Abstract
Objectives:
This study evaluates the utility of meniscus allografts in combination with other procedures to delay knee arthroplasty in patients older than 50 years of age previously advised to have a joint arthroplasty. The reason this study is important is because a 10-year delay in knee arthroplasty has been shown to reduce the lifetime revision rate. It was hypothesized that as opposed to debridement or meniscectomy alone, these subjects would benefit from a meniscus transplant in terms of improved knee symptoms, function, and delay of arthroplasty.
Methods:
One-hundred eight meniscus allograft transplants (MATs) using the arthroscopic 3-tunnel technique between 1997 and 2019 in patients over 50 were reviewed. Eighty-six of 108 (79.6%) patients met eligibility for this case series report. Inclusion criteria were patients recommended a knee arthroplasty with pain and preservation of some joint space by standing anterior-posterior and posterior-anterior flexion x-ray. Exclusion criteria were defined as lack of joint space, failure to comply with rehabilitation protocol or complete questionnaires. International Knee Documentation Committee and visual analog scale scores were obtained longitudinally. Time from meniscus transplantation to arthroplasty was measured with failure defined as allograft revision or excision, progression to arthroplasty, or same or increased pain.
Results:
Over the follow-up range of 2 to 25 years, 41 of 86 (47.6%) patients progressed to arthroplasty at a mean of 8.6 years. At the time of reporting, 41 of 86 (47.6%) patients had intact meniscus transplants. In subjects with intact meniscus allografts, significant improvements (p < 0.05) were observed in pain and function. These improvements were sustained through ten years post-operatively, which correlated to a mean of 65.8 years of age.
Conclusions:
Meniscus allografts in combination with other arthroscopic knee treatments delay arthroplasty and improve symptoms of pain and function in a population over 50 who are otherwise candidates for knee arthroplasty. Limitations include the lack of a control population and the difficulty separating the relative contribution of concomitant procedures from meniscus transplantation alone to the clinical benefit observed.
