Better meniscal volume and quality reduce cartilage degeneration following autologous osteochondral transfer: A retrospective comparative study with a mean 6-year follow-up.

BACKGROUND

Autologous osteochondral transfer (AOT) surgery yields favorable outcomes with appropriate patient selection. Although several factors influencing surgical outcomes have been identified, the effect of meniscal volume and quality on AOT outcomes remains unclear.

HYPOTHESIS: Better meniscal status would be associated with reduced deterioration of cartilage repair over time following AOT.

MATERIALS AND

METHODS

Patients who underwent AOT between March 2002 and March 2021 were retrospectively reviewed. Inclusion criteria were: (1) magnetic resonance imaging (MRI) at 1-2 years postoperatively for evaluation of meniscal status, and (2) follow-up MRI after at least 2 years. Meniscal lesions were addressed during surgery, and postoperative residual meniscal status was graded using a 6-point scale (0-3 for volume, 0-3 for quality). Patients were divided into better meniscus (BM) and poorer meniscus (PM) groups using a cutoff score of 2.5, derived from a time-dependent receiver operating characteristic (ROC) curve that maximized early deterioration in the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score after AOT. Follow-up intervals were categorized into early (1-2 years), short-term (2-5 years), mid-term (5-10 years), and long-term (>10 years). Structural outcomes including MOCART scores, joint space width (JSW), and cartilage T2 relaxation times, and patient-reported outcome measurements (PROMs) including Lysholm score, IKDC subjective score, Tegner activity scale, and visual analog scale (VAS) for pain were compared.

RESULTS

A total of 35 patients were finally included in the study, with a mean follow-up of 6.8 ± 5.2 years. Among them, 22 were classified into the BM group and 13 into the PM group. Significant group-by-time interaction effects were observed for MOCART scores (p = .048) and JSW (p = .03); the BM group demonstrated higher MOCART scores from the short-term follow-up (p = .005) and less JSW narrowing from the mid-term follow-up (p = .009). In contrast, no significant group differences were found in T2 relaxation times. Clinically, IKDC (53.5 ± 16.4 to 76.3 ± 11.0; p = .03), Lysholm (66.1 ± 18.3 to 91.7 ± 7.4; p = .02), and VAS pain scores (5.1 ± 2.3 to 1.8 ± 1.8; p = .01) significantly improved from preoperative to early postoperative follow-up and were maintained thereafter. However, no significant group differences were found.

CONCLUSION

Meniscal lesions should be properly addressed during AOT, as residual meniscal status was associated with cartilage degeneration. However, structural improvements on MRI did not translate into better clinical outcomes, as T2 relaxation times and PROMs were not correlated.

LEVEL OF EVIDENCE: IV.