Meniscal allograft transplantation shows a mismatch between anatomic and clinical failures.

ABSTRACT

PURPOSE: Clinical results of meniscal allograft transplantation (MAT) are not always consistent with graft status. This study aimed to investigate (1) the degree and pattern of mismatch between anatomic and clinical failures in MAT and (2) preoperative factors associated with the mismatch. METHODS: Two hundred and ninety-eight consecutive patients who underwent primary medial or lateral MAT during 2004-2015 were reviewed. Anatomic failure was defined as an allograft showing meniscal tear involving > 50% of the graft or unstable peripheral rim. Clinical failure included poor Lysholm score of < 65 and any requirement for re-operations such as arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (more than 50% of the graft or to the zone of meniscocapsular junction). Failure cases were categorised according to the type of failure as follows (1) type 1, anatomic failure followed by clinical failure; (2) type 2, anatomic failure did not lead to clinical failure; and (3) type 3, clinical failure without anatomic failure. Preoperative factors including age, sex, body mass index, MAT compartment, time from previous meniscectomy, alignment, cartilage status, and accompanying procedures were analysed according to the failure type. RESULTS: Forty (13.4%) patients showed anatomical or clinical failure during the median (25th-75th percentile) follow-up duration of 47 (30-72) months (range 24-178 months). Eleven (3.7%) patients showed both anatomical and clinical failure (type 1 failure). Seventeen (5.7%) patients showed anatomic failure that did not lead to clinical failure (type 2 failure). Twelve (4.0%) patients failed clinically without meniscal tear (> 50% of graft) or unstable peripheral rim (type 3 failure). Comparative analyses among failure types found a significant difference in MAT compartment (p = 0.01). In particular, the incidence of type 3 failure was higher in medial than in lateral MAT (p = 0.003). CONCLUSION: A notable number of failure cases of MAT showed a mismatch between anatomic and clinical failures. Even with anatomic failure, MAT did not always lead to poor clinical scores or re-operations, whereas MAT could have poor results without substantial allograft problems. Therefore, both anatomic and clinical aspects should be considered when evaluating MAT. In particular, type 3 failure occurred more frequently in medial than in lateral MAT. LEVEL OF EVIDENCE III.