Meniscal Transplants in Young Patients: Great While They Last
Meniscal transplantation is often recommended after total meniscectomy for patients younger than 50 who remain symptomatic and show articular cartilage deterioration. But for how long are these transplants effective?
That’s what Noyes et al. attempt to answer in a survivorship analysis in the August 5, 2015 Journal of Bone & Joint Surgery. Extending the follow-up from a JBJS study they published in 2005, the authors tracked 40 cryopreserved menisci implanted into 38 patients for an average of 11 years. They measured transplant survival in two distinct ways:
- In terms of symptom-driven endpoints, including transplant removal, revision, or tibiofemoral compartment pain
- In terms of additional asymptomatic “worst-case” endpoints, including grade-3 signal intensity, extrusion (>50% of meniscal width), evident meniscal tear (per MRI or physical examination), or radiographic loss of joint space.
Using Kaplan-Meier survivorship analyses, Noyes et al. estimated transplant survival according to the first set of criteria as follows:
- 88% at 5 years
- 63% at 10 years
- 40% at 15 years
Using the more clinically stringent worst-case criteria, the authors estimated transplant survival as follows:
- 73% at 5 years
- 48% at 10 years
- 15% at 15 years
From these numbers, the authors conclude that “most (if not all) meniscal transplants will undergo a deleterious remodeling process at different time periods postoperatively.” They therefore stress that “patient candidates…should be advised that the procedure is not curative.”
Nevertheless, Noyes et al. emphasize that meniscal transplantation provides many patients with substantial short- and medium-term improvements in knee pain and function and that “there are patients who demonstrate worst-case imaging findings who remain relatively asymptomatic for several years.”
Ultimately, the authors say this study gives clinicians “reasonable survival percentages with regard to the potential to delay the necessity for subsequent major procedures.”