Thanks, everyone. My name is Bill Krieger. I'm stepping in for Dr. Yanke, who had a concurrent presentation in next door. So I'm going to be presenting our work on meniscal holograph transplantation. Here are disclosures, none of which are relevant to this talk. So as we know, meniscal holograph transplantations are known to have good clinical outcomes that are sustained at long-term follow-up. Clinically significant outcomes, or CSOs, have been defined for patients undergoing meniscal holograph transplantations, including both minimal clinically important difference, or MCID, and patient acceptable symptomatic state, or PAST. However, the timing and factors associated with achieving these significant outcomes is not well-defined within the literature. Thus the purpose of this study was to determine time to achieve MCID and PAST, as well as any risk factors affecting achievement of these clinically significant outcomes. We hypothesized that BMI, work comp status, and baseline PROs would be associated with time to achieve clinically significant outcomes following meniscal holograph transplantation. We retrospectively analyzed prospectively collected data on all patients undergoing meniscal holograph transplantation over a five-year period, including those that had concomitant procedures and had both preoperative patient-reported outcomes and at least six-month postoperative follow-up. We excluded patients who underwent revision transplantation, who failed within the study period, or who did not complete preoperative patient-reported outcomes, or have one full set of completed postoperative patient-reported outcomes. We collected IKDC as well as KUS subscores at six months, one year, and two years, with a two-month window at each time point. Prior MCID and PAST values reported by Lew et al. were utilized for our study. We applied Kappemeier survival curves to calculate the cumulative percentages of MCID and PAST achievement, and we also looked at demographic and intra-op factors that affected earlier or delayed achievement of clinically significant outcomes. Overall, there were a total of 80 patients with an even mix of medial and lateral meniscal transplants. Eighty-six percent of patients had six-month PRO data, 95 percent of patients completed one-year PRO data, 68 percent of patients had a concomitant cartilage procedure, whereas around 25 percent of patients underwent isolated meniscal transplantation, and about 18 percent had an associated coronal realignment procedure or osteotomy. When looking at clinically significant outcomes, you can see that in terms of IKDC, both MCID and PAST was achieved at six-month post-op, where all values reached MCID and PAST at one year except for the KUS quality-of-life patient acceptable symptomatic state. Looking at time to MCID, this ranged from 5.8 to eight months, and time to PAST ranged from 5.6 to 11 months. Factors that delayed time to achieve MCID included work comp status, increased BMI, increased number of focal chondral defects, and higher preoperative patient-reported outcome scores. Factors that decreased time to achieve MCID included a concomitant realignment procedure. When looking at factors associated with time to achieve PAST, workers' comp status and increased BMI were associated with a delay in time to achieve PAST, whereas higher preoperative patient-reported outcome scores were associated with a decreased time to achieve PAST. So based on these findings, most patients achieve clinically significant outcomes by about six to eight months after meniscal allograft transplantation with regards to MCID, and most achieve PAST by six to 11 months. Based on the timeframe of patient-reported outcome improvement, most patients have pain relief before they have improvement in quality of life, which makes sense intuitively. BMI and work comp status significantly delayed the achievement of both MCID and PAST with multiple patient-reported outcomes, and this has been borne out in prior literature. We did not find that patients undergoing an isolated transplant had decreased time to clinically significant outcomes, and in fact, those that had a realignment procedure appeared to do better quicker than those that had isolated transplants. Additionally, those that underwent a concomitant cartilage procedure did not have a delay in time to CSO. So in conclusion, most patients have clinically significant improvement in both pain and function following meniscal allograft transplantation with over half of patients experiencing clinically significant outcomes within the first postoperative year. Patients experience pain relief following transplantation faster than improvements in quality of life in both work comp status and increased BMI prolong the time to achievement of clinically significant outcomes following meniscal allograft transplant. Thank you.

meniscal holograph transplantation

clinically significant outcomes

timing

factors

pain relief