High-grade preoperative osteoarthritis of the index compartment is a major predictor of meniscal allograft failure

• Published in: Archives of orthopaedic and trauma surgery 2023-01, Vol.143 (1), p.399-407
• Main Authors: Winkler, Philipp W., Wagala, Nyaluma N., Hughes, Jonathan D., Musahl, Volker
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Allografts; Arthritis; Arthroscopy and Sports Medicine; Cartilage Diseases - surgery; Follow-Up Studies; Humans; Medicine; Medicine & Public Health; Menisci, Tibial - surgery; Menisci, Tibial - transplantation; Orthopedics; Osteoarthritis; Patients; Retrospective Studies; Transplantation, Homologous; Young Adult
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-021-04306-z

Introduction Preoperatively available predictors of meniscal allograft failure would help in patient counseling and surgical indication for meniscal allograft transplantation (MAT). It was hypothesized that young patient age, high posterior tibial slope (PTS), and high-grade osteoarthritis (OA) are predictors of meniscal allograft failure. Materials and methods Patients undergoing MAT with a minimum follow-up of 2 years were included in this retrospective study. Demographic and surgical data, and causes of meniscal allograft failure were collected. PTS and degree of OA (low-grade: Kellgren–Lawrence 0, 1, and 2; high-grade: Kellgren–Lawrence 3 and 4) of the index and opposite tibiofemoral compartments were determined on preoperative radiographs. Results This study included 77 patients with a mean age of 25.7 ± 10.1 years at the time of MAT. After a mean follow-up of 7.6 ± 5.6 years, meniscal allograft failure was observed in 26 patients (34%). The median time from MAT to meniscal allograft failure was 1.3 years (inter-quartile range, 2.5 years). Meniscal allograft tears (88%) were the primary cause of graft failure, followed by high-grade OA (12%). Patients experiencing meniscal allograft failure were an average of 2.7 years (95% CI [2.2, 7.5], p  = 0.202) older at the time of MAT than patients without failure. PTS was not found to be a predictor of meniscal allograft failure (odds ratio, 0.884 (95% CI [0.727, 1.073], p  = 0.212)). Patients with high-grade preoperative OA of the index compartment had 28 times higher odds of experiencing meniscal allograft failure than patients with low-grade preoperative OA ( p  = 0.008). Conclusions High-grade preoperative OA of the index compartment was found to be a significant and clinically relevant predictor of meniscal allograft failure. Surgeons should be aware of the impact of OA on meniscal allograft survival, which needs to be considered in patient counseling and surgical indication for MAT in patients.