Return to Sport After ACL Reconstruction With Meniscal Allograft Transplantation Versus Isolated ACL Reconstruction: A Matched-Cohort Study
Authors: Rigsby Victoria , Shaw Joshua , Stankaitis Caroline , Higbie Steven , Kleihege Jacquelyn , Brooks William , Lowe Walter R. , Bailey Lane B. 
Published: January 2025

Background:

Meniscal allograft transplantation (MAT) is indicated in the setting of anterior cruciate ligament (ACL) reconstruction to restore proper arthrokinematics and load distribution for the meniscus-deficient knee. Objective outcomes after ACL reconstruction with concomitant MAT in athletic populations are scarcely reported and highly variable.

Purpose:

To compare patient outcomes using an objective functional performance battery, self-reported outcome measures, and return-to-sport rates between individuals undergoing ACL reconstruction with concomitant MAT and a matched group undergoing isolated ACL reconstruction.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A single-surgeon ACL reconstruction database (N = 1431) was used to identify patients undergoing ACL reconstruction with concomitant MAT between 2014 and 2019. Patients were age-, sex-, and revision-matched to a group undergoing isolated ACL reconstruction. Baseline patient and surgical data were obtained. Patients completed an objective functional performance battery at the time of return to sport that included range of motion, single-leg squat performance, single-leg hop test performance, self-reported function (International Knee Documentation Committee [IKDC] score), and psychological readiness (ACL Return to Sports After Injury scale). Between-limb comparisons were assessed using limb symmetry indices. Injury surveillance was conducted for 2 years and included the Single Assessment Numeric Evaluation (SANE), reinjury rates, complications, and current level of sports participation. Between-group comparisons at the time of return to sport and 2 years later were analyzed using generalized linear models for parametric and nonparametric equivalents with an a priori alpha level of .05.

Results:

A total of 46 patients were included in the ACL reconstruction with concomitant MAT group (38 medial MAT, 8 lateral MAT), and 46 patients were included in the isolated ACL reconstruction group. Baseline differences existed between groups, with the MAT group exhibiting lower body weight (84.0 ± 14.1 vs 93.2 ± 191.8 kg; P = .036) and Marx scores (4.8 ± 4.5 vs 9.3 ± 4.1; P = .024) than the isolated ACL reconstruction group, respectively. At the time of return to sport, the MAT group reported lower IKDC scores (83.2 ± 12.6 vs 91.1 ± 11.3; P = .037); however, no other functional performance or self-reported differences were observed. At 2 years, no significant differences existed between groups for SANE score (87.8 ± 12.3 vs 89.3 ± 11.4; P = .793), ACL graft reinjury rates (6.5% vs 2.2%; P = .688), or level of return to sport ( P > .05). The MAT group demonstrated a significantly lower rate of return to previous level of sport (69.5% vs 78.3%; P = .026).

Conclusion:

The majority of patients (87%) undergoing ACL reconstruction with concomitant MAT were able to return to some level of sports participation at 2 years with a low risk of revision ACL reconstruction or meniscal transplant failure. Patients receiving a concomitant MAT exhibited lower self-reported function at return to sport compared with matched controls undergoing isolated ACL reconstruction; however, these differences were not present at 2 years. Clinicians should consider patient characteristics, self-reported function, and return-to-sport rates when counseling patients regarding ACL reconstruction with MAT.