Biological knee reconstruction: A systematic review of combined meniscal allograft transplantation and cartilage repair or restoration

Purpose: Combined meniscal allograft transplantation (MAT) and cartilage repair or restoration is a recognized treatment for patients with painful, meniscus-deficient knees and full-thickness cartilage damage. The purpose of this systematic review was to compare outcomes after combined MAT and cartilage repair/restoration with the outcomes of isolated MAT or cartilage repair/restoration. Methods: Multiple databases were searched with specific inclusion and exclusion criteria for clinical outcome studies after combined MAT and cartilage repair or restoration. Results: Six studies were identified for inclusion. In total 110 patients underwent combined MAT/cartilage repair or restoration (medial compartment in 66 and lateral compartment in 44). Patients underwent MAT and either autologous chondrocyte implantation (n = 73), osteochondral allograft (n = 20), osteochondral autograft transfer (n = 17), or microfracture (n = 3). Thirty-six patients underwent additional concurrent surgeries (high tibial or distal femoral osteotomy, cruciate or collateral ligament reconstruction, and hardware removal). All clinical outcomes were improved at final follow-up (mean, 36 months). In 4 of 6 studies, overall outcomes of combined surgery were equivalent to those of either procedure performed in isolation. In 2 studies outcomes of combined surgery were not as good as those of either procedure performed in isolation. Failure occurred in 12% of patients who underwent combined MAT and cartilage restoration, and they required revision surgery. Most failures (85%) of combined surgery were due to failure of the MAT (as opposed to the cartilage technique). One-half of all patients required at least 1 surgery after the index procedure before final follow-up. Conclusions: Clinical outcomes after combined MAT and cartilage repair/restoration are similar to those after either procedure in isolation. Despite low rates of complications and failures, there is a high rate of subsequent surgery after combined MAT and cartilage repair or restoration. Level of Evidence: Level IV, systematic review of Level IV studies.