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

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.