Meniscal Allograft Transplantation: Indications, Techniques, Outcomes

Area of Science:

• Orthopedic surgery
• Sports medicine
• Regenerative medicine

Background:

• Meniscal allograft transplantation (MAT) is an established surgical treatment for symptomatic meniscal deficiency in select patients, typically under 50 years old.
• It can be combined with anterior cruciate ligament reconstruction or articular cartilage repair in the same knee compartment.
• Contraindications include severe osteoarthritis, uncorrectable malalignment, instability, irreparable chondral damage, infection, or inflammatory arthropathy.

Purpose of the Study:

• To review the current indications, contraindications, graft preservation methods, surgical techniques, and outcomes of meniscal allograft transplantation (MAT).
• To provide an overview of the survival rates, failure times, patient-reported outcomes, and reoperation rates associated with MAT.
• To highlight the limitations of existing studies and suggest future directions for improving MAT outcomes.

Main Methods:

• Review of current literature on meniscal allograft transplantation (MAT).
• Analysis of graft preservation techniques, surgical approaches (open vs. arthroscopic), and fixation methods (soft-tissue, bone-plug, bone-bridge, inside-out, all-inside).
• Evaluation of reported survival rates, time to failure, patient-reported outcomes, and reoperation rates, considering study quality and patient heterogeneity.

Main Results:

• MAT survival rates are estimated at 73.5% at 10 years and 60.3% at 15 years, with mean failure times around 8.2 years (medial) and 7.6 years (lateral).
• Significant improvements in patient-reported outcomes are observed, with 90% of patients willing to undergo the procedure again.
• Reoperation rates are approximately 32%, with meniscal allograft tear being the most common complication.

Conclusions:

• Meniscal allograft transplantation (MAT) is an acceptable treatment for select young patients with meniscal deficiency, offering good functional recovery and high patient satisfaction.
• Fresh-frozen allografts are preferred, and concomitant knee conditions should be addressed for optimal results.
• Further research is needed to overcome study limitations and enhance MAT outcomes through improved patient selection, graft preparation, and surgical techniques.