Purpose

Successful outcomes of meniscal allograft transplantation are dependent on adequate size matching of donor and patient meniscus. The extent that donor pools meet the demands of the patient pool is unknown. The purpose of this study was to analyze the variability in meniscus size and anthropometric data between donors (supply) and patients (demand), and determine the impact on time to match.

Methods and Materials

Lateral and medial meniscal measurements, sex, patient height and weight, and time to match a donor graft were extracted from a tissue supplier database. Distributions of meniscus size for patient and donor pools were analyzed. Body Mass Index (BMI), meniscus area, body mass to meniscus area index (BMMI), and height to meniscus area index (HMI) were compared via chi-square tests and independent samples t-test. The effect of size on time to match was analyzed using ANOVA and post-hoc Tukey test.

Results

The distributions of meniscus sizes were significantly different for meniscus donor and patient populations (Fig1A-D). The lateral meniscus patients showed a higher frequency of larger size meniscus and the medial meniscus patients showed a higher frequency of smaller size meniscus. The lateral meniscus analysis showed significantly greater meniscus area and increased average height in the patient population. The medial meniscus analysis showed significantly smaller meniscus areas in the patient population contributing to an increased BMMI and HMI. The time to match a donor meniscus was affected by the patient meniscus size.

Figure 1: Distribution of donor (blue) and patient (gray) meniscus sizes.

Conclusion

This analysis demonstrates variations in frequency of meniscus sizes between donor and patient populations. This variation is attributed to significant differences in anthropometric data between patient and donor populations. This work identifies a mismatch between demand and supply. Areas of size mismatch were further substantiated by the longer time period to identify a donor match.

Purpose

Management of young patients with degenerative joint disease (DJD) of the knee is challenging. The spectrum of surgical options include joint preservation and arthroplasty. Direct clinical comparison of these procedures would be useful. We sought to compare the “treatment effect” of various surgical interventions in young patients with knee DJD.

Methods and Materials

Our institution’s registry identified 283 patients age 30-50 who underwent surgery for DJD of the knee by a single surgeon: 68 TKA, 60 UKA, 96 osteochondral allograft (OCA) transplantation, 35 distal femoral osteotomy (DFO), and 24 high tibial osteotomy (HTO) were included. Knee injury and Osteoarthritis Outcome Scores (KOOS) were captured preoperatively and postoperatively. KOOS subscales include symptoms, pain, activities of daily living, sports and recreation, and quality of life.

Results

Mean follow-up was 5.2 years (range, 2-14 years). Mean age was 42 years. Clinically significant improvements were seen on every KOOS subscale for all treatments (p<0.001) (Table 1.) Largest improvement in symptoms was for UKA (30 points). OCA had the lowest improvement (17 points), but pre and postoperative mean scores were highest. Best pain score improvement was for TKA and UKA (both 29 points). Lowest pain score improvement was for OCA (19 points). ADL scores improved most for TKA (31 points) and least for OCA (18 points). Improvement in sports and recreation was similar for TKA, UKA, OCA, and DFO (34, 33, 35, and 39 respectively and lowest for HTO (17 points). Quality of life improved most for TKA (42 points), followed by HTO (37 points) and UKA (36 points).

Conclusion

Arthroplasty had the largest treatment effects for symptoms, pain, and activities of daily living. Osteotomy had the largest treatment effects for sports and recreation (DFO) and quality of life (HTO). OCA had the lowest treatment effects but highest mean KOOS scores.

Purpose

The impact of donor characteristics on clinical outcomes of OCA transplantation is not well understood. Several studies have reported inconsistent findings when considering storage time for fresh OCA grafts on clinical outcomes. No studies to date have investigated the possibility of donor characteristics impacting clinical outcomes. The purpose of this study was to determine if donor characteristics and graft storage time were associated with graft survivorship.

Methods and Materials

In this cohort study, data were analyzed from patients who underwent primary OCA transplantation of the knee (Table 1). All patients had a minimum 2-year follow-up. Survival rate (grafts remaining in situ) and survivorship were compared between patients who received OCA graft from donors (i) aged > 20 years old or ≤ 20 years old, (ii) with BMI ≤ 30 or with BMI > 30, (iii) of same sex (matched) or different sex (mismatched), (iv) released early (1-14d) or late (15-28d) using chi-square testing and log-rank analysis.

Results

The mean follow-up was 8.0 years. Patients who received OCA grafts from older donors had a significantly lower survival rate of 88.3% (grafts remaining in situ) compared to OCAs from younger donors (96.7%, P = 0.039). The 10-year survivorship (Figure 1) of the OCA was 89.3% for older donor group and 100.0% for younger donor group. Interestingly, OCA survival rate for early release (77.3%) was significantly lower than late-release (94.0%) group (P = 0.002). The 10-year survivorship rate was 85.6% in the early-release and 96.1% in the late-release group. Donor BMI and sex matching did not impact survivorship.

Conclusion

Donor factors are important variables that have not been previously studied. The findings of this work suggest that donor age can impact survivorship of OCA transplantation. Late-release grafts were also associated with higher graft survivorship.