Abstract
Objectives:
Meniscal allograft transplantation (MAT) is indicated for active patients with symptomatic meniscal deficiency. Various graft fixation techniques have been described, including bone plugs, bone bridge-and-slot, and transosseous fixation. More recently, with the advent of all-inside meniscal repair devices, suture-only graft fixation methods have also gained popularity, although the comparative outcomes of this technique remain uncertain. This study aims to investigate the relationship between various meniscal allograft fixation techniques and reoperation rates following MAT.
Methods:
A retrospective chart review was conducted to identify patients who underwent MAT at a single academic institution. Patient demographics, including age at surgery, sex, and BMI were collected. Meniscal allograft fixation technique was recorded, as well as subsequent ipsilateral knee surgeries that occurred following the index MAT procedure. The fixation methods analyzed were bone plug, bone bridge-and-slot, and suture-only. Fisher’s exact test was used to evaluate the association between fixation technique and reoperation rate. Statistical significance was set at p < 0.05.
Results:
A total of 155 patients were included in the study cohort, with 86 (55.48%) being male. The average time to follow-up was 5.89 years with a mean age at the time of surgery of 29.4 ± 9.83 years and mean BMI of 27.5 ± 5.58. Lateral MAT was performed in 81 (52.26%) of cases whereas the remaining 74 (47.74%) underwent medial MAT. Patients who underwent MAT with suture-only fixation had a significantly higher reoperation rate (19/53, 35.8%) than those who underwent either bone bridge-and-slot (8/50, 16.0%) or bone plug (8/52, 15.4%) fixation (p = 0.023) (Table 1). The most common reoperation procedures were partial meniscectomy (14/35, 40%) and meniscal root repair (6/35, 17.14%), which together accounted for over half of all reoperations within the cohort.
Conclusions:
Suture-only meniscal allograft fixation was associated with a significantly higher reoperation rate than either bone bridge-and-slot or bone plug fixation, with the majority of reoperations being either partial meniscectomy or meniscal root repair. Although previous meta-analyses have reported similar graft survivorship between bony and suture-based fixation, our findings suggest that there may be a greater likelihood of reoperation (including revision meniscal procedures) with suture-only graft fixation. Surgeons may consider this information when selecting their preferred MAT technique and counseling patients preoperatively regarding the expected risks and benefits of the procedure.
