title: Survival and reoperation rates after meniscal allograft transplantation: analysis of failures for 172 consecutive transplants at a minimum 2-year follow-up.
abstract: BACKGROUND
  Meniscal allograft transplantation (MAT) is a treatment option for knee pain in young patients with meniscal deficiency in the setting of intact articular surfaces, ligamentous stability, and normal alignment. It is being performed with increasing frequency, and the need for reoperations is not uncommon. A mean survival rate of allografts and indications for reoperations would be helpful information when counseling patients regarding the procedure. Purpose/
  
  
  OBJECTIVE
  The purpose of this study was to quantify survival for MAT and report findings at reoperation. The hypothesis was that the reoperation rate would be frequent and that the most common secondary surgery would be arthroscopic debridement.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A retrospective review of a prospectively collected database of patients who underwent MAT from 2003 to 2011 was conducted; all surgeries were performed by a single surgeon. The reoperation rate, timing of reoperation, procedure performed at reoperation, and findings at surgery, including the status of the meniscal and articular cartilage, were reviewed. Survival was defined as a lack of revision MAT or knee arthroplasty. Descriptive statistics, log-rank testing, cross-tabulation, and χ2 testing were analyzed, with an α value of .05 set as significant.
  
  
  RESULTS
  Of 200 patients who underwent MAT during the study period, 172 patients (86%; mean age, 34.3 ± 10.3 years) were evaluated at a mean of 59 months (range, 24-118 months) with a minimum 2-year follow-up. Forty-one percent of MATs were isolated, while 60% were performed with concomitant procedures. Sixty-four patients (32%) returned to the operating room after their index procedure. Arthroscopic debridement was performed in 59% (38/64) of these patients. The mean time to subsequent surgery was 21 months (range, 2-107 months), with 73% occurring within 2 years. Eight of 172 patients (4.7%) went on to require revision MAT or total knee replacement. Patients requiring secondary surgery within 2 years had an odds ratio of 8.4 (95% CI, 1.6-43.4) for future arthroplasty or MAT revision (P = .007).
  
  
  CONCLUSIONS
  In this series, there was a 32% reoperation rate for MAT, with simple arthroscopic debridement being the most common surgical treatment (59%), and a 95% allograft survival rate at a mean of 5 years. Those requiring additional surgery still benefited, having an 88% allograft survival rate, but were at an increased risk of failure. Patients requiring secondary surgery within 2 years had an odds ratio of 8.4 for future arthroplasty or MAT revision.
authors.affiliation: Frank McCormick, MC USNR, Holy Cross Orthopedic Institute, 5597 Dixie Hwy, Ft Lauderdale, FL 33334, USA. Drfrankmccormick@yahoo.com.
authors.forename: Frank
authors.initials: F
authors.lastname: McCormick
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Abrams
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Hussey
authors.forename: Hillary
authors.initials: H
authors.lastname: Wilson
authors.forename: Rachel
authors.initials: R
authors.lastname: Frank
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D018771:Arthralgia / Q000601:surgery; D001178:Arthroplasty / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000637:transplantation*; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: knee; meniscal allograft transplantation; reoperation rates; survival analysis