Suture-Only Fixation of Meniscal Allograft Is Associated With a Higher Reoperation Rate Than Bone Plug or Bone Bridge-in-Slot Fixation Techniques.

Abstract

To compare meniscus-specific reoperation rates among various meniscal allograft transplantation (MAT) fixation techniques including bone plug, bone bridge-in-slot, and suture-only fixation. A retrospective review was conducted of patients who underwent MAT at a single academic institution between 2011 and 2023. Patients were included if they had documented fixation technique and a minimum of 1-year follow-up. Demographics, fixation techniques (bone plug, bone bridge-in-slot, and suture-only), and subsequent ipsilateral knee surgeries were recorded. Statistical analyses assessed the influence of fixation techniques and other factors on meniscus-specific reoperation rates defined as subsequent ipsilateral meniscectomy, meniscus repair, revision MAT, or knee arthroplasty. The study included 139 patients (54% male patients; mean age: 29.4 ± 10.0 years; body mass index: 27.3 ± 5.6) with a mean follow-up of 6.6 ± 3.1 years. Lateral compartment MAT was performed in 51.1% of cases. Patients undergoing suture-only fixation had significantly higher meniscus-specific reoperation rates (15/48, 31.3%) compared with bone bridge-in-slot (4/45, 8.9%) and bone plug (5/46, 10.9%) fixation (P = .006). Meniscectomy (15/35, 42.9%) and meniscal repair (7/35, 20.0%) were the most common reoperations. Other reoperations included 2 total knee arthroplasties within the suture-only cohort and a single MAT revision in the bone bridge-in-slot cohort. This study reveals that MAT using suture-only fixation exhibits significantly higher reoperation rates than bone plug and bone bridge-in-slot techniques, with meniscectomy and meniscal repair representing the predominant subsequent surgeries. Level III, retrospective comparative study.