Meniscal Allograft Transplantation: Does Surgical Technique Influence Clinical Outcomes?

Meniscal allograft transplantation is intended to address painful knees with symptoms that can be attributed to meniscal deficiency through injury or meniscectomy. Initially viewed as an experimental procedure, refinements in patient selection and surgical technique have led to improved clinical outcomes with wider acceptance. Our intention with this paper is to provide a review of meniscal allograft transplantation, with the focus on the different surgical techniques employed and their influence on outcomes.

The main debate regarding surgical technique is using bone or only soft tissue for fixation of the meniscal horns. Biomechanical and other basic science studies show improved function and less extrusion when the grafts are secured with bone. However, several clinical studies show no difference in outcomes. Long-term studies have shown improved success with less graft extrusion and may illustrate the important function of bone fixation. Many clinical studies, including those with long-term outcomes, have shown meniscal allografts can decrease patient pain and improve function. It is a technically challenging procedure with good clinical outcomes regardless of the method of graft fixation. Bone fixation provides less extrusion which is associated with improved graft function and decreased rate of joint deterioration. Further study is needed to determine if other methods to decrease extrusion are able to improve graft function and outcomes.