No differences in clinical outcomes and return to sport in patients with sex-mismatched meniscal allograft transplantation: Average 6-year follow up.

Abstract

Risks associated with graft transplantation due to donor-recipient sex differences have been reported in whole organ transplantation literature but are not well-described in meniscal allograft transplantation (MAT). This study assessed the effect of donor-recipient sex mismatch on patient-reported outcomes (PROs) following MAT. A retrospective review of patients <50 years of age that underwent unicompartmental MAT from 2010 to 2023 at a single institution with minimum 2-year follow up was conducted. Exclusion criteria were revision procedures or insufficient donor information. PROs collected included: Knee Injury and Osteoarthritis and Outcome Score (KOOS), Visual Analog scale (VAS) for pain and satisfaction, and return to sport (RTS). PROs were compared between donor-recipient graft matching groups (same-sex (SS) or different-sex (DS)) and by donor sex. Fifty-seven patients (31 males, 26 females) met inclusion criteria with mean age of 29.1 ± 8.9 years, BMI (body mass index) of 26.8 ± 5.7 kg/m², and follow up of 73.4 ± 29.2 months. Donors were mostly male (77.2 %). Thirty-six patients (63.3 %) received SS grafts and 21 (36.8 %) received DS grafts. There were no significant differences between groups in KOOS subscores, VAS pain, satisfaction scores, or RTS rates (P > 0.05). Donor sex also showed no association with PROs. Linear and logistic regression models controlling for age, BMI, and average follow up demonstrated that graft mismatch was not associated with KOOS scores, RTS, or graft failure. Decreasing patient age was associated with improved KOOS-pain (β: -0.376; 95 % CI (-1.892, -0.155); P = 0.022). Patients that undergo MAT with grafts from a different sex had similar outcomes to patients receiving grafts from a donor of the same sex. Sex-mismatch was not associated with functional outcomes or RTS. The results of this paper support the use of geometrically matched donor grafts, independent of donor sex, which should expand available graft options when matching a patient for MAT.