Original Article| Volume 35, ISSUE 11, P3090-3096, November 2019

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Return to Sport and Work After High Tibial Osteotomy With Concomitant Medial Meniscal Allograft Transplant


      (1) To examine the timeline of return to sport (RTS) and return to work (RTW) after high tibial osteotomy (HTO) with concomitant medial meniscal allograft transplant (MAT), (2) to evaluate the degree of function on RTS and RTW, and (3) to identify reasons patients do not return to sport- or work-related activity.


      Patients undergoing HTO plus MAT were reviewed retrospectively at a minimum of 2 years postoperatively. The exclusion criterion was any concomitant procedure except cartilage restoration for focal full-thickness medial femoral condylar defects. Patients completed a subjective sport and work questionnaire, a visual analog scale for pain, the Single Assessment Numeric Evaluation, and a satisfaction questionnaire.


      Twenty-two patients (aged 35.1 ± 8.1 years) were included at 9.3 ± 3.7 years postoperatively. Sixteen patients participated in sports within 3 years before surgery, and 14 patients (87.5%) returned to sport by 9.7 ± 3.8 months postoperatively. Only 7 patients (43.8%) returned to their preinjury status. Eighteen patients were employed within 3 years before surgery, and all patients returned to work; however, only 16 patients (88.9%) returned at the same occupational intensity by 3.1 ± 2.4 months. The rates of RTW for light-, medium-, and heavy-intensity occupations were 100%, 75.0%, and 85.7%, respectively, whereas the duration of RTW was 2.1 months, 2.3 months, and 4.8 months, respectively. Of the patients, 20 (90.9%) reported at least 1 complaint postoperatively, with 13 patients (59.1%) returning to the operating room for recurrent symptoms, including 1 patient who received a knee replacement at 7.75 years postoperatively.


      In patients with medial meniscal deficiency and varus deformity, HTO plus MAT provided high rates of RTS (87.5%) and RTW (100%) by 9.7 months and 3.1 months, respectively. It is imperative that clinicians manage expectations because patients may RTS and RTW after HTO plus MAT; however, return to high-intensity activities or occupations may be unlikely or delayed.

      Level of Evidence

      Level IV, retrospective case series.
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        • Myers P.
        • Tudor F.
        Meniscal allograft transplantation: How should we be doing it? A systematic review.
        Arthroscopy. 2015; 31: 911-925
        • Spalding T.
        • Getgood A.
        Defining outcome after meniscal allograft transplantation: Is buying time a valid measure of success?.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1424-1426
        • Bin S.I.
        • Nha K.W.
        • Cheong J.Y.
        • Shin Y.S.
        Midterm and long-term results of medial versus lateral meniscal allograft transplantation: A meta-analysis.
        Am J Sports Med. 2018; 46: 1243-1250
        • Lee B.S.
        • Kim H.J.
        • Lee C.R.
        • et al.
        Clinical outcomes of meniscal allograft transplantation with or without other procedures: A systematic review and meta-analysis.
        Am J Sports Med. 2018; 46: 3047-3056
        • Lee Y.S.
        • Lee O.S.
        • Lee S.H.
        Return to sports after athletes undergo meniscal surgery: A systematic review.
        Clin J Sport Med. 2019; 29: 29-36
        • Novaretti J.V.
        • Patel N.K.
        • Lian J.
        • et al.
        Long-term survival analysis and outcomes of meniscal allograft transplantation with minimum 10-year follow-up: A systematic review.
        Arthroscopy. 2019; 35: 659-667
        • Harris J.D.
        • Cavo M.
        • Brophy R.
        • Siston R.
        • Flanigan D.
        Biological knee reconstruction: A systematic review of combined meniscal allograft transplantation and cartilage repair or restoration.
        Arthroscopy. 2011; 27: 409-418
        • Kahlenberg C.A.
        • Nwachukwu B.U.
        • Hamid K.S.
        • Steinhaus M.E.
        • Williams III, R.J.
        Analysis of outcomes for high tibial osteotomies performed with cartilage restoration techniques.
        Arthroscopy. 2017; 33: 486-492
        • Bonnin M.P.
        • Laurent J.R.
        • Zadegan F.
        • Badet R.
        • Pooler Archbold H.A.
        • Servien E.
        Can patients really participate in sport after high tibial osteotomy?.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 64-73
        • Liu J.N.
        • Garcia G.H.
        • Wong A.C.
        • et al.
        Return to work after anatomic total shoulder arthroplasty for patients 55 years and younger at average 5-year follow-up.
        Orthopedics. 2018; 41: e310-e315
        • Liu J.N.
        • Wu H.H.
        • Garcia G.H.
        • Kalbian I.L.
        • Strickland S.M.
        • Shubin Stein B.E.
        Return to sports after tibial tubercle osteotomy for patellofemoral pain and osteoarthritis.
        Arthroscopy. 2018; 34: 1022-1029
        • Hurwit D.J.
        • Liu J.N.
        • Garcia G.H.
        • et al.
        A comparative analysis of work-related outcomes after humeral hemiarthroplasty and reverse total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2017; 26: 954-959
        • Garcia G.H.
        • Liu J.N.
        • Mahony G.T.
        • et al.
        Hemiarthroplasty versus total shoulder arthroplasty for shoulder osteoarthritis: A matched comparison of return to sports.
        Am J Sports Med. 2016; 44: 1417-1422
        • Liu J.N.
        • Garcia G.H.
        • Mahony G.
        • et al.
        Sports after shoulder arthroplasty: A comparative analysis of hemiarthroplasty and reverse total shoulder replacement.
        J Shoulder Elbow Surg. 2016; 25: 920-926
        • Garcia G.H.
        • Wu H.H.
        • Liu J.N.
        • Huffman G.R.
        • Kelly IV, J.D.
        Outcomes of the remplissage procedure and its effects on return to sports: Average 5-year follow-up.
        Am J Sports Med. 2016; 44: 1124-1130
        • Garcia G.H.
        • Liu J.N.
        • Sinatro A.
        • et al.
        High satisfaction and return to sports after total shoulder arthroplasty in patients aged 55 years and younger.
        Am J Sports Med. 2017; 45: 1664-1669
      1. United States Department of Labor. Dictionary of occupational titles (4th ed, rev 1991): appendix C. Accessed February 6, 2019.

        • Grassi A.
        • Bailey J.R.
        • Filardo G.
        • Samuelsson K.
        • Zaffagnini S.
        • Amendola A.
        Return to sport activity after meniscal allograft transplantation: At what level and at what cost? A systematic review and meta-analysis.
        Sports Health. 2019; (1941738118819723)
        • Zaffagnini S.
        • Grassi A.
        • Marcheggiani Muccioli G.M.
        • et al.
        Is sport activity possible after arthroscopic meniscal allograft transplantation? midterm results in active patients.
        Am J Sports Med. 2016; 44: 625-632
        • Verdonk P.C.
        • Demurie A.
        • Almqvist K.F.
        • Veys E.M.
        • Verbruggen G.
        • Verdonk R.
        Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.
        J Bone Joint Surg Am. 2005; 87: 715-724
        • Saltzman B.M.
        • Cotter E.J.
        • Stephens J.P.
        • et al.
        Preoperative tibial subchondral bone marrow lesion patterns and associations with outcomes after isolated meniscus allograft transplantation.
        Am J Sports Med. 2018; 46: 1175-1184
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 3: Pearls and pitfalls of meta-analyses and systematic reviews.
        Arthroscopy. 2017; 33: 1594-1602
        • Jevsevar D.S.
        • Sanders J.
        • Bozic K.J.
        • Brown G.A.
        An introduction to clinical significance in orthopaedic outcomes research.
        JBJS Rev. 2015; 3
        • Cole B.J.
        • Cotter E.J.
        • Wang K.C.
        • Davey A.
        Patient understanding, expectations, and satisfaction regarding rotator cuff injuries and surgical management.
        Arthroscopy. 2017; 33: 1603-1606
        • Oh J.H.
        • Yoon J.P.
        • Kim J.Y.
        • Kim S.H.
        Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics.
        J Shoulder Elbow Surg. 2012; 21: 715-721
        • Garcia G.H.
        • Mahony G.T.
        • Fabricant P.D.
        • et al.
        Sports- and work-related outcomes after shoulder hemiarthroplasty.
        Am J Sports Med. 2016; 44: 490-496

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