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HTA of meniscal allograft transplantation for post-meniscectomy syndrome in Austria
On 20th of July, 2018, the Austrian HTA body, the Ludwig-Boltzmann Institute (LBI) has published HTA of meniscal allograft transplantation for post-meniscectomy syndrome in Austria.
Post-meniscectomy syndrome is broadly characterized by intractable pain following the partial or total removal of a meniscus. Removal of a meniscus can lead to joint instability, increased risk of osteoarthritis, and eventually total joint replacement.
Meniscal allograft transplantation (MAT) involves the transplant of a cadaveric meniscal allograft into the knee of a patient who has had a prior (sub)total meniscectomy. The transplanted allograft is intended to be permanent and aims to restore the load-bearing and shock absorption function provided by the meniscus. In theory, MAT is proposed to relieve the pain and swelling associated with the post-meniscectomy syndrome, lower the risk of progression to osteoarthritis, and prolong the need for a total knee replacement and associated revisions.
The authors have conducted a systematic search of the literature in order to assess whether meniscus allograft transplantation is more effective concerning changes in pain, changes in function, and necessity of total joint replacement, as well as safety (concerning complications and transplant failure) in comparison to conservative management The literature was searched on Medline, Embase, Cochrane Library and the University of York Centre for Reviews and Dissemination.
One (1) non-randomised comparative study with 36 patients was identified regarding the effectiveness of MAT, while five (5) prospective case series with a total of 308 patients were identified regarding the safety of MAT.
Regarding the clinical effectiveness, the authors have revealed that the change in patient-reported pain was significantly improved in the MAT group compared to conservative management at 12 months (MD 15.1, 95% CI 2.4 to 27.8, p=0.021). Regarding function, MAT demonstrates partly significantly better improvements. Quality of life showed both clinically significant and statistically significant increases in the MAT group.
Regarding the safety, there were no significant differences in complications comparing with conservative management. Nearly all difficulties with MAT required re-operations.
The authors conclude that there is not enough evidence demonstrating benefits in order to include MAT into the Austrian benefit catalogue.
See the full report in English (with summary in German) here.
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