Meniscus transplantation

Abstract

Understanding the structure and function of the meniscus is critical to understanding its role in overall knee joint function. Injury to, or removal of, meniscal tissue may be associated with articular cartilage wear, knee instability, and, ultimately, the progression of osteoarthritis. While every effort is made for preserving and/or repairing damaged meniscal tissue, in some cases, the meniscus is not amenable to repair after injury. For appropriately indicated patients with symptomatic meniscal deficiency, meniscus allograft transplantation is an excellent surgical solution aimed at reducing pain and improving function. Indications for meniscus allograft transplantation are limited, and concomitant procedures such as osteotomy for malalignment, ligamentous, and/or articular cartilage restoration may be necessary in order to ensure an optimal result following meniscus allograft transplantation. Surgical techniques for meniscus allograft transplantation are variable and include soft-tissue fixation versus bone plug fixation versus bone bridge fixation. Outcomes following meniscus allograft transplantation are generally good to excellent, though reoperation rates are relatively high. The purpose of this article is to provide a concise review of recently published data on meniscus allograft transplantation, with a focus on recent outcomes studies.

Editorial Commentary: Fresh-Frozen Meniscal Allografts—Cold Does Not Always Cause Shrinkage

“…Our preference is to use fresh-frozen nonirradiated allografts because of easier processing, lower immunogenicity, and lower cost. 2 The results of Lee et al 1 corroborate our clinical experience with fresh-frozen MATs over the past 2 decades, and we have been pleased with our survivorship 5,6 despite allowing most of our patients to return to activities as tolerated, knowing that the transplants will inevitably fail if enough time passes despite modern fixation and processing techniques. Ultimately, although long-term graft shrinkage rates are unknown, we are advocates of performing MAT in the appropriately selected meniscus-deficient patient.…”

Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Servicemembers from 2010 to 2015

“…17 The medial meniscus, in particular, disperses axial forces into hoop stresses, supporting up to 70% of load during normal gait; reduction of the medial meniscus through meniscectomy results in increased joint contact pressures, reportedly as great as 100 to 350%. 15,18,19 The potential for future development of osteoarthritis after meniscectomy is likely a contributing factor in the higher rate of meniscal repairs in younger patients. Notably, lateral meniscectomy has been shown to be associated with longer time to return to preinjury activity levels in high-level athletes.…”

The results of meniscal allograft transplantation surgery: what is success?

“…The menisci act primarily as load bearers and secondary stabilisers within the knee joint, and are chondroprotective. Loss of meniscal tissue through trauma or degeneration increases the joint contact forces by up to 350%, exacerbating articular cartilage degeneration [1]. Meniscal tears are particularly common in sportspersons [2,3] with the typical mechanism of injury involving twisting on a flexed knee or loaded hyperflexion [4].…”