Meniscectomy is a common treatment for a young patient with a traumatic meniscal tear, despite the known negative consequences. Meniscal allograft transplantation has been performed for over thirty years in young symptomatic patients following a meniscectomy but it has never been rigorously evaluated for effectiveness. Therefore the aim of this thesis was to perform the development and pilot work to inform a future multi-centre pragmatic randomised controlled trial comparing meniscal allograft transplantation to physiotherapy. Systematic reviews in this thesis showed that in case series, meniscal allograft transplantation resulted in improved patient reported outcome measures in the short and medium term, although there were no comparator groups. There was no strong evidence for chondroprotection with either meniscal allograft transplantation or physiotherapy in this patient population. In the systematic review it was also identified that full thickness cartilage lesions were a contraindication to meniscal allograft transplantation for most surgeons. A Cox proportional hazards model was used on a case series of meniscal allograft transplantations performed locally, which showed that a full thickness cartilage lesion was a strong predictor of failure. It was therefore determined that these patients should be excluded from the pilot trial. A comprehensive cohort study incorporating a pilot randomised controlled trial was performed, with 36 participants being recruited over one year. The trial processes worked successfully and the pilot randomised trial recruitment rate was 55%. There were no losses to follow up in the randomised arm of the trial. Patient reported outcome measures showed a trend towards a bigger improvement in the meniscal allograft transplantation group, which was statistically significant in the KOOS score when the randomised and preference groups were merged. Sample size calculations for the data in the trial using the KOOS score suggest that between 70 and 114 participants would be needed in a full trial. The results of this thesis suggest that a full trial is warranted and could be deliverable within the UK, with some small adjustments to the trial design.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:687165 |
| Date | January 2015 |
| Creators | Smith, Nicholas A. |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/79960/ |
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