Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Am J Sports Med. 2023 Sep;51(11):2954-2963. doi: 10.1177/03635465231188657. Epub 2023 Aug 18.
Meniscal allograft transplantation (MAT) has been shown to provide clinical benefits in patients with symptomatic meniscal deficiency in the short term and midterm. There is, however, a paucity of data regarding long-term outcomes after MAT using fresh-frozen allografts and the bridge-in-slot technique.
To report clinical outcomes and revision rates after primary MAT with fresh-frozen allografts and the bridge-in-slot technique in a large case series of patients at a 10-year minimum follow-up.
Case series; Level of evidence, 4.
A retrospective review of prospectively collected data was performed on patients undergoing primary MAT between 2001 and 2012. Lysholm, International Knee Documentation Committee subjective form, and Knee injury and Osteoarthritis Outcome Score subscales were collected preoperatively and at 1-, 2-, 5-, and minimum 10-year follow-ups. Cox proportional hazards modeling was used to identify variables associated with reoperation and failure, defined as revision MAT or conversion to arthroplasty. Reoperation was defined as a subsequent surgical intervention on the transplanted meniscus, including partial or total meniscectomy, meniscal repair, or failure as defined in the previous sentence.
A total of 174 patients undergoing MAT met the inclusion criteria and were followed for a mean of 12.7 ± 2.7 years (range, 10.0-21.0 years). The mean age at surgery was 28.3 ± 10.1 years. The patients were predominantly female (n = 92; 53%), and medial MAT was the most commonly performed procedure (n = 91; 52%). Concomitant procedures were performed in 115 patients (66%), with the most common procedure being osteochondral allograft transplantation (n = 59; 34%). Patients demonstrated statistically significant postoperative improvements at all time points for all patient-reported outcome measures (≤ .0001). A total of 65 patients (37%) underwent a meniscal reoperation at a mean time of 6.6 ± 5.5 years (range, 0.3-16.7 years) postoperatively. A total of 40 patients (23%) met the criteria for failure at a mean time of 7.3 ± 5.0 years (range, 1.0-17.4 years) after MAT, with 22 of these patients having undergone a previous meniscal reoperation. At the final follow-up, 13 patients (7%) had undergone revision MAT and 27 (15%) had converted to arthroplasty. The MAT survival rates free of meniscal reoperation and failure were 73% and 85% at 10 years and 60% and 72% at 15 years, respectively. At the time of the final follow-up, 86% of patients reported that they were satisfied with their overall postoperative condition.
Primary MAT demonstrates efficacy and durability with high rates of patient satisfaction at a minimum 10-year follow-up. Patients should be counseled that although reoperation rates may approach 40% at 15 years, rates of overall revision MAT and conversion to arthroplasty remain low at long-term follow-up.
半月板同种异体移植（MAT）在短期和中期为有症状的半月板缺失患者提供了临床益处。然而，使用新鲜冷冻同种异体移植物和插槽桥接技术的 MAT 长期结果数据很少。
报告在一项至少 10 年随访的大型病例系列中，使用新鲜冷冻同种异体移植物和插槽桥接技术进行初次 MAT 后的临床结果和翻修率。
病例系列；证据水平，4 级。
对 2001 年至 2012 年间进行初次 MAT 的患者前瞻性收集的数据进行回顾性分析。收集术前和 1、2、5 年及至少 10 年随访时的 Lysholm、国际膝关节文献委员会主观评分表和膝关节损伤和骨关节炎结局评分亚量表。使用 Cox 比例风险模型确定与翻修和失败相关的变量，翻修和失败定义为 MAT 再次翻修或转换为关节置换。翻修定义为对移植半月板进行的后续手术干预，包括部分或全半月板切除术、半月板修复或上述定义的失败。
共有 174 名符合纳入标准的 MAT 患者接受了随访，平均随访时间为 12.7±2.7 年（范围，10.0-21.0 年）。手术时的平均年龄为 28.3±10.1 岁。患者主要为女性（n=92；53%），内侧 MAT 最常见（n=91；52%）。115 名患者（66%）同时进行了其他手术，最常见的手术是骨软骨同种异体移植（n=59；34%）。所有患者报告的测量指标在所有时间点均有统计学意义的术后改善（≤.0001）。65 名患者（37%）在术后平均 6.6±5.5 年（范围，0.3-16.7 年）进行了半月板再次翻修。40 名患者（23%）在 MAT 后平均 7.3±5.0 年（范围，1.0-17.4 年）达到失败标准，其中 22 名患者此前已进行过半月板再次翻修。在最终随访时，13 名患者（7%）接受了 MAT 再次翻修，27 名患者（15%）接受了关节置换。10 年时 MAT 无半月板再次翻修和失败的生存率分别为 73%和 85%，15 年时分别为 60%和 72%。在最终随访时，86%的患者表示对术后整体状况满意。
初次 MAT 在至少 10 年的随访中表现出疗效和耐用性，患者满意度高。应告知患者，尽管 15 年时再次翻修率可能接近 40%，但长期随访时 MAT 整体翻修和转换为关节置换的比例仍较低。
