Good afternoon, I'm actually not Ryan, I'm Chris Broussalis, a sports medicine fellow at Rush. Ryan, unfortunately, couldn't be here today. But today I'll be discussing our study investigating midterm outcomes of meniscal allograft transplantation among adolescents. Meniscal injuries in adolescent populations are increasingly common, have been attributed to increases in athletic competition, sports specialization, and injury awareness in the literature. Increasing evidence supports the need to preserve the meniscus to maintain normal knee mechanics. In patients with tears that are not amenable to repair or following a failed prior meniscal repair, meniscal allograft transplantation serves as a possible treatment option. However, reports regarding meniscal allograft transplantation in adolescents remains comparatively sparse. The senior author of the present study has previously reported on short-term outcomes following meniscal transplants in adolescents. Among 32 patients with a minimum of two years of clinical follow-up, favorable clinical outcomes were achieved. However, there was a trend towards worsening functional outcomes at the final time point and IKDC scores appeared to decline at follow-up beyond two years. So based on the results of that study from 2016, our team revisited that same patient cohort to investigate the durability of the clinical improvement following meniscal allograft transplantation at longer-term follow-up. We hypothesized first that short-term outcome improvements would be maintained at midterm points and also that graft survivability would be comparable to midterm outcomes among adult populations. So we retrospectively queried a single surgeon database to identify adolescent patients with MAT using a bone-in-slot or bone bridge technique with a minimum of five years of follow-up. We evaluated patient-reported outcomes, rates of reoperation, and revision MAT. And it should be noted that the senior author employs this bridge-in-slot technique for his meniscal allograft transplantation. Advantages of this technique include secure bony fixation, maintaining native anterior and posterior horn attachments, and the ease of performing concomitant procedures. The bone is contained completely within the proximal tibial epiphysis with minimal risk to the proximal tibial thysis. So looking at our registry, our query returned 62 eligible patients of which 44 patients had clinical follow-up data. Five-year patient-reported outcome metrics were available in 53% of patients. Three-quarters of patients were female, mean age was 16 years old, and 80% of the transplants were of the lateral meniscus. The majority of patients underwent concomitant procedures which included cartilage restoration, ACL reconstruction, and correction of lower extremity alignment. Mean duration of follow-up for this cohort was 9.5 years. All patient-reported outcomes were improved at one years, two years, and at the follow-up. Lysholm scores at final follow-up were significantly improved when compared to baseline. However, when comparing the final outcome scores to scores at two years postoperatively, there was a trend towards decreased outcomes. However, this trend did not reach statistical significance. Looking at reoperations, 11 patients underwent a reoperation to address the transplanted meniscus, 10 patients underwent partial meniscectomy, and one patient underwent a repair. According to our Kaplan-Meier survival analysis, the overall probability of undergoing a re—of having a reoperation-free survival at 2, 5, and 10 years was 91%, 80%, and 71% respectively. Three patients underwent revision MAT. Given that this was an adolescent population, all three were treated with revision MAT rather than a unilateral or total knee arthroplasty. Overall, MAT survival-free from failure at 2 years was 100%, and at 5 years was 93%. No patient or condition trait was associated with a higher likelihood of MAT failure. So how do the outcomes of MAT in adolescents compare to those in the adult population? On the left is a summary of our outcomes, which, with all prompts, significantly improved at final follow-up compared to baseline. Reoperation rates, again, were 25% at 9.5 years, and overall survival-free from failure was 93%. On the right is a meta-analysis of MAT outcomes published in 2019 in a patient cohort with a mean age of 33 years. The survival rate at 10 years among this cohort was 75%. Although there are multiple variables that make direct comparison between these data challenging, it does suggest that MAT among adolescents can achieve comparable durability despite potentially higher loading challenges from an active population. So in conclusion, meniscal allograft transplantation is a safe and effective treatment modality for adolescents with previous meniscal injury who have ongoing pain and dysfunction. Given the longevity and high demands placed upon meniscal allografts transplanted into adolescent patients, continued surveillance of this patient population is critical. Thank you.

meniscal allograft transplantation

adolescents

midterm outcomes

durability

functional outcomes