Abstract
Objectives:
The impact of full-thickness chondral defects (FTD) on outcomes after meniscus allograft transplantation (MAT) remains unknown. The purpose of this study was to determine the impact of FTD on outcomes following MAT.
Methods:
Patients undergoing MAT between 9/1997-3/2013 with minimum two-year follow-up were identified and split into two groups based upon presence or absence of FTD identified intra-operatively: No defect (“ND’, Outerbridge Grade 0/I) or FTD (Outerbridge Grade IV). All FTD were treated with cartilage restoration procedures (microfracture, osteochondral allo/autograft, DeNovo or autologous chondrocyte implantation). Reoperations, failures (revision MAT or conversion to arthroplasty), and patient-reported outcomes (PROs) were reported at six-months, one-year, two-years and final follow-up. Inter-group comparisons were made using unpaired student t-tests.
Results:
A total of 91 patients - 22 with ND and 69 with a FTD were identified and followed for a mean 4.48 and 3.84 years, respectively. There were no significant between-group differences in age, body mass index (BMI), or number of prior surgeries. One complication occurred in the FTD group (1.3%), and no complications in the ND group. There were no significant differences in number of subsequent surgeries or failures. Comparison of the cohorts found no differences in PROs preoperatively. At 6-months postoperative, significantly greater values were reported in the FTD cohort for KOOS-Pain and KOOS-ADL and greater values for the ND cohort for WOMAC-Function and WOMAC-Total. At 1-year postoperative, significantly greater values were reported for the ND cohort for KOOS-Symptoms and KOOS-QOL, but at 2-years postoperative and final follow-up, no further significant differences in any PROs were present. At final follow-up, the ND and FTD cohorts reported significant improvements in the majority of PRO categories, with a greater number of PRO subscales demonstrating significance in the FTD group (Figure 1; Table 1).
Conclusion:
FTD when treated at the time of MAT have no significant influence on outcome following MAT, including PROs, failures or reoperations. Clinicians performing MAT in meniscus deficient patients with full-thickness chondral defects should counsel their patients that if these defects are treated concomitantly with MAT that they can expect similar outcomes to patients without full-thickness chondral defects at long-term follow-up.
Chage from Preoperative to Final Follow-up in Patient Reported Outcomes
| PRO | “No defect” (grade 0/1 defects) | “Full-thickness defect” (grade 4 defects) | P Value |
|---|---|---|---|
| Lysholm | 14.8±14.4 | 21.1±19.8 | 0.410 |
| IKDC | 15.3±14 | 24.2±23.1 | 0.301 |
| KOOS | |||
| Pain | 13.6±13.4 | 17.6±17.1 | 0.549 |
| Symptoms | 11.3±12 | 15.2±19.3 | 0.530 |
| ADL | 10.1±9.4 | 17.3±17.4 | 0.279 |
| Sports | 8.3±12 | 28.0±28.2 | 0.153 |
| QOL | 20.5±22.6 | 23.1±26.6 | 0.783 |
| WOMAC | |||
| Pain | -1.7±2.1 | -2.7±3.2 | 0.389 |
| Stiffness | -0.9±1.4 | -1.1±2.3 | 0.806 |
| Function | -6.9±6.4 | -11.8±11.8 | 0.278 |
| Total | -9.9±9.2 | -14.8±15.4 | 0.420 |
| Overall Knee Function | 2.3±2.7 | 3.1±3.0 | 0.402 |
| Symptom Rate | 2.9±0.9 | 1.1±1.9 | 0.173 |
| SF-12 Physical | 5.2±8.3 | 2.5±6.9 | 0.395 |
| SF-12 Mental | 0.8±9.7 | 0.5±8.7 | 0.741 |
| PRO = patient reported outcome; IKDC = International Knee Documentation Committee; KOOS = Knee Injury and Osteoarthritis Outcome Score; ADL = activities of daily living; QOL = quality of life; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index; SF-12 = Short Form-12 | |||