Combined meniscal allograft transplantation and anterior cruciate ligament reconstruction show good 2- to 14-year outcomes: a systematic review

Abstract

Purpose: To evaluate the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with meniscal allograft transplantation (MAT) through a systematic review of current available evidence. Methods: A systematic database search of PubMed, Embase, Web of Science, and CINAHL was performed from inception up to December 7, 2021, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Follow-up studies (inception cohort studies/nonrandomized controlled trials/retrospective cohort studies) and case series that had more than 10 people published in English and involved patients who underwent a combination of ACLR and MAT were included. The quality of these studies was appraised using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions tool. Systematic review of International Knee Documentation Committee (IKDC), Lysholm, and Tegner activity scores were conducted. Results: Seven studies involving 363 patients were included. The average mean follow-up time was 4.08 years, ranging from 1.75 to 14 years. All studies used the Lysholm Knee Scoring system to report clinical outcomes, whereas 2 studies and 4 studies used the IKDC Questionnaire and Tegner activity scale respectively to measure clinical outcomes postoperatively. Comparing postoperative with preoperative scores, we found an improvement above the minimal clinically important difference for the Lysholm (mean difference [MD] range 16.00-26.10) and Tegner activity scores (MD range 1.50-1.90). All but one study reported an increase above the minimal clinically important difference for IKDC scores postoperatively (MD range 5.60-23.00). Conclusions: Combined MAT and ACLR have good 2- to 14-year clinical outcomes postoperatively and is an optimal procedure for patients with concurrent ACL injuries with irreparable meniscus injuries. Level of Evidence: IV, systematic review and/or meta-analysis of studies with Levels I to IV.