Purpose
(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.
Methods
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.
Results
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.
Conclusions
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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References
- Meniscal allograft transplantation: How should we be doing it? A systematic review.Arthroscopy. 2015; 31: 911-925
- Defining outcome after meniscal allograft transplantation: Is buying time a valid measure of success?.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1424-1426
- Midterm and long-term results of medial versus lateral meniscal allograft transplantation: A meta-analysis.Am J Sports Med. 2018; 46: 1243-1250
- 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
- Return to sports after athletes undergo meniscal surgery: A systematic review.Clin J Sport Med. 2019; 29: 29-36
- Long-term survival analysis and outcomes of meniscal allograft transplantation with minimum 10-year follow-up: A systematic review.Arthroscopy. 2019; 35: 659-667
- Biological knee reconstruction: A systematic review of combined meniscal allograft transplantation and cartilage repair or restoration.Arthroscopy. 2011; 27: 409-418
- Analysis of outcomes for high tibial osteotomies performed with cartilage restoration techniques.Arthroscopy. 2017; 33: 486-492
- Can patients really participate in sport after high tibial osteotomy?.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 64-73
- 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
- Return to sports after tibial tubercle osteotomy for patellofemoral pain and osteoarthritis.Arthroscopy. 2018; 34: 1022-1029
- A comparative analysis of work-related outcomes after humeral hemiarthroplasty and reverse total shoulder arthroplasty.J Shoulder Elbow Surg. 2017; 26: 954-959
- Hemiarthroplasty versus total shoulder arthroplasty for shoulder osteoarthritis: A matched comparison of return to sports.Am J Sports Med. 2016; 44: 1417-1422
- Sports after shoulder arthroplasty: A comparative analysis of hemiarthroplasty and reverse total shoulder replacement.J Shoulder Elbow Surg. 2016; 25: 920-926
- 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
- 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
United States Department of Labor. Dictionary of occupational titles (4th ed, rev 1991): appendix C. www.oalj.dol.gov/PUBLIC/DOT/REFERENCES/DOTAPPC.HTM. Accessed February 6, 2019.
- 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)
- Is sport activity possible after arthroscopic meniscal allograft transplantation? midterm results in active patients.Am J Sports Med. 2016; 44: 625-632
- Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.J Bone Joint Surg Am. 2005; 87: 715-724
- Preoperative tibial subchondral bone marrow lesion patterns and associations with outcomes after isolated meniscus allograft transplantation.Am J Sports Med. 2018; 46: 1175-1184
- 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
- An introduction to clinical significance in orthopaedic outcomes research.JBJS Rev. 2015; 3
- Patient understanding, expectations, and satisfaction regarding rotator cuff injuries and surgical management.Arthroscopy. 2017; 33: 1603-1606
- Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics.J Shoulder Elbow Surg. 2012; 21: 715-721
- Sports- and work-related outcomes after shoulder hemiarthroplasty.Am J Sports Med. 2016; 44: 490-496
Article info
Publication history
Accepted:
May 23,
2019
Received:
February 26,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.B.Y. receives research support from Arthrex and Organogenesis and is a paid consultant for JRF Ortho. B.J.C. receives research support from Aesculap/B.Braun and National Institutes of Health; is on the editorial or governing board of the American Journal of Orthopedics, American Journal of Sports Medicine, Arthroscopy, Cartilage, Journal of Shoulder and Elbow Surgery, and Journal of the American Academy of Orthopaedic Surgeons; receives royalties and research support from and is a paid consultant for Arthrex; is a board or committee member of the Arthroscopy Association of North America and International Cartilage Repair Society; receives other financial support from Athletico; receives IP royalties from Elsevier Publishing; receives financial or material support from JRF Ortho; receives publishing royalties from Operative Techniques in Sports Medicine; receives stock or stock options from Ossio; is a paid consultant for and receives stock or stock options from Regentis; and is a paid consultant for Smith & Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 3097
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© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Return to Sport Should Not Be Your Goal Following High Tibial Osteotomy With Concomitant Medial Meniscal Allograft TransplantationArthroscopyVol. 35Issue 11
- PreviewMeniscal allograft transplantation has been done for 3 decades as a salvage procedure for patients with painful compartments following total or near-total meniscectomy. In malaligned joints, periarticular osteotomies often are performed in conjunction with the transplantation. The goal has been to reduce pain and improve function. Early series showed that retear of transplanted menisci was common. Because many recipients of meniscal transplantations are young, the goal has been to reduce pain and restore function, and high-demand work or sporting activities have been discouraged.
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