Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 6, pp 1891–1899 | Cite as

Higher survivorship following meniscal allograft transplantation in less worn knees justifies earlier referral for symptomatic patients: experience from 240 patients

  • Benjamin Bloch
  • Laura Asplin
  • Nick Smith
  • Peter Thompson
  • Tim SpaldingEmail author



To analyse the clinical outcome and survivorship of meniscal allograft transplantation (MAT), performed in a single unit, specifically to assess the impact of concomitant operations and the influence of articular cartilage lesions on outcome.


A prospective case series analysis of 240 patients undergoing MAT with follow-up greater than 12 months (range 1–10 years) was performed. Group A represented patients with good chondral surfaces (ICRS 0–3A); Group B had good chondral surfaces with concomitant realignment osteotomy. Group C had good chondral surfaces with ACL reconstruction performed at the same time. Groups D and E had bare bone on one or both surfaces respectively. Kaplan–Meier survivorship and PROMS including Lysholm, KOOS, Tegner, and IKDC subjective scores were analysed.


Overall survivorship was 96.7% at 1 year, 87% at 5 years and 82.2% at 7 years. Groups A–C (knees without significant chondral damage) had significantly improved survivorship (95% at 5 years) compared to Groups D, E (full-thickness chondral wear) with 77% survivorship at 5 years. Survivorship and PROMS were equivalent between Groups A–C. Groups D and E had similar PROMS to Group A, but did have a higher failure rate. Overall 27% required further operative intervention.


Meniscal transplantation is clinically effective in treating patients with symptomatic meniscal deficiency. Where indicated, the addition of osteotomy or ACL reconstruction achieves results similar to patients undergoing simple meniscal transplantation in stable and normally aligned knees. Survivorship is lower in patients with full-thickness chondral loss and future treatments should, therefore, be directed at improving success in this at-risk group. The results support encouragement for earlier referral of symptomatic patients to a specialist meniscal reconstruction centre before a significant chondral damage is sustained.

Level of evidence



Meniscal Allograft Transplant Survivorship Outcome Meniscus transplantation 



No funding obtained.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Outcome data collection and analysis was approved by the Research and Development Department at University Hospital Coventry and Warwickshire NHS Trust.


  1. 1.
    Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584CrossRefPubMedGoogle Scholar
  2. 2.
    Alentorn-Geli E, Seijas Vázquez R, García Balletbó M, Álvarez Díaz P, Steinbacher G, Cuscó Segarra X, Rius Vilarrubia M, Cugat Bertomeu R (2011) Arthroscopic meniscal allograft transplantation without bone plugs. Knee Surg Sports Traumatol Arthrosc 19:174–182CrossRefPubMedGoogle Scholar
  3. 3.
    Alford W, Cole BJ (2005) Failed ACL reconstruction and meniscus deficiency. Sports Med Arthrosc 13:93–102CrossRefGoogle Scholar
  4. 4.
    Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Jt Surg Br 66:666–671CrossRefGoogle Scholar
  5. 5.
    Amendola A (2007) Knee osteotomy and meniscal transplantation: indications, technical considerations, and results. Sports Med Arthrosc 15:32–38CrossRefPubMedGoogle Scholar
  6. 6.
    Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ, International Knee Documentation Committee (2006) The international knee documentation committee subjective knee evaluation form: normative data. Am J Sports Med 34:128–135CrossRefPubMedGoogle Scholar
  7. 7.
    Arnold MP, Hirschmann MT, Verdonk PCM (2012) See the whole picture: knee preserving therapy needs more than surface repair. Knee Surg Sports Traumatol Arthrosc 20:195–196CrossRefPubMedGoogle Scholar
  8. 8.
    Biant LC, McNicholas MJ, Sprowson AP, Spalding T (2015) The surgical management of symptomatic articular cartilage defects of the knee: consensus statements from United Kingdom knee surgeons. Knee 22:446–449CrossRefPubMedGoogle Scholar
  9. 9.
    Bonasia DE, Amendola A (2009) Combined medial meniscal transplantation and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 18:870–873CrossRefPubMedGoogle Scholar
  10. 10.
    Chalmers PN, Karas V, Sherman SL, Cole BJ (2013) Return to high-level sport after meniscal allograft transplantation. Arthroscopy 29:539–544CrossRefPubMedGoogle Scholar
  11. 11.
    Covall DJ, Wasilewski SA (1992) Roentgenographic changes after arthroscopic meniscectomy: five-year follow-up in patients more than 45 years old. Arthroscopy 8:242–246CrossRefPubMedGoogle Scholar
  12. 12.
    Dye SF (1996) The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res 325:10–18CrossRefGoogle Scholar
  13. 13.
    Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19:147–157CrossRefPubMedGoogle Scholar
  14. 14.
    Farr J, Rawal A, Marberry KM (2007) Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year follow-up. Am J Sports Med 35:1459–1466CrossRefPubMedGoogle Scholar
  15. 15.
    Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10:585–608Google Scholar
  16. 16.
    Gelber PE, Verdonk P, Getgood AM, Monllau JC (2017) Meniscal transplantation: state of the art. J ISAKOS 2:339–349CrossRefGoogle Scholar
  17. 17.
    Getgood A, Gelber J, Gortz S, De Young A, Bugbee W (2015) Combined osteochondral allograft and meniscal allograft transplantation: a survivorship analysis. Knee Surg Sports Traumatol Arthrosc 23:946–953CrossRefPubMedGoogle Scholar
  18. 18.
    Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T, IMREF Group (2016) International meniscus reconstruction experts forum (IMREF) 2015 consensus statement on the practice of meniscal allograft transplantation. Am J Sports Med 45:1195–1205CrossRefPubMedGoogle Scholar
  19. 19.
    González-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC (2010) Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients. Arthroscopy 26:1633–1640CrossRefPubMedGoogle Scholar
  20. 20.
    Graf KW, Sekiya JK, Wojtys EM, Arbor A, Michigan USA (2004) Department of Orthopaedic Surgery, University of Michigan Medical Center. Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study. Arthroscopy 20:129–140CrossRefPubMedGoogle Scholar
  21. 21.
    Harris JD, Hussey K, Saltzman BM, McCormick FM, Wilson H, Abrams GD, Cole BJ (2014) Cartilage repair with or without meniscal transplantation and osteotomy for lateral compartment chondral defects of the knee: case series with minimum 2-year follow-up. Orthop J Sports Med 2:2325967114551528PubMedPubMedCentralGoogle Scholar
  22. 22.
    Harris JD, Hussey K, Wilson H, Pilz K, Gupta AK, Gomoll A, Cole BJ (2015) Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease. Arthroscopy 31:275–282CrossRefPubMedGoogle Scholar
  23. 23.
    Kempshall PJ, Parkinson B, Thomas M, Robb C, Standell H, Getgood A, Spalding T (2015) Outcome of meniscal allograft transplantation related to articular cartilage status: advanced chondral damage should not be a contraindication. Knee Surg Sports Traumatol Arthrosc 23:280–289CrossRefPubMedGoogle Scholar
  24. 24.
    Lee B-S, Bin S-I, Kim J-M, Kim W-K, Choi JW (2016) Survivorship after meniscal allograft transplantation according to articular cartilage status. Am J Sports Med 45:1095–1101CrossRefGoogle Scholar
  25. 25.
    Lee B-S, Kim H-J, Lee C-R, Bin S-I, Lee D-H, Kim N-J, Kim C-W (2018) clinical outcomes of meniscal allograft transplantation with or without other procedures: a systematic review and meta-analysis. Am J Sports Med 46:3047–3056CrossRefPubMedGoogle Scholar
  26. 26.
    Mahmoud A, Young J, Bullock-Saxton J, Myers P (2018) Meniscal allograft transplantation: the effect of cartilage status on survivorship and clinical outcome. Arthroscopy 34:1871–1876.e1CrossRefPubMedGoogle Scholar
  27. 27.
    Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13:1–11CrossRefPubMedGoogle Scholar
  28. 28.
    Moens K, Dhollander A, Moens P, Verdonk K, Verdonk R, Almqvist KF, Victor J (2014) Meniscal transplantation: still experimental surgery? A review. Acta Orthop Belg 80:403–413PubMedGoogle Scholar
  29. 29.
    Myers P, Tudor F (2015) Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy 31:911–925CrossRefPubMedGoogle Scholar
  30. 30.
    Pengas IP, Assiotis A, Nash W, Hatcher J, Banks J, McNicholas MJ (2012) Total meniscectomy in adolescents: a 40-year follow-up. J Bone Jt Surg Br 94-B:1649–1654CrossRefGoogle Scholar
  31. 31.
    Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11:684–687CrossRefPubMedGoogle Scholar
  32. 32.
    Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Rue J-PH, Yanke AB, Busam ML, McNickle AG, Cole BJ (2008) Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2-year follow-up. Am J Sports Med 36:1770–1778CrossRefPubMedGoogle Scholar
  34. 34.
    Rueff D, Nyland J, Kocabey Y, Chang HC, Caborn DNM (2006) Self-reported patient outcomes at a minimum of 5 years after allograft anterior cruciate ligament reconstruction with or without medial meniscus transplantation: an age-, sex-, and activity level-matched comparison in patients aged approximately 50 years. Arthroscopy 22:1053–1062CrossRefPubMedGoogle Scholar
  35. 35.
    Saltzman BM, Bajaj S, Salata M, Daley EL, Strauss E, Verma N, Cole BJ (2012) Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up. J Knee Surg 25:165–176CrossRefPubMedGoogle Scholar
  36. 36.
    Saltzman BM, Meyer MA, Leroux TS, Gilelis ME, Debot M, Yanke AB, Cole BJ (2018) The influence of full-thickness chondral defects on outcomes following meniscal allograft transplantation: a comparative study. Arthroscopy 34:519–529CrossRefPubMedGoogle Scholar
  37. 37.
    Saltzman BM, Meyer MA, Weber AE, Poland SG, Yanke AB, Cole BJ (2017) Prospective clinical and radiographic outcomes after concomitant anterior cruciate ligament reconstruction and meniscal allograft transplantation at a mean 5-year follow-up. Am J Sports Med 45:550–562CrossRefPubMedGoogle Scholar
  38. 38.
    Smith NA, MacKay N, Costa M, Spalding T (2014) Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:270–279CrossRefPubMedGoogle Scholar
  39. 39.
    Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2015) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 2016 24:2923–2935CrossRefGoogle Scholar
  40. 40.
    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. Bone Jt J 100-B:56–63CrossRefGoogle Scholar
  41. 41.
    Spalding T, Parkinson B, Smith NA, Verdonk P (2015) Arthroscopic meniscal allograft transplantation with soft-tissue fixation through bone tunnels. Arthrosc Tech 4:e559–e563CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Stone KR, Walgenbach AW, Turek TJ, Freyer A, Hill MD (2006) Meniscus allograft survival in patients with moderate to severe unicompartmental arthritis: a 2- to 7-year follow-up. Arthroscopy 22:469–478CrossRefPubMedGoogle Scholar
  43. 43.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49Google Scholar
  44. 44.
    van Arkel ER, de Boer HH (1995) Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up. J Bone Jt Surg Br 77:589–595CrossRefGoogle Scholar
  45. 45.
    Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2006) Transplantation of viable meniscal allograft. JBJS Essential Surg Tech 88:109–118CrossRefGoogle Scholar
  46. 46.
    Verdonk PCM, Verstraete KL, Almqvist KF, De Cuyper K, Veys EM, Verbruggen G, Verdonk R (2006) Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc 14:694–706CrossRefPubMedGoogle Scholar
  47. 47.
    Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30:174–181CrossRefPubMedGoogle Scholar
  48. 48.
    Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Benzi A, Roberti di Sarsina T, Signorelli C, Raggi F, Marcacci M (2016) Is sport activity possible after arthroscopic meniscal allograft transplantation? Midterm results in active patients. Am J Sports Med 44:625–632CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Nottingham Elective Orthopaedic ServicesNottingham University Hospitals NHS TrustNottinghamUK
  2. 2.Department of OrthopaedicsUniversity Hospital Coventry and Warwickshire NHS TrustCoventryUK

Personalised recommendations