Concomitant Cartilage Procedures With Meniscal Allograft Transplantation Do Not Substantially Alter Failure or Survival Rates Relative to Meniscal Allograft Transplantation Without Cartilage Procedures: A Systematic Review

Background: Timely recognition and addressing of concomitant cartilage damage at the time of meniscal allograft transplantation (MAT) is critical to warrant future success. However, there remains a scarcity of data comparing outcomes between MAT with and without cartilage procedures. Purpose: To compare patient-reported outcomes and rates of complications, failures, reoperations, and graft survivorship after MAT with concomitant cartilage procedures (MAT/Cart) and MAT without (MAT/NoCart). Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed according to the 2020 PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) using the Scopus, PubMed, and Embase computerized databases from inception to January 7, 2024. Human clinical studies with levels of evidence 1 to 4 were included that evaluated patient-reported outcomes, postoperative complications, failures, reoperations, and graft survivorship with a minimum mean follow-up of 2 years. Study quality was assessed using the Methodological Index for Non-randomized Studies criteria and Modified Coleman Methodology Score. Results: Twenty-six studies from 2006 to 2024 consisting of 1031 patients were included. Thirteen studies (n = 367) reported on MAT/Cart with a mean patient age of 37.6 years and mean follow-up of 72.9 months. Thirteen studies (n = 665) reported on MAT/NoCart procedures in patients with a mean age of 33.6 years and mean follow-up of 58.6 months. Postoperatively, both study groups had improved clinical outcomes, with International Knee Documentation Committee scores ranging from 55.3 to 74.4 in the MAT/Cart group versus 61.7 to 89.8 in the MAT/NoCart group and Lysholm scores from 62.5 to 85.9 versus 72 to 92.4, respectively. The incidence of failure ranged from 0% to 33% after MAT/Cart versus 3.8% to 43.7% after MAT/NoCart. All included patients either had well-aligned lower extremities in the coronal plane, within 3° to 5° of neutral on the affected side, or underwent correction via an osteotomy before or during the MAT procedure. Subsequent surgery not related to failure was higher in the MAT/Cart group (range, 11.8%-83.3%) as compared with the MAT/NoCart group (range, 4.3%-30.8%). The mean survival rates after MAT/Cart ranged from 86.2% to 100% at 2 years, 75% to 97.9% at 5 years, and 70% to 85% at 10 years. The mean survival rates after MAT/NoCart ranged from 83.5% to 93% at 2 years, 82.6% to 85% at 5 years, and 55% to 90% at 10 years. Decreased range of motion and arthrofibrosis were the most frequently reported complications in each group. Conclusion: In patients with normal lower limb coronal plane alignment, performing cartilage restoration procedures in combination with MAT does not substantially alter clinical outcomes or complication, failure, and survival rates relative to isolated MAT.