Long-term Survival Analysis of Meniscus Allograft Transplantation With Bone Fixation.
OBJECTIVE
To investigate the long-term clinical results and clinical survival rate of meniscus allograft transplantation (MAT) with bone fixation.


METHODS
The inclusion criteria of this study were previous MAT with bone fixation technique in our institution and minimum follow-up duration of 8 years. Potential subjects were identified using the medical records and database that was prospectively collected from December 1996 to December 2005. The exclusion criteria were diffuse International Cartilage Repair Society grade IV articular cartilage degeneration that was not treated with a concomitant or staged cartilage repair procedure. Surgical indication for MAT was previous total or subtotal meniscectomy followed by persistent swelling and pain in involved compartment. Recommendations to return to contact sports or strenuous activities were not made. Clinical outcomes were evaluated using the modified Lysholm score, and comparison between preoperative and final Lysholm score was done using Student t-test. During the follow-up period, failure was defined as (1) subtotal resection of the allograft, (2) conversion to total knee arthroplasty, or (3) a modified Lysholm score less than 65 or that of the preoperative status. Survival analysis was performed using the Kaplan-Meier method.


RESULTS
During the study period, 52 knees underwent MAT in our institution and 49 knees were eligible for this study. Three knees were excluded because they had diffuse grade IV cartilage degeneration in the respective compartment. Among the 49 knees enrolled, 34 underwent lateral and 15 underwent medial MAT. Two patients had bilateral lateral MAT. Of those 47 patients, 37 were male and 10 were female. Mean patient age at the time of the MAT was 30.4 ± 8.6 years. The median follow-up period was 11.5 years (8 to 17 years). The preoperative mean modified Lysholm score was 73.2 ± 10.6, which significantly increased to 89.4 ± 13.2 at the time of the final follow-up (P < .001). There were 2 failures noted at 6 months and 11.3 years, respectively, after MAT. All of the other allografts were surviving at the time of the latest follow-up. The 10-year survival rate was 98.0% (95% confidence interval [CI], 94.1%-100%), and the 15-year survival rate was 93.3% (95% CI, 83.7%-100%) according to the Kaplan-Meier analysis.


CONCLUSIONS
MAT using the bone fixation techniques demonstrated a high clinical survival rate according to the long-term observation.


METHODS
Level IV, therapeutic case series.
Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Jong-Min
JM
Kim
Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: sibin@amc.seoul.kr.
Seong-Il
SI
Bin
Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Bum-Sik
BS
Lee
Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Nam-Ki
NK
Kim
Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Ju-Ho
JH
Song
Department of Orthropaedic Surgery, Namyangju Hanyang General Hospital, Seoul, Republic of Korea.
Jun-Weon
JW
Choi
Department of Orthopedic Surgery, Inje University, Busan Paik Hospital, Busan, Republic of Korea.
Chang-Rack
CR
Lee
D000328:Adult; D064591:Allografts; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D065466:Lysholm Knee Score; D008297:Male; D008592:Menisci, Tibial / Q000637:transplantation*; D011182:Postoperative Care; D012189:Retrospective Studies