title: Prospective Clinical and Radiographic Outcomes After Concomitant Anterior Cruciate Ligament Reconstruction and Meniscal Allograft Transplantation at a Mean 5-Year Follow-up.
abstract: BACKGROUND
  Concomitant anterior cruciate ligament reconstruction and meniscal allograft transplantation (ACLR/MAT) has demonstrated short-term success in small, retrospective cohort studies. Patient- and disease-specific predictors of success after ACLR/MAT are largely unknown.
  
  
  OBJECTIVE
  To (1) prospectively evaluate the subjective and objective clinical and radiographic outcomes after ACLR/MAT and (2) conduct a subgroup analysis to identify patient- or disease-related factors that correlate with failure.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Patient-reported outcomes (PROs) were prospectively collected on 40 patients undergoing concomitant ACLR/MAT. Nineteen athletes responded to return-to-sport data. Clinical data (physical examination including Lachman and pivot-shift testing and KT-1000 arthrometer testing) were obtained on 28 patients who returned for an evaluation, while 24 of those patients additionally had radiographic data (progression of Kellgren-Lawrence [KL] grade and joint-space narrowing) evaluated. Reoperations and failures were documented for all patients at their final follow-up.
  
  
  RESULTS
  The overall cohort of 40 patients had a mean age of 30.3 ± 9.6 years (range, 16.0-54.0 years) and a mean body mass index of 27.7 ± 4.2 kg/m2. The mean follow-up time was 5.7 ± 3.2 years (range, 1.7-16.5 years). There were 33 (83%) medial meniscal transplants performed compared with 7 (17%) lateral meniscal transplants. Patients underwent a mean of 2.9 ± 1.9 prior surgical procedures. Nineteen patients underwent concomitant procedures, including, most commonly, 9 hardware removals and 9 osteochondral allografts. There were significant improvements in 11 of 14 PRO measures as well as a 50% return-to-sport rate. Knee stability significantly improved in 28 patients who returned for a physical examination, and KT-1000 arthrometer testing indicated no differences between the affected and unaffected sides at final follow-up (mean, 0.9 ± 1.5 mm [range, -2 to 4 mm] in comparison to contralateral knee at 30 lb of testing; mean, 0.9 ± 1.9 mm [range, -4 to 4 mm] in comparison to contralateral knee at maximum manual strength). Significant improvements were seen in patients with Lachman grade ≥2A at final follow-up (18% vs 97%, respectively; P < .01) and with pivot shift ≥1+ at final follow-up (36% vs 94%, respectively; P < .01) compared with preoperatively. For the 24 patients with radiographic data, no significant joint-space decrease was recorded in the medial compartment for medial MAT-treated patients or the lateral compartment for lateral MAT-treated patients. The mean KL grade increased from 0.7 ± 0.8 to 1.6 ± 0.9 at final follow-up ( P < .01). There were no major (0%) and 2 minor (5%) complications, which constituted early postoperative drainage treated successfully with oral antibiotics. While 35% of patients underwent reoperations, the majority of these were simple arthroscopic debridements and occurred after nearly 4 years from the index surgery. The overall survival rate at final follow-up was 80%. Failures occurred at a mean of 7.3 years, and those who converted to arthroplasty did so at a mean of 8.3 years from the time of index ACLR/MAT. Patients with failed grafts were more frequently associated with workers' compensation claims (38% vs 13%, respectively) and less frequently self-identified as athletes (13% vs 56%, respectively) compared with patients with intact grafts.
  
  
  CONCLUSIONS
  Concomitant ACLR/MAT can provide significant improvements in clinical outcomes and enhancement in objective knee stability and was associated with an insignificant degree of radiographic joint-space narrowing changes with a 5-year survivorship of more than 80% for those with data available. Athlete status may be a preoperative predictor of midterm survival.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Saltzman
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Maximilian A
authors.initials: MA
authors.lastname: Meyer
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Weber
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Poland
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Yanke
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000637:transplantation*; D008875:Middle Aged; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: ACLR; MAT; anterior cruciate ligament reconstruction; meniscal allograft transplantation