Background:

Meniscal allograft transplant (MAT) is an important treatment option for young patients with deficient menisci; however, there is a lack of consensus on the optimal method of allograft fixation.

Hypothesis:

The various methods of MAT fixation have measurable and significant differences in outcomes.

Study Design:

Meta-analysis; Level of evidence, 4.

Methods:

A single-arm meta-analysis of studies reporting graft failure, reoperations, and other clinical outcomes after MAT was performed. Studies were stratified by suture-only, bone plug, and bone bridge fixation methods. Proportionate rates of failure and reoperation for each fixation technique were pooled with a mixed-effects model, after which reconstruction of relative risks with confidence intervals was performed using the Katz logarithmic method.

Results:

A total of 2604 patients underwent MAT. Weighted mean follow-up was 4.3 years (95% CI, 3.2-5.6 years). During this follow-up period, graft failure rates were 6.2% (95% CI, 3.2%-11.6%) for bone plug fixation, 6.9% (95% CI, 4.5%-10.3%) for suture-only fixation, and 9.3% (95% CI, 6.2%-13.9%) for bone bridge fixation. Transplanted menisci secured using bone plugs displayed a lower risk of failure compared with menisci secured via bone bridges (RR = 0.97; 95% CI, 0.94-0.99; P = .02). Risks of failure were not significantly different when comparing suture fixation to bone bridge (RR = 1.02; 95% CI, 0.99-1.06; P = .12) and bone plugs (RR = 0.99; 95% CI, 0.96-1.02; P = .64). Allografts secured using bone plugs were at a lower risk of requiring reoperations compared with those secured using sutures (RR = 0.91; 95% CI, 0.87-0.95; P < .001), whereas allografts secured using bone bridges had a higher risk of reoperation when compared with those secured using either sutures (RR = 1.28; 95% CI, 1.19-1.38; P < .001) or bone plugs (RR = 1.41; 95% CI, 1.32-1.51; P < .001). Improvements in Lysholm and International Knee Documentation Committee scores were comparable among the different groups.

Conclusion:

This meta-analysis demonstrates that bone plug fixation of transplanted meniscal allografts carries a lower risk of failure than the bone bridge method and has a lower risk of requiring subsequent operations than both suture-only and bone bridge methods of fixation. This suggests that the technique used in the fixation of a transplanted meniscal allograft is an important factor in the clinical outcomes of patients receiving MATs.

中文翻译：

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使用骨塞固定移植的半月板同种异体移植物可降低移植失败和再次手术的风险：荟萃分析

 背景：

同种异体半月板移植（MAT）是年轻半月板缺陷患者的重要治疗选择；然而，对于同种异体移植固定的最佳方法缺乏共识。

 假设：

不同的 MAT 固定方法在结果上具有可测量且显着的差异。

 学习规划：

荟萃分析；证据级别，4。

 方法：

对报告移植失败、再次手术和 MAT 后其他临床结果的研究进行了单臂荟萃分析。研究按仅缝合、骨塞和骨桥固定方法进行分层。将每种固定技术的失败率和再手术率与混合效应模型进行汇总，然后使用 Katz 对数方法重建相对风险与置信区间。

 结果：

共有 2604 名患者接受了 MAT。加权平均随访时间为 4.3 年（95% CI，3.2-5.6 年）。在此随访期间，骨塞固定的移植失败率为 6.2%（95% CI，3.2%-11.6%），仅缝合固定的移植失败率为 6.9%（95% CI，4.5%-10.3%），而骨栓固定的移植失败率为 9.3%（95% CI，4.5%-10.3%）。 % (95% CI, 6.2%-13.9%) 用于骨桥固定。与通过骨桥固定的半月板相比，使用骨塞固定的移植半月板失败的风险较低（RR = 0.97；95% CI，0.94-0.99； P = .02）。比较缝合固定骨桥（RR = 1.02；95% CI，0.99-1.06； P = .12）和骨塞（RR = 0.99；95% CI，0.96-1.02； P = 0.12）时，失败风险没有显着差异。 .64）。与使用缝线固定的同种异体移植物相比，使用骨塞固定的同种异体移植物需要再次手术的风险较低（RR = 0.91；95% CI，0.87-0.95； P < .001），而使用骨桥固定的同种异体移植物再次手术的风险较高与使用缝线（RR = 1.28；95% CI，1.19-1.38； P < .001）或骨塞（RR = 1.41；95% CI，1.32-1.51； P < .001）固定的相比。 Lysholm 和国际膝关节文献委员会评分的改善在不同组之间具有可比性。

 结论：

这项荟萃分析表明，与骨桥方法相比，移植半月板同种异体移植物的骨塞固定失败的风险较低，并且比仅缝合和骨桥固定方法需要后续手术的风险较低。这表明移植半月板同种异体移植物的固定技术是接受 MAT 的患者临床结果的重要因素。