Meniscal allograft transplantation survivorship and conversion to arthroplasty in patients older and younger than 40: a systematic review and meta-analysis

Background

Meniscal allograft transplantation (MAT) aims to restore meniscal deficiency with cadaveric meniscal tissue.

Objectives

To compare MAT survivorship and conversion to arthroplasty in patients <40 and ≥40 years old.

Data sources

Pubmed, Embase, Cochrane databases.

Study eligibility criteria

Studies were included if they evaluated medial or lateral MAT, evaluated survivorship or conversion to arthroplasty, reported mean patient age, and were published after 2004.

Study appraisal and synthesis methods

Patient cohorts were sorted into 2 groups where mean age was lesser or greater than 40 years. Data were pooled with the DerSimonian-Laird random-effects model.

Results

A total of 1436 studies were identified, 41 included. Each study had MINORS score ≥9 indicating low risk of bias. There were 4079 patients (59.4% male) in the <40-year cohort, with mean-weighted age 31.3 years, follow-up 6.4 years. There were 625 patients (66.9% male) in the ≥40-year cohort, with mean-weighted age 41.2 years, follow-up 8.0 years. Older patients had significantly more medial MATs (300; 61.9% vs 1746; 48.4%). Patients <40 had weighted mean survivorship 76.3% (95% CI: 69.1%-83.5%) and conversion rate 5.0% (95% CI: 3.5%-6.6%). Patients ≥40 had weighted mean survivorship 72.1% (95% CI: 46.9%-97.3%) and conversion rate 13.1% (95% CI: 4.2%-22.0%).

Limitations

Unavailability of individual data sets.

Conclusions

There appears to be no significant differences in MAT survivorship or conversion to arthroplasty rates in patients <40 and ≥40 in appropriately indicated patients that have concomitant pathology addressed. Older patients undergoing MAT have a higher rate of medial MAT compared with younger cohorts.