Germany has a high demand in meniscal allograft transplantation but is subject to health economic and legal challenges: a survey of the German Knee Society.

PURPOSE: To determine the current status and demand of meniscal allograft transplantation (MAT) in Germany among members of the German Knee Society (= Deutsche Kniegesellschaft; DKG). METHODS: An online survey was conducted between May 2021 and June 2021 and sent to all members of the DKG. The survey questionnaire consisted of 19 questions to determine the demand and technical aspects of MAT among the participants and to identify areas of improvement in MAT in Germany. RESULTS: Overall, 152 participants, 136 (89.5%) from Germany, 8 (5.3%) from Switzerland, 6 (4.0%) from Austria, and 2 (1.3%) from other countries completed the online survey, with the majority working in non-academic institutions. According to the regulations of the DKG, 87 (57.2%) participants were board certified as specialized knee surgeons and 97 (63.8%) worked primarily in the field of orthopedic sports medicine. MAT was considered clinically necessary in Germany by 139 (91.5%) participants. Patient age (83.6%), post-meniscectomy syndrome in isolated lateral (79.6%) and medial (71.7%) meniscus deficiency, and functional and athletic demands (43.4%) were the most important determinants to consider MAT in patients. Participants reported that reimbursement (82.9%), jurisdiction over the use of donor grafts (77.6%), and the availability of meniscal allografts (76.3%) are the main challenges in performing MAT in Germany. The most frequently used meniscal allograft types by 54 (35.5%) participants who had already performed MAT were fresh-frozen grafts (56.6%), peracetic acid-ethanol sterilized grafts (35.9%), and cryopreserved grafts (7.6%). Participants reported to perform suture-only fixation more often than bone block fixation for both medial (73.6% vs. 22.6%) and lateral (69.8% vs. 24.5%) MAT. CONCLUSION: More than 90% of the responding members of the DKG indicated that MAT is a clinically important and valuable procedure in Germany. Reimbursement, jurisdiction over the use of donor grafts, and the availability of meniscal allografts should be improved. This survey is intended to support future efforts to facilitate MAT in daily clinical practice in Germany. LEVEL OF EVIDENCE: Level V.

Soft tissue injury of the shoulder after single non-dislocating trauma: prevalence and spectrum of intraoperative findings during shoulder arthroscopy and treatment results.

BACKGROUND AND PURPOSE: The purpose of our study was to present the spectrum and prevalence of intraarticular lesions in patients with shoulder pain after a single non-dislocating shoulder trauma and to evaluate the clinical results according to pathology and workers' compensation status. METHODS: Sixty consecutive patients (61 shoulders) with shoulder pain following a single non-dislocating shoulder trauma had shoulder arthroscopy. The indication for surgery was either persistent pain for 3 months or longer after trauma and/or an intraarticular lesion on MRI. Patients with history of shoulder complaints, previous shoulder surgery, a complete rotator cuff tear or a fracture of the shoulder girdle were excluded. Intraarticular findings during shoulder arthroscopy were retrospectively analyzed. After a minimum follow-up of 1 year patients were contacted by telephone interview and ASES score, Simple Shoulder Test, Subjective Shoulder Value and residual pain were assessed for the entire population and for patients with and without workers' compensation. RESULTS: The most common intraarticular findings were SLAP (44.3 %) and Pulley (19.7 %) lesions followed by lesions of the anterior or posterior labrum (14.8 %). The mean age of the 13 women and 47 men was 41.9 years (SD 10.9). Patients with workers' compensation had significantly lower scores than patients without and had a significantly lower return to work rate than patients without. INTERPRETATION: In patients with persistent shoulder pain after sprain or contusion arthroscopy revealed a broad spectrum of intraarticular findings. Patients with workers' compensation claims had worse results than those without. LEVEL OF EVIDENCE: Case series (Level IV).