Brian R Waterman1, Nicholas Rensing1, Kenneth L Cameron2, Brett D Owens3, Mark Pallis1. 1. Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA. 2. The John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, US Military Academy, West Point, New York, USA. 3. The John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, US Military Academy, West Point, New York, USA owensbrett@gmail.com.
Abstract
BACKGROUND: There are limited data evaluating the clinical outcomes of meniscal allograft transplantation (MAT) in physically active cohorts. PURPOSE: To determine the survivorship, complication rates, and functional outcomes of MAT in an active military population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All military patients undergoing MAT between 2007 and 2013 were identified from the Military Health System. Previous/concomitant procedures, perioperative complications, reoperation rate, revision, and initiation of medical discharge for persistent knee disability were recorded. Univariate analysis was performed to identify associations between patient-based and surgical variables on selected endpoints. RESULTS: A total of 230 MATs (227 patients; 228 knees) were identified; the mean patient age was 27.2 years (range, 18-46 years), and the cohort was predominately male (89%). Approximately half (51%) of the patients had undergone prior, nonmeniscal knee procedures. Medial MATs were performed in 160 (69%) cases, and isolated MATs were most common (60%). A total of 51 complications occurred in 46 (21.1%) patients, including a secondary tear or extrusion (9%). At a mean clinical follow-up of 2.14 years, 10 (4.4%) patients required secondary meniscal debridement, while 1 (0.4%) patient required revision MAT and 2 (0.9%) patients underwent total knee arthroplasty. After MAT, 50 (22%) patients underwent knee-related military discharge at a mean of 2.49 years postoperatively. Tobacco use (P = .028) was associated with significantly increased risk of failure, and operation by fellowship-trained surgeons trended toward significance as a protective factor (P = .078). Furthermore, high-volume surgeons (≥1 MAT/year; range, 9-35) had significantly reduced rates of failure (P = .046). CONCLUSION: While reporting low reoperation and revision rates, this investigation indicates that 22% of patients with MAT were unable to return to military duty due to persistent knee limitations at short-term follow-up. Increased surgical experience may decrease rates of failure after MAT. Careful patient selection and referral to subspecialty-trained, higher-volume surgeons should be considered to optimize clinical outcomes after MAT.
BACKGROUND: There are limited data evaluating the clinical outcomes of meniscal allograft transplantation (MAT) in physically active cohorts. PURPOSE: To determine the survivorship, complication rates, and functional outcomes of MAT in an active military population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All military patients undergoing MAT between 2007 and 2013 were identified from the Military Health System. Previous/concomitant procedures, perioperative complications, reoperation rate, revision, and initiation of medical discharge for persistent knee disability were recorded. Univariate analysis was performed to identify associations between patient-based and surgical variables on selected endpoints. RESULTS: A total of 230 MATs (227 patients; 228 knees) were identified; the mean patient age was 27.2 years (range, 18-46 years), and the cohort was predominately male (89%). Approximately half (51%) of the patients had undergone prior, nonmeniscal knee procedures. Medial MATs were performed in 160 (69%) cases, and isolated MATs were most common (60%). A total of 51 complications occurred in 46 (21.1%) patients, including a secondary tear or extrusion (9%). At a mean clinical follow-up of 2.14 years, 10 (4.4%) patients required secondary meniscal debridement, while 1 (0.4%) patient required revision MAT and 2 (0.9%) patients underwent total knee arthroplasty. After MAT, 50 (22%) patients underwent knee-related military discharge at a mean of 2.49 years postoperatively. Tobacco use (P = .028) was associated with significantly increased risk of failure, and operation by fellowship-trained surgeons trended toward significance as a protective factor (P = .078). Furthermore, high-volume surgeons (≥1 MAT/year; range, 9-35) had significantly reduced rates of failure (P = .046). CONCLUSION: While reporting low reoperation and revision rates, this investigation indicates that 22% of patients with MAT were unable to return to military duty due to persistent knee limitations at short-term follow-up. Increased surgical experience may decrease rates of failure after MAT. Careful patient selection and referral to subspecialty-trained, higher-volume surgeons should be considered to optimize clinical outcomes after MAT.
Authors: Ivan J Antosh; Kenneth L Cameron; Nathan A Marsh; Matthew A Posner; Thomas M DeBerardino; Steven J Svoboda; Brett D Owens Journal: Clin Orthop Relat Res Date: 2020-04 Impact factor: 4.755
Authors: Alfredo Dos Santos Netto; Camila Cohen Kaleka; Mariana Kei Toma; Julio Cesar de Almeida E Silva; Ricardo de Paula Leite Cury; Patricia Maria de Moraes Barros Fucs; Nilson Roberto Severino Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-02-23 Impact factor: 4.342
Authors: Joseph N Liu; Anirudh K Gowd; Michael L Redondo; David R Christian; Brandon C Cabarcas; Adam B Yanke; Brian J Cole Journal: Orthop J Sports Med Date: 2019-01-04