Prognostic Factors to Determine Survivorship of Meniscal Allograft Transplant: A Systematic Review

Ding-Yu Wang; Cassandra A Lee; Yan-Zhang Li; Bo Zhang; Nan Li; Dong Jiang; Jia-Kuo Yu

doi:10.1177/23259671211007215

Prognostic Factors to Determine Survivorship of Meniscal Allograft Transplant: A Systematic Review

Orthop J Sports Med. 2021 Jun 4;9(6):23259671211007215. doi: 10.1177/23259671211007215. eCollection 2021 Jun.

Authors

Ding-Yu Wang^{1

2}, Cassandra A Lee³, Yan-Zhang Li⁴, Bo Zhang⁴, Nan Li⁵, Dong Jiang^{1

2}, Jia-Kuo Yu^{1

2}

Affiliations

¹ Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
² Institute of Sports Medicine of Peking University, Beijing, China.
³ Department of Orthopedic Surgery, Sports Medicine and Arthroscopy, University of California, Davis, Sacramento, California, USA.
⁴ Peking University First Hospital, Beijing, China.
⁵ Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.

Abstract

Background: There is much room for improvement and optimization of meniscal allograft survivorship.

Purpose: To understand prognostic factors for survivorship using evidence-based selection criteria in order to identify patients who would best benefit from meniscal allograft transplant (MAT).

Study design: Systematic review; Level of evidence, 4.

Methods: We conducted this systematic review to analyze prognostic factors for survivorship of MAT. The Cochrane Central Register, PubMed publisher, Embase.com, and Web of Science databases were searched through August 8, 2019. Included studies entailed patients of any age who received MAT with a reported association between prognostic factors and survivorship of the allograft. Two reviewers independently screened all titles and abstracts for eligibility, extracted the data, assessed the risk of bias using the Newcastle-Ottawa Scale, and performed a best-evidence synthesis.

Results: The review included 18 studies with a total of 1920 patients. The mean follow-up time was 6.0 years (range, 2.1-11.2 years). A total of 20 prognostic factors were identified and shown to be associated with survivorship of MAT. Strong evidence was found that severe cartilage damage was associated with poor survivorship. Strong evidence was also found showing that sex, knee compartment, surgical side, concomitant anterior cruciate ligament (ACL) reconstruction, and concomitant osteotomy for malalignment had no effect on survivorship. Moderate evidence was found that body mass index (<36), tobacco use, and arthroscopic versus open procedure had no influence on survivorship. Conflicting evidence was found that older age and kissing cartilage lesions (lesions on both the femur and tibia vs on a single side) decreased survivorship.

Conclusion: Severe cartilage damage decreases the survivorship of MAT. Concomitant ACL reconstruction and osteotomy showed no relationship to survivorship. Many determinants showed conflicting and limited evidence. Older age may be of interest and should be further studied.

Keywords: ACL; cartilage; meniscal allograft transplant; osteotomy; prognostic factor; survivorship.

Publication types

Review