Comparison of Suture Versus Bony Fixation in Meniscal Allograft Transplantation Outcomes: A Meta-analysis.

Abstract

Background: Meniscal allograft transplantation replaces damaged meniscal tissue with grafts, aiming to restore knee stability and function. The method employed in the fixation of the meniscal graft-suture or bony fixation-has sparked clinical interest and ongoing discussions.

Purpose: To compare suture fixation with bony fixation of the meniscal graft, with the focus on functional and clinical outcomes.

Study design: Meta-analysis and systematic review; Level of evidence, 4.

Methods: Meta-analyses were performed with a multidatabase search according to PRISMA guidelines on August 15, 2023. Data from published articles meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model.

Results: A total of 6 studies were included consisting of 334 patients: 184 suture fixation and 150 bony fixation. No statistical analysis could be performed for clinical outcomes given the heterogeneity of raw data, but no observable trends were observed from individual studies. Suture and bony fixation showed no statistically significant difference in the risks of infection (relative risk [RR], 1.52; 95% CI, 0.29-7.80; P = .62), graft failure (RR, 0.86; 95% CI, 0.19-3.78; P = .84), graft tear (RR, 1.14; 95% CI, 0.10-13.21; P = .91), minor graft extrusion (RR, 0.77; 95% CI, 0.20-2.92; P = .70), and major graft extrusion (RR, 1.20; 95% CI, 0.28-5.07; P = .81).

Conclusion: There was no significant difference in clinical outcomes or complications between suture and bony fixation of meniscal grafts. However, the short- to medium-term follow-up in this meta-analysis prompts the need for studies with long-term follow-up, given that meniscal allograft transplantation longevity is of utmost importance in this patient group to restore function and potentially reduce the risk of arthritis progression.