Osteochondral Allograft Transplantation With Concomitant Meniscal Allograft Transplantation Improves Clinical Outcomes and Yields High Patient Satisfaction: A Systematic Review.

Abstract

Purpose: To conduct a systematic review evaluating subjective patient-reported outcomes, reoperations, and graft failure after concomitant osteochondral allograft (OCA) transplantation and meniscal allograft transplantation (MAT).

Methods: A literature search was performed by querying the MEDLINE, Embase, and PubMed databases according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The inclusion criteria were limited to peer-reviewed, English-language, Level I to IV studies with at least 10 patients that reported clinical outcomes and complications after OCA transplantation with concomitant MAT for osteochondral defects and meniscal deficiency with minimum 2-year follow-up. For most of the included studies, failure was defined as conversion to arthroplasty, revision OCA, or graft failure on postoperative imaging.

Results: Six studies with a total of 188 patients met the inclusion and exclusion criteria. The mean patient age was 32.4 years (range, 15-66 years). Improvement in the following outcome scores was observed across all included studies from preoperatively to postoperatively: Lysholm knee score (+21 to +26.69); International Knee Documentation Committee Subjective Knee Form score (+19 to +26.55); Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale (+17.91 to +26), KOOS Symptom subscale (+9 to +18.16), KOOS Activities of Daily Living subscale (+11.91 to +23.4), KOOS Sport subscale (+19 to +26.04), KOOS Quality of Life subscale (+22 to +35.01), 12-Item Short Form Survey physical score (+5 to +12.26), and 12-Item Short Form Survey mental score (+1.8 to +4) (P < .05 for all). The reoperation rate was between 6.7% and 54%. The failure rate was between 13% and 22.9%. Although patient satisfaction data were only available in 2 studies, 82% to 90% of patients would choose to undergo OCA transplantation with MAT again.

Conclusions: OCA transplantation with concomitant MAT for the treatment of focal chondral defects in the presence of meniscal deficiency results in improved patient-reported outcome measures with high patient satisfaction rates. The mean reoperation rate and failure rate at a mean follow-up time of 4.7 years are 37.3% and 17.1%, respectively, which are expected and consistent with the existing literature on isolated procedures.

Level of evidence: Level IV, systematic review of Level III and IV studies.