SRS122 - Time stratified outcomes of meniscal replacement: a systematic review and meta-analysis

Abstract Background Prior evidence comparing meniscal allograft transplantation (MAT) and meniscal scaffold implantation (MSI) is limited by variable follow-up, with patient-reported-outcome-measures (PROMs) pooled across disparate time points. We addressed this with time-stratified outcome pooling. Methods We searched MEDLINE, Embase, and Web of Science Core Collection to 25 April 2025; PROSPERO registration CRD42024536408. Adults undergoing MAT or MSI (≥10 participants; >2-year follow-up) were eligible. Random-effects meta-analyses pooled PROMs at 0–2, 2–5, and >5 years; survival, return-to-sport (RTS), and complications were summarised descriptively. Risk of bias was assessed using Modified Coleman Methodology Score (MCMS). Results Eighty-one studies (MAT 59, n = 4292; MSI 22, n = 1009) were included. Overall study quality was fair-to-poor (MCMS 58.8 ± 11.1). PROMs improved after both. MAT maintained gains beyond five years (IKDC 73.1 at 2–5 years; 71.1 > 5 years), whereas MSI peaked at 2–5 years then declined (IKDC 72.5; 67.6 > 5 years); Tegner scores mirrored this pattern. Heterogeneity was considerable (27/29 analyses I² > 50% and 24/29 I² > 75%). Failure proportions were similar (MAT 18.6%; MSI 19.6%), but time to failure was longer after MAT (5.9 versus 3.1 years). Survival at fixed time points was comparable (∼90% at 5 years; ∼77% at 10 years). RTS was similar (∼65% return by 1 year; ∼50% to pre-injury level). Complications differed; further intervention was more commonly undertaken post-MAT. Conclusions Accounting for follow-up duration, MAT sustains functional gains beyond five years and shows greater durability than MSI. Prospective comparative studies with standardised failure definitions are needed to refine patient selection and expectations.