Meniscal Allograft Transplantation: State of the Art

Abstract

Meniscal allograft transplantation has evolved over the years to provide a state-of-the-art technique for the sports medicine surgeon to utilize in preserving contact mechanics and function of the knee in irreparable meniscal pathology. However, this procedure continues to spark considerable debate on proper tissue processing techniques, acceptable indications, methods of implantation, and potential long-term outcomes.

Meniscus allograft transplantation: indications, techniques and outcomes

“…On the other hand, classical contraindications are: advanced osteoarthritis, obesity, skeletal immaturity, inflammatory arthritis, previous septic arthritis, and synovial disease. 1 However, in recent years, different studies have disputed these indications. Stone et al 3 reported 49 MATs in patients with grade III or IV Outerbridge chondral defects that were followed up for a mean 8.6 ± 4.2 years.…”

“…Contrarily, an undersized graft may potentially experience significant shear forces leading to tears of the MAT. 1…”

“…Freeze-drying or cryopreservation has been abandoned because the extreme temperatures used for this method can cause deleterious effects on the mechanical properties of the allograft and it can result in high rates of failure. 1…”

“…In recent years, meniscal allograft transplantation (MAT) has become the state-of-the-art treatment for the orthopaedic surgeon presented with symptomatic subtotal or total menisectomy patients, especially in the young population. 1 Given the long-term degenerative consequences of subtotal and total meniscectomy, 2 MAT was developed as an intuitive method to restore the normal contact pressures of the knee joint that were lost with the ultimate goal of delaying the progression of degenerative arthritis.…”

Diagnosing Meniscal Pathology and Understanding How to Evaluate a Postoperative Meniscus Based on the Operative Procedure

“…The major distinction in modern techniques for meniscus allograft transplantation is whether fixation is achieved using free soft tissue transplantation or whether bony fixation is also utilized. 60 There are proponents for both techniques. Most commonly, separate anterior and posterior bone plug fixation with transtibial suture fixation or a bone-bridge (i.e., trough or bone-in-slot) techniques with interference fit/ interference screw fixation are utilized.…”