Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 6, pp 1908–1913 | Cite as

Meniscal allograft transplantation in the paediatric population: early referral is justified

  • S. Middleton
  • L. Asplin
  • C. Stevenson
  • P. Thompson
  • T. SpaldingEmail author



The need for meniscal allograft transplantation (MAT) in children is rare, and as a result, there is a paucity of evidence detailing survivorship and clinical outcome. MAT has been shown to significantly reduce pain and improve function in the adult population. The aim of this study was to document the outcomes of a single surgeon case series of MAT in the paediatric population.


Analysis of a prospective meniscal allograft transplantation (MAT) group database of 280 patients was performed. Twenty-three patients met the inclusion criteria—undergoing MAT aged 18 years or younger.


Fourteen were female and nine were male with median age of 17 (range 8–18). Thirteen (57%) were right knee and nineteen (83%) were lateral. Additional procedures included high tibial osteotomy, anterior cruciate ligament reconstruction, and microfracture procedures. The median follow-up was 3.8 years (range of 0.2 to 7.8 years). There have been no cases of graft failure. All patients demonstrated improvement in all the modalities of the KOOS outcome scores. At 5 years, the Lysholm score had improved from 57.9 to 87.6 (SD 12.1), Tegner activity score had improved from 2 to 5 (range 4–7) and IKDC score had improved from 40.6 to 78.6 (SD 15.8). Four patients required secondary surgical intervention. No patients developed a superficial or deep infection.


Meniscal allograft transplantation in children is founded on the successful results of MAT in the adult population. We have demonstrated in this series that MAT can improve function and reduce pain in the paediatric population, and is, therefore, a viable treatment option for the management of the symptomatic paediatric meniscal-deficient knee. Early referral should be considered in the patients with post-meniscectomy syndrome, pain on weight bearing with a history of previous menisectomy.

Level of evidence



Meniscal allograft transplant Paediatric meniscal injury Paediatric knee pain 


Author contributions

SM: data collection and analysis, and author of manuscript; LA: data collection and analysis; CS: manuscript editing; PT: manuscript editing; TS: concept of study, performed surgery, data collection, analysis, and manuscript editing.


No funding was obtained for this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Collection of outcome data was approved by the hospital research and development department.


  1. 1.
    Anderson M, Green WT, Messner MB (1963) Growth and predictions of growth in the lower extremities. J Bone Joint Surg Am 45:1–4CrossRefPubMedGoogle Scholar
  2. 2.
    Bellisari G, Samora W, Klingele K (2011) Meniscus tears in children. Sports Med Arthrosc Rev 19:50–55CrossRefPubMedGoogle Scholar
  3. 3.
    De Bruycker M, Verdonk PC, Verdonk RC (2017) Meniscal allograft transplantation: a meta-analysis. SICOT J 3:1–15CrossRefGoogle Scholar
  4. 4.
    Dimeglio A (2001) Growth in pediatric orthopaedics. J Pediatr Orthop 21:549–555PubMedGoogle Scholar
  5. 5.
    Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG (2010) Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. Am J Sports Med 38:2448–2455CrossRefPubMedGoogle Scholar
  6. 6.
    Jang SH, Kim JG, Ha JG, Shim JC (2011) Reducing the size of the meniscal allograft decreases the percentage of extrusion after meniscal allograft transplantation. Arthroscopy 27:914–922CrossRefPubMedGoogle Scholar
  7. 7.
    Kelly BT, Potter HG, Deng XH, Pearle AD, Turner AS, Warren RF, Rodeo SA (2006) Meniscal allograft transplantation in the sheep knee: evaluation of chondroprotective effects. Am J Sports Med 34:1464–1477CrossRefPubMedGoogle Scholar
  8. 8.
    Lee DH, Kim TH, Lee SH, Kim CW, Kim JM, Bin SI (2008) Evaluation of meniscus allograft transplantation with serial magnetic resonance imaging during the first postoperative year: focus on graft extrusion. Arthroscopy 24:1115–1121CrossRefPubMedGoogle Scholar
  9. 9.
    Manzione M, Pizzutillo PD, Peoples AB, Schweizer PA (1983) Meniscectomy in children: a long-term follow-up study. Am J Sports Med 3:111–115CrossRefGoogle Scholar
  10. 10.
    Parfitt AM, Travers R, Rauch F, Glorieux FH (2000) Structural and cellular changes during bone growth in healthy children. Bone 27:487–494CrossRefPubMedGoogle Scholar
  11. 11.
    Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23:240–244CrossRefPubMedGoogle Scholar
  12. 12.
    Riboh JC, Tilton AK, Cvetanovich GL, Campbell KA, Cole BJ (2016) Meniscal allograft transplantation in the adolescent population. Arthroscopy 32:1133–1140CrossRefPubMedGoogle Scholar
  13. 13.
    Riboh JC, Tilton AK, Cvetanovich G, Campbell KA, Cole BJ (2015) Outcomes of meniscal allograft transplantation in the pediatric athlete. Orthop J Sports Med 3:suppl2. CrossRefGoogle Scholar
  14. 14.
    Rosso F, Bisicchia S, Bonasia DE, Amendola A (2015) Meniscal allograft transplantation: a systematic review. Am J Sports Med 43:998–1007CrossRefPubMedGoogle Scholar
  15. 15.
    Sabbag OD, Hevesi M, Sanders TL, Camp CL, Dahm DL, Levy BA, Stuart MJ, Krych AJ (2018) Incidence and treatment trends of symptomatic discoid lateral meniscus: an 18 year population based study. Orthop J Sports Med 24:1–6. CrossRefGoogle Scholar
  16. 16.
    Seedhom BB (1979) Transmission of the load in the knee joint with special reference to the role of the menisci: Part I: anatomy, analysis and apparatus. Eng Med 8:207–219CrossRefGoogle Scholar
  17. 17.
    Smith NA, MacKay N, Costa M, Spalding T (2015) Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:270–279CrossRefPubMedGoogle Scholar
  18. 18.
    Smith NA, Parsons N, Wright D, Hutchinson C, Metcalfe A, Thompson P, Costa ML, Spalding T (2018) A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. J Bone Joint Surg 100:56–63CrossRefGoogle Scholar
  19. 19.
    Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 24:2923–2935CrossRefPubMedGoogle Scholar
  20. 20.
    Spalding T, Parkinson B, Pujol N, Verdonk P (2016) Arthroscopic meniscal allograft transplantation with soft tissue fixation through bone tunnels. Surg Meniscus 56:503–512CrossRefGoogle Scholar
  21. 21.
    Tanner JM, Hughes PC, Whitehouse RH (1981) Radiographically determined widths of bone muscle and fat in the upper arm and calf from age 3–18 years. Ann Hum Biol 8:495–517CrossRefPubMedGoogle Scholar
  22. 22.
    Verdonk P, Smith N, Verdonk R, Spalding T (2016) Meniscal allograft transplantation: indications, technique and results. Arthroscopy 6:143–151Google Scholar
  23. 23.
    Watanabe M, Takeda S, Ikeuchi H (1979) Atlas of arthroscopy. Igaku-Shoin, Tokyo, pp 75–130Google Scholar
  24. 24.
    Yoon JR, Kim TS, Lim HC, Lim HT, Yang JH (2011) Is radiographic measurement of bony landmarks reliable for lateral meniscal sizing? Am J Sports Med 39:582–589CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • S. Middleton
    • 1
  • L. Asplin
    • 1
  • C. Stevenson
    • 1
  • P. Thompson
    • 1
  • T. Spalding
    • 1
    Email author
  1. 1.University Hospital Coventry and Warwickshire NHS TrustCoventryUK

Personalised recommendations