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.