C. Leite (Boston, US)
Brigahm and Women's Hospital OrthopaedicPresenter Of 2 Presentations
16.3.7 - Sex Mismatch Between Donor and Recipient is Associated with Decreased Graft Survivorship After Osteochondral Allograft Transplantation
Abstract
Purpose
Sex mismatch between donor and recipient has been considered a potential contributor to adverse outcomes following solid organ transplantation. However, the influence of sex mismatching in osteochondral allograft (OCA) transplantation is yet to be determined. The purpose of this study was to evaluate whether donor-recipient sex mismatching impacts graft survival after OCA transplantation.
Methods and Materials
Patients who underwent OCA transplantation between November 2013 and November 2017 by a single surgeon were included. Cumulative survival was performed through the Kaplan–Meier method using log-rank tests to compare patients with similar donor groups. Multivariable Cox regression analysis adjusted for patient age, graft size and BMI were used to evaluate the influence of donor-recipient sex on graft survival.
Results
A total of 154 patients were included, 102 (66.2%) who received OCAs from a same-sex donor, and 52 (33.8%) from a different sex donor. At 5 years follow-up, a significantly lower graft survival rate was observed for different-sex donor transplantation in comparison to the same-sex donors (63% versus 92%, p=0.01). When correcting for age, graft size and BMI, donor-recipient sex mismatching demonstrated a 2.9 times greater likelihood to fail at 5 years compared to the donor-recipient same-sex (p=0.03). A subgroup analysis showed no significant difference in graft survival between female-to-female and female-to-male groups (91% and 84%, respectively). Conversely, male-to-male demonstrated a significantly higher cumulative 5-year survival (94%, p=0.04), whereas a lower survival was found in the male-to-female group (64%, p = 0.04). Multivariable Cox regression indicated a 2.6 times higher likelihood of failure for male-to-female in comparison with other groups (p=0.04). Male-to-male had a tendency toward the decreased likelihood of OCA failure (0.33 hazard ratio), although without statistical significance (p=0.052).
Conclusion
Mismatch between donor and recipient sex has a negative effect on OCA survival following transplantation, particularly in those cases when male donor tissue was transplanted into a female recipient.
P120 - Systematic Review of Medial Meniscus Allograft Transplantation: Surgical Technique, Graft Extrusion and Functional Outcomes
Abstract
Purpose
To systematically summarize the medial meniscus allograft transplantation (MAT) reported outcomes and evaluate whether the surgical technique is associated with allograft extrusion and knee function.
Methods and Materials
In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a literature review was performed utilizing PubMed, Embase and Cochrane Library databases. Inclusion criteria were English-language clinical studies involving arthroscopically assisted medial MAT that reported the surgical technique as well as the presence of graft extrusion, and/or functional outcomes after surgery. Studies in which the outcomes for medial MAT could not be separated from lateral MAT were excluded. Surgical technique, allograft-related characteristics and clinical outcomes were extracted.
Results
Twenty-five studies were included, the majority of them classified as level of evidence 4 (56%). Of the 335 considered cases of medial MAT, 235 (70.1%) used bone plug technique, 55 (16.4%) bone bridge trough technique, and 45 (13.4%) soft-tissue techniques. Pooled mean value of absolute extrusion after surgery was 3.2 ± 0.9 mm, and the rate of major extrusion (> 3 mm) was 35.8%. Overall, functional scores improved after medial MAT. None of the surgical techniques were associated with poor functional outcomes and extruded meniscus; however, non-anatomically placement of allograft horns increased meniscus extrusion. Graft tear was the most common cause of reoperation (24.4%). Failure rate of 16.7% was demonstrated.
Conclusion
Medial MAT provides favorable outcomes, with acceptable rates of complication and failure regardless of surgical technique. While allograft extrusion appears equivalent for both bone plug and soft-tissue fixation techniques, positioning allograft horns at the native meniscal footprint may be critical for preventing extrusion. However, the heterogeneity and low level of evidence of the studies included in this systematic review prevent decisive conclusions regarding optimal MAT fixation techniques, clinical significance of allograft extrusion, or comparative clinical outcomes after medial MAT.
Presenter Of 1 Presentation
P120 - Systematic Review of Medial Meniscus Allograft Transplantation: Surgical Technique, Graft Extrusion and Functional Outcomes
Abstract
Purpose
To systematically summarize the medial meniscus allograft transplantation (MAT) reported outcomes and evaluate whether the surgical technique is associated with allograft extrusion and knee function.
Methods and Materials
In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a literature review was performed utilizing PubMed, Embase and Cochrane Library databases. Inclusion criteria were English-language clinical studies involving arthroscopically assisted medial MAT that reported the surgical technique as well as the presence of graft extrusion, and/or functional outcomes after surgery. Studies in which the outcomes for medial MAT could not be separated from lateral MAT were excluded. Surgical technique, allograft-related characteristics and clinical outcomes were extracted.
Results
Twenty-five studies were included, the majority of them classified as level of evidence 4 (56%). Of the 335 considered cases of medial MAT, 235 (70.1%) used bone plug technique, 55 (16.4%) bone bridge trough technique, and 45 (13.4%) soft-tissue techniques. Pooled mean value of absolute extrusion after surgery was 3.2 ± 0.9 mm, and the rate of major extrusion (> 3 mm) was 35.8%. Overall, functional scores improved after medial MAT. None of the surgical techniques were associated with poor functional outcomes and extruded meniscus; however, non-anatomically placement of allograft horns increased meniscus extrusion. Graft tear was the most common cause of reoperation (24.4%). Failure rate of 16.7% was demonstrated.
Conclusion
Medial MAT provides favorable outcomes, with acceptable rates of complication and failure regardless of surgical technique. While allograft extrusion appears equivalent for both bone plug and soft-tissue fixation techniques, positioning allograft horns at the native meniscal footprint may be critical for preventing extrusion. However, the heterogeneity and low level of evidence of the studies included in this systematic review prevent decisive conclusions regarding optimal MAT fixation techniques, clinical significance of allograft extrusion, or comparative clinical outcomes after medial MAT.