膝关节MAT后与移植物失败相关的风险因素进行系统评价和荟萃分析。
系统评价；证据等级，4级。
2021年10月检索了PubMed、OVID/Medline和Cochrane数据库。记录了与研究特征和MAT后失败相关的风险因素的数据。构建DerSimonian-Laird二元随机效应模型，通过生成比值比（OR）形式的效应估计值及95%置信区间（CI），定量评估风险因素与MAT移植物失败之间的关联。进行定性分析以描述不同研究报告的风险因素。
共纳入17项研究，包括2184例患者。最新随访时失败的总体合并患病率为17.8%（范围为3.3%-81.0%）。在10项报告5年失败率的研究中，失败的合并患病率为10.9%（范围为4.7%-23%）。在4项报告10年失败率的研究中，合并患病率为22.7%（范围为8.1%-55.0%）。共识别出39个风险因素，尽管以适合荟萃分析的方式呈现的原始数据仅允许对其中3个因素进行定量探讨。有强有力的证据支持国际软骨修复与关节保护学会分级>3a（OR，5.32；95%CI，2.75-10.31；P<0.001）是MAT后失败的一个重要风险因素。没有统计学上显著的证据无可争议地支持患者性别（OR，2.16；95%CI，0.83-5.64；P=0.12）或MAT的侧别（OR，1.11；95%CI，0.38-3.28；P=0.85）与MAT后失败风险增加相关。
基于所综述的研究，有强有力的证据表明MAT时软骨损伤程度与移植物失败相关；然而，关于侧别或患者性别是否与移植物失败相关的证据尚无定论。
