caa a22 4500 605455724 CHVBK 20210128100214.0 cr unu---uuuuu 210128e20150101xx s 000 0 eng 10.1007/s00167-014-3431-5 doi (NATIONALLICENCE)springer-10.1007/s00167-014-3431-5 Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication [Elektronische Daten] [P. Kempshall, B. Parkinson, M. Thomas, C. Robb, H. Standell, A. Getgood, T. Spalding] Purpose: Advanced chondral damage (bare bone) at presentation is considered a contraindication to meniscal allograft transplantation (MAT), yet there are few other options for young patients where arthroplasty is not appropriate. This study hypothesis is that MAT in patients with advanced chondral damage can obtain good clinical outcomes, equivalent to patients with minimal chondral damage. Method: A prospective longitudinal study of 99 consecutive patients who underwent MAT between May 2005 and Feb 2013, with a minimum of 1-year follow-up. Patients were categorised into two groups: 60 in Group A (Good) up to ICRS Chondral grade 3b involving <1cm2 and 39 in Group B (Bare) ICRS grade 3b involving >1cm2 or worse. Outcomes were assessed by PROMS (KOOS, IKDC, Lysholm, Tegner Activity Scale), with an endpoint of meniscal allograft failure. Results: Mean follow-up was 2.9years (range 1.1-9.1, SD 1.23), with a similar male to female and lateral to medial ratios between the groups (n.s). The age of Group B was significantly older than Group A (35 vs 29years, p=0.002). The status of the articular cartilage at the time of transplant was directly related to the number of years since index meniscectomy [(A) Mean 6.9years, SD 6.3; (B) 11.9 years, SD 7.4; p=0.001]. Pre-operatively, patients in Group B had significantly worse pain and functional outcome scores (KOOS p=0.022, Lysholm p=0.025, IKDC pain subset p=0.035). The mean increase PROMs was significant in both groups at 1year (KOOS p<0.05, IKDC p<0.001, Lysholm p<0.001), and the pain and functional scores were no longer significantly different between groups (n.s.). The outcome measures continued to improve in both groups at 2 and 3years, with slightly greater improvement in Group A. Failure of the meniscal allograft occurred in 9 patients (A:1, B:8) at a mean time of 1.1years (SD 0.55). Kaplan-Meier survival at 2years was 97.9% (A) and 78% (B) (p=0.002). Logistic regression analysis demonstrated a relationship between survival and chondral grade (p=0.001) and number of concomitant procedures (p<0.001). Conclusion: Patients with advanced chondral damage should not be excluded from MAT. Though there is a higher initial failure rate, these patients obtain a similar therapeutic benefit to the traditional, ideal patient group. Level of evidence: III. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), 2014 Meniscus nationallicence Transplant nationallicence Allograft nationallicence Chondral damage nationallicence Meniscectomy nationallicence Post-meniscectomy pain nationallicence Kempshall P. University Hospital Coventry and Warwickshire, Coventry, UK aut Parkinson B. University Hospital Coventry and Warwickshire, Coventry, UK aut Thomas M. University Hospital Coventry and Warwickshire, Coventry, UK aut Robb C. University Hospital Coventry and Warwickshire, Coventry, UK aut Standell H. University Hospital Coventry and Warwickshire, Coventry, UK aut Getgood A. University Hospital Coventry and Warwickshire, Coventry, UK aut Spalding T. University Hospital Coventry and Warwickshire, Coventry, UK aut Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/1(2015-01-01), 280-289 0942-2056 23:1<280 2015 23 167 https://doi.org/10.1007/s00167-014-3431-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00167-014-3431-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kempshall P. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 700 1- Parkinson B. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 700 1- Thomas M. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 700 1- Robb C. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 700 1- Standell H. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 700 1- Getgood A. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 700 1- Spalding T. University Hospital Coventry and Warwickshire, Coventry, UK aut NATIONALLICENCE 773 0- Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/1(2015-01-01), 280-289 0942-2056 23:1<280 2015 23 167