Failed meniscus transplantation. A report of three cases

Treatment of patients with an established disabling compartment arthrosis after total meniscectomy is an important clinical problem. Meniscal transplantation may be an alternative method of treatment. Between 1989 and 1992, 25 cryopreserved nontissue antigen matched meniscal transplantations were performed. In three patients with a medial meniscus, the transplantation failed because of partial loosening of the meniscus. The donor meniscus was removed in one case after 12 months and in the other two cases after 20 and 24 months. In two cases, there was a varus malalignment of the knee. In the third case, the knee was unstable because of an insufficient anterior and posterior cruciate ligament. The retrieved menisci were stained with enzyme and immunohistochemical reactions. Focal areas of degeneration were noted, with vital cells around the microvascular supply and at the synovial side. The growth potential of vital parts of the grafts, as shown by proliferation markers, seemed to be virtually nil. The success of meniscal transplantation seems to depend on factors responsible for vascularization. Malalignment and instability of the joint, causing abnormal pressure on the graft, may be responsible for vascular damage leading to degeneration and loosening of the graft.