How Predictable Is Return to Sport After Meniscal Allograft?

Return to sport after meniscal allograft transplantation is questionable, according to a new study. While case studies claim a higher return to sports rate after meniscal allograft use, this research team questioned that and called for additional data in order to put a reliable p-value on whatever the outcomes are.

In the study, “Return to Sports Following Meniscal Allograft Transplantation is Possible but Remains Questionable: A Systematic Review,” published online on November 13, 2021 in the journal Arthroscopy, the research team did a systematic review of the literature in order to tease out whatever return to sport data might exist.

The team searched PubMed, Web of Science and Embase, all roughly a year ago, December 2020. They looked specifically for clinical studies which provided return to sport rate data following meniscal allograft transplantation with at least 12-month follow-up.

They found 14 case series with data covering an aggregate of 670 patients. Five of the studies, they found, used the bone bridge technique. Another five studies provided data regarding suture fixations with bone tunnels were used for all transplantation. In two case studies, the focus was on bone plugs for medial menisci and bone bridge for lateral menisci. One additional study covered suture fixation for medial menisci and bone bridge for lateral menisci.

Overall, the research team found, return to sports rates ranged between 20% and 92%. Two studies, specifically, reported a low return to sport rate.

How long did it take for these allograft transplanted athletes to return to sport? It ranged from 7.6 and 16.9 months. Furthermore, the percentage of athletes who were able to return to pre-injury levels ranged from 7% to 100%, depending on the study and the procedure (naturally).

Interestingly, 2 of the 14 studies reported that meniscal allograft athletes were able to exceed their prior level of sports activity.

The studies reviewed did not commonly report on return to a lower level of sports activity. In aggregate, the Lysholm knee scores, the subjective international knee documentation committee scores and the Knee Osteoarthritis Outcome Score all showed significant improvements after the transplantation.

In one study the Knee Osteoarthritis Outcome Score did not change significantly.

Reoperation rates ranged all over the place, from 3.1% to 80%. Similarly, procedure failure rates ranged from 1.1% and 30.1%.

“Despite that most studies reported high return to sports rate, the current level of evidence is low with all studies being case series. There is significant variability in the reported return to sports rate, time, and level. Therefore, high-quality comparative studies are mandated to elucidate whether meniscal allograft transplantation is associated with higher return to sports rates and levels,” the authors wrote.

Bottom line: This is a fertile area for more and better clinical study.

The study authors included Abdulaziz F. Ahmed, M.D. of Johns Hopkins University School of Medicine, Joseph Rinaldi of Florida International University, Ali S. Noorzad, M.D. of Cedars-Sinai Medical Center, and Bashir A. Zikria, M.D. of Johns Hopkins University School of Medicine.