title: Factors Predicting Meniscal Allograft Transplantation Failure.
abstract: BACKGROUND
  Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined.
  
  
  OBJECTIVE
  To determine predictors of MAT failure in a large series to refine the indications for surgery and better inform future patients.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  All patients undergoing MAT at a single institution between May 2005 and May 2014 with a minimum of 1-year follow-up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation, or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of the index surgery: group 1, intact or partial-thickness chondral loss; group 2, full-thickness chondral loss 1 condyle; and group 3, full-thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure, independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model.
  
  
  RESULTS
  There were 125 consecutive MATs performed, with 1 patient lost to follow-up. The median follow-up was 3 years (range, 1-10 years). The 5-year graft survival for the entire cohort was 82% (group 1, 97%; group 2, 82%; group 3, 62%). The probability of failure in group 1 was 85% lower (95% CI, 13%-97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% CI, 16%-89%) than medial allografts at any time.
  
  
  CONCLUSIONS
  This study showed that the presence of severe cartilage damage at the time of MAT and medial allografts were significantly predictive of failure. Surgeons and patients should use this information when considering the risks and benefits of surgery.
authors: Department of Orthopaedics, Cairns Hospital, Cairns, Queensland, Australia.
authors: Ben
authors: B
authors: Parkinson
authors: University of Warwick, Clinical Sciences Research Laboratories, Coventry, UK.
authors: Nicholas
authors: N
authors: Smith
authors: University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK.
authors: Laura
authors: L
authors: Asplin
authors: University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK.
authors: Peter
authors: P
authors: Thompson
authors: University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK.
authors: Tim
authors: T
authors: Spalding
keywords: articular cartilage repair; meniscal allograft transplant; meniscus