Poster 58. Preoperative Corticosteroid Injection History Does Not Influence Meniscal Allograft Transplantation Survivorship or Failure Rates
2325-9671
Abstract
Objective: Meniscal allograft transplantation (MAT) is a joint-preserving option for patients with symptomatic meniscal deficiency unresponsive to nonoperative care. By restoring tibiofemoral load transmission, MAT can relieve pain, improve function, and potentially delay osteoarthritis progression. However, graft survivorship remains variable, with failure rates of 10-30% at mid- to long-term follow-up. Identifying perioperative factors that influence outcomes is therefore critical for patient selection and surgical planning. Intra-articular corticosteroid injections are frequently used to manage knee pain before surgery, offering short-term relief through reduced synovial inflammation and modulation of pain pathways. Yet, concerns persist regarding potential adverse effects on cartilage, meniscal tissue, and joint healing. Evidence from arthroplasty and cartilage procedures has linked corticosteroid use to impaired healing, increased infection risk, and worse outcomes, though findings are inconsistent. In the context of MAT, the effect of preoperative corticosteroid injections remains largely unknown. Given their common use in patients with meniscal deficiency, clarifying whether these injections compromise graft survival, increase failure risk, or affect Patient Reported Outcome Measures (PROMs) is essential. This study aimed to evaluate the impact of preoperative corticosteroid injections on MAT outcomes at mid-term follow-up. Methods: We retrospectively reviewed 156 MAT patients, of whom 20 (12.8%) received preoperative corticosteroid injections. Patients were matched 2:1 (no steroid : steroid) using propensity scores based on age, sex, BMI, fixation technique (bone bridge, bone plug, suture-only), compartment, and isolated meniscus procedure, yielding 54 matched patients (35 no steroid, 19 steroid). Balance was confirmed across covariates. Graft failure was defined as revision MAT, graft removal, or conversion to total knee arthroplasty. Outcomes were analyzed using Kaplan-Meier survival estimates, logistic regression, and Cox proportional hazards models with cluster-robust standard errors. PROMs were collected at final follow-up from 126 patients, including the Tegner Activity Scale, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) Subjective Score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscales [Symptoms, Pain, Activities of Daily Living (ADL), and Sport/Rec], and Visual Analog Scale (VAS) for pain. Results: Mean survival time was 4.71 years in the no-steroid group and 4.46 years in the steroid group (difference = -0.13 years, 95% CI -1.75 to 1.48, p = 0.87). Kaplan-Meier estimates showed comparable survival at all timepoints: 1-year (89.4% vs 89.5%), 2-year (86.4% vs 83.1%), 5-year (83.2% vs 83.1%), and 10-year (83.2% vs 83.1%) for no steroid versus steroid, respectively. The odds of graft failure were similar (OR 1.00, 95% CI 0.17-5.94, p = 1.00), and Cox regression confirmed no survival disadvantage with steroid use (HR 1.05, 95% CI 0.22-5.07, p = 0.95). Subgroup analyses by age and BMI showed no significant effect modification. PROMs demonstrated functional improvement but persistent symptoms: Tegner activity scores declined from 6.5 ± 2.3 to 4.2 ± 1.8 (Δ = -2.3, p < 0.001); mean Lysholm and IKDC were 73.9 ± 22.3 and 73.4 ± 22.0, respectively; KOOS subscores averaged 70.6 (Symptoms), 80.0 (Pain), 86.8 (ADL), and 57.5 (Sport/Rec). Postoperative VAS pain was 30.2 ± 26.2; 74.6% of patients reported improvement, but only 38.9% achieved complete resolution. Conclusions: After matching for key patient and surgical factors, preoperative corticosteroid injections were not independently associated with reduced MAT survivorship or increased failure risk. Survival curves and regression models demonstrated nearly identical outcomes between groups, and no evidence of interaction with age or BMI was observed. PROMs confirmed meaningful improvements in pain and function, although activity levels typically declined compared to baseline and complete symptom resolution was uncommon, reflecting the complex nature of recovery after MAT. These findings suggest that preoperative corticosteroid injections do not impact the outcomes of MAT and can be considered a safe option for symptom management before surgery without compromising graft survival or patient-reported recovery. Importantly, the study underscores that while MAT consistently improves pain and functional measures, expectations regarding long-term activity restoration and complete resolution of symptoms should be carefully managed in clinical practice. Larger prospective studies with extended follow-up are warranted to validate these results, identify subgroups that may respond differently, and further define how preoperative management strategies, including corticosteroid injections, influence both functional recovery and long-term graft durability.