Background:

Collagen meniscal implant (CMI) is a biologic scaffold that can be used to replace meniscus host tissue after partial meniscectomy. The short-term results of this procedure have already been described; however, little is known about risk factors for failure.

Purpose:

To determine the factors that predict failure of meniscal scaffold implantation in a large series of patients treated at a single institution and to better define the indications for surgery.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The analysis included 186 consecutive patients with a minimum 5-year follow-up who underwent CMI scaffold implantation or combined procedures. Patients’ characteristics and details of the surgery were obtained via chart review. Patients with a Lysholm score <65 were considered to have experienced clinical failure. Surgical failure was defined as partial or total scaffold removal.

Results:

The final analysis included 156 patients (84%) at a mean follow-up of 10.9 ± 4.3 years. The patients’ mean age at surgery was 42.0 ± 11.1 years, and the survival rate was 87.8%. Subgroup analysis identified Outerbridge grade 3-4 (Hazard ratio [HR], 3.8; P = .004) and a lateral meniscal implant (HR, 3.2; P = .048) as risk factors for failure. The survival rate was 90.4% for medial implants and 77.4% for lateral implants. An Outerbridge grade 3-4 (HR, 2.8; P < .001) and time from meniscectomy to scaffold >10 years (HR, 2.8; P = .020) were predictive of surgical or clinical failure.

Conclusion:

CMI for partial meniscal deficiency provided good long-term results, with 87.8% of the implants still in situ at a mean 10.9 years of follow-up. Outerbridge grade 3-4, lateral meniscal implants, and longer time from the meniscectomy to implantation of the CMI were identified as risk factors for clinical and surgical failure.

中文翻译：

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影响半月板部分缺损的胶原半月板植入物存活率的危险因素：平均 10 年随访的 156 例连续病例分析

背景：

胶原半月板植入物 (CMI) 是一种生物支架，可用于在部分半月板切除术后替代半月板宿主组织。这个过程的短期结果已经描述过；然而，人们对失败的风险因素知之甚少。

目的：

确定在单一机构治疗的大量患者中预测半月板支架植入失败的因素，并更好地确定手术适应症。

学习规划：

病例对照研究；证据水平，3。

方法：

该分析包括 186 名接受 CMI 支架植入或联合手术的至少 5 年随访的连续患者。通过图表回顾获得患者的特征和手术细节。Lysholm 评分 <65 的患者被认为经历了临床失败。手术失败被定义为部分或全部支架移除。

结果：

最终分析包括 156 名患者 (84%)，平均随访时间为 10.9 ± 4.3 年。患者平均手术年龄为42.0±11.1岁，生存率为87.8%。亚组分析确定 Outerbridge 3-4 级（风险比 [HR]，3.8；P = .004）和外侧半月板植入物（HR，3.2；P = .048）是失败的危险因素。内侧种植体的成活率为90.4%，外侧种植体的成活率为77.4%。Outerbridge 3-4 级（HR，2.8；P < .001）和从半月板切除到支架的时间>10 年（HR，2.8；P = .020）可预测手术或临床失败。

结论：

部分半月板缺损的 CMI 提供了良好的长期结果，在平均 10.9 年的随访中，87.8% 的植入物仍在原位。Outerbridge 3-4 级、外侧半月板植入物以及从半月板切除术到植入 CMI 的时间较长被确定为临床和手术失败的危险因素。