Skip to main content
Log in

Meniscal allograft transplantation: a review of indications, techniques, and outcomes

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Abstract

When compared to meniscectomy, meniscus allograft transplantation (MAT) may provide superior long-term benefits to young, active patient populations who have lost meniscal function because of irreparable damage, such as, an avascular tear, previous repair failure, and unsalvageable tear types. Positive outcomes are most likely to be achieved when meniscus allograft transplantation is performed in appropriately selected patients. Indications include patients younger than 50 years of age, with a history of subtotal or total meniscectomy without concomitant articular cartilage defects, uncorrectable joint malalignment, and/or knee instability. Outcomes for meniscal allograft transplantation are promising with studies reporting long-term graft survivorship as high as 89% at 10 years and significant improvements in multiple patient reported outcome measures.

Level of evidence

Level V.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Alentorn-Geli E, Seijas Vázquez R, García Balletbó M, Álvarez Díaz P, Steinbacher G, Cuscó Segarra X et al (2011) Arthroscopic meniscal allograft transplantation without bone plugs. Knee Surg Sports Traumatol Arthrosc 19:174–182

    Google Scholar 

  2. Alentorn-Geli E, Vázquez RS, Díaz PA, Cuscó X, Cugat R (2010) Arthroscopic meniscal transplants in soccer players: outcomes at 2- to 5-year follow-up. Clin J Sport Med 20:340–343

    Google Scholar 

  3. Bloch B, Asplin L, Smith N, Thompson P, Spalding T (2019) Higher survivorship following meniscal allograft transplantation in less worn knees justifies earlier referral for symptomatic patients: experience from 240 patients. Knee Surg Sports Traumatol Arthrosc 27:1891–1899

    Google Scholar 

  4. Chalmers PN, Karas V, Sherman SL, Cole BJ (2013) Return to high-level sport after meniscal allograft transplantation. Arthroscopy 29:539–544

    Google Scholar 

  5. Cole BJ, Carter TR, Rodeo SA (2003) Allograft meniscal transplantation: background, techniques, and results. Instr Course Lect 52:383–396

    Google Scholar 

  6. Fanelli D, Mercurio M, Gasparini G, Galasso O (2019) Predictors of meniscal allograft transplantation outcome: a systematic review. J Knee Surg. https://doi.org/10.1055/s-0039-1695043

    Article  Google Scholar 

  7. Flanigan D (2018) Meniscus allograft transplant. New York, NY: ConMed, pp 20178

  8. Getgood A et al (2017) International meniscus reconstruction experts forum (IMREF) 2015 consensus statement on the practice of meniscal allograft transplantation. Am J Sports Med 45:1195–1205

    Google Scholar 

  9. 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 23:946–953

    Google Scholar 

  10. 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 26:1633–1640

    Google Scholar 

  11. Ha JK, Jang H-W, Jung JE, Cho SI, Kim JG (2014) Clinical and radiologic outcomes after meniscus allograft transplantation at 1-year and 4-year follow-up. Arthroscopy 30:1424–1429

    Google Scholar 

  12. Ha JK, Kim YS, Kwon MS, Chung KS, Kim SB, Kim JG (2019) The international knee documentation committee score indicates midterm patient satisfaction with outcomes after meniscal allograft transplantation. Indian J Orthop 53:431–436

    Google Scholar 

  13. Hannon MG, Ryan MK, Strauss EJ (2015) Meniscal allograft transplantation a comprehensive historical and current review. Bull Hosp Joint Dis 73:100–108

    Google Scholar 

  14. Harris JD, Cavo M, Brophy R, Siston R, Flanigan D (2011) Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy 27:409–418

    Google Scholar 

  15. Farr J, Gomell AH (2014) Meniscal transplantation techniques. Cartilage restoration-practical clinical applications. Spinger, New York, pp 199–221

    Google Scholar 

  16. Jeon B, Kim JM, Lee CR, Kim KA, Bin SI (2015) An osteophyte in the tibial plateau is a risk factor for allograft extrusion after meniscus allograft transplantation. Am J Sports Med 43:1215–1221

    Google Scholar 

  17. Jiménez-Garrido C, Gómez-Cáceres A, Espejo-Reina MJ, Espejo-Reina A, Tamimi I, Serrano-Fernández JM et al (2019) Obesity and meniscal transplant failure: a retrospective cohort study. J Knee Surg. https://doi.org/10.1055/s-0039-1695041

    Article  Google Scholar 

  18. Kim J-H, Lee S, Ha DH, Lee SM, Jung K, Choi W (2018) The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation. J Orthop Surg Res 13:181–181

    Google Scholar 

  19. LaPrade RF, Wills NJ, Spiridonov SI, Perkinson S (2010) A prospective outcomes study of meniscal allograft transplantation. Am J Sports Med 38:1804–1812

    Google Scholar 

  20. Lee B-S, Kim H-J, Lee C-R, Bin S-I, Lee D-H, Kim N-J et al (2018) Clinical outcomes of meniscal allograft transplantation with or without other procedures: a systematic review and meta-analysis. Am J Sports Med 46:3047–3056

    Google Scholar 

  21. Lee S-M, Bin S-I, Kim J-M, Lee B-S, Lee C-R, Son D-W et al (2019) Long-term outcomes of meniscal allograft transplantation with and without extrusion: mean 12.3-year follow-up study. Am J Sports Med 47:815–821

    Google Scholar 

  22. Lee S-M, Bin S-I, Kim J-M, Lee B-S, Park J-G (2020) Absolute meniscal extrusion after lateral meniscal allograft transplantation does not progress during long-term follow-up: average of 10.3 years' follow-up longitudinal magnetic resonance imaging study. Am J Sports Med 48:326–333

    Google Scholar 

  23. Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J et al (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34:1334–1344

    Google Scholar 

  24. Liu JN, Agarwalla A, Garcia GH, Christian DR, Gowd AK, Yanke AB et al (2019) Return to sport and work after high tibial osteotomy with concomitant medial meniscal allograft transplant. Arthroscopy 35:3090–3096

    Google Scholar 

  25. 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.e1871

    Google Scholar 

  26. Marcacci M, Marcheggiani Muccioli GM, Grassi A, Ricci M, Tsapralis K, Nanni G et al (2014) Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up stud. Am J Sports Med 42:382–388

    Google Scholar 

  27. McCormick F, Harris JD, Abrams GD, Hussey KE, Wilson H, Frank R et al (2014) Survival and reoperation rates after meniscal allograft transplantation: analysis of failures for 172 consecutive transplants at a minimum 2-year follow-up. Am J Sports Med 42:892–897

    Google Scholar 

  28. Menetrey J et al (1999) Posterior peripheral sutures in meniscal allograft replacement. Arthroscopy 15:663–668

    CAS  Google Scholar 

  29. Noyes FR, Barber-Westin SD (2015) Meniscal transplantation in symptomatic patients under fifty years of age: survivorship analysis. J Bone Joint Surg Am 97:1209–1219

    Google Scholar 

  30. Ortega-Orozco R, Rodríguez-Ávila NG, Miranda-Ramírez E, Casillas-Arista KS, Felipe-Gutiérrez J, Estrella-González CA et al (2018) Meniscal transplant: clinical and functional experience at one year follow-up. Acta Orthop Mex 32:329–333

    CAS  Google Scholar 

  31. Park J-G, Bin S-I, Kim J-M, Lee B-S, Lee C-R, Son D-W et al (2019) A magnetic resonance imaging analysis of shrinkage of transplanted fresh-frozen lateral meniscal allografts during a minimum follow-up of 8 years. Arthroscopy 35:2887–2895

    Google Scholar 

  32. Park J-G, Bin S-I, Kim J-M, Lee B-S, Lee S-M, Kwon O-J et al (2019) Large chondral defect not covered by meniscal allograft is associated with inferior graft survivorship after lateral meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05713-x

    Article  Google Scholar 

  33. Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11:684–687

    CAS  Google Scholar 

  34. Puzzitiello RN, Liu JN, Garcia GH, Redondo ML, Christian DR, Yanke AB et al (2020) Return to sport and outcomes after concomitant lateral meniscal allograft transplant and distal femoral varus osteotomy. Arthroscopy 36:253–260

    Google Scholar 

  35. Ren S, Zhang X, You T, Jiang X, Jin D, Zhang W (2018) Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up. J Orthop Surg Res 13:97–97

    Google Scholar 

  36. Rucinski K, Cook JL, Crecelius CR, Stucky R, Stannard JP (2019) Effects of compliance with procedure-specific postoperative rehabilitation protocols on initial outcomes after osteochondral and meniscal allograft transplantation in the knee. Orthop J Sports Med 7:2325967119884291–2325967119884291

    Google Scholar 

  37. Saltzman BM, Bajaj S, Salata M, Daley EL, Strauss E, Verma N et al (2012) Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up. J Knee Surg 25:165–175

    Google Scholar 

  38. Saltzman BM, Cotter EJ, Stephens JP, Cvetanovich GL, Madden B, Wang K et al (2018) Preoperative tibial subchondral bone marrow lesion patterns and associations with outcomes after isolated meniscus allograft transplantation. Am J Sports Med 46:1175–1184

    Google Scholar 

  39. Saltzman BM, Meyer MA, Leroux TS, Gilelis ME, Debot M, Yanke AB et al (2018) The influence of full-thickness chondral defects on outcomes following meniscal allograft transplantation: a comparative study. Arthroscopy 34:519–529

    Google Scholar 

  40. 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 45:550–562

    Google Scholar 

  41. Samitier G, Alentorn-Geli E, Taylor DC, Rill B, Lock T, Moutzouros V et al (2015) Meniscal allograft transplantation. Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation. Knee Surg Sports Traumatol Arthrosc 23:310–322

    Google Scholar 

  42. Southworth TM, Naveen NB, Tauro TM, Chahla J, Cole BJ (2020) Meniscal allograft transplants. Clin Sports Med 39:93–123

    Google Scholar 

  43. Stevenson C, Mahmoud A, Tudor F, Myers P (2019) Meniscal allograft transplantation: undersizing grafts can lead to increased rates of clinical and mechanical failure. Knee Surg Sports Traumatol Arthrosc 27:1900–1907

    Google Scholar 

  44. Stone KR, Adelson WS, Pelsis JR, Walgenbach AW, Turek TJ (2010) Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage: a prospective two- to 12-year follow-up report. J Bone Joint Surg Br 92:941–948

    CAS  Google Scholar 

  45. van Arkel ER, de Boer HH (2002) Survival analysis of human meniscal transplantations. J Bone Joint Surg Br 84:227–231

    Google Scholar 

  46. Vundelinckx B, Bellemans J, Vanlauwe J (2010) Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sports Med 38:2240–2247

    Google Scholar 

  47. Zaffagnini S, Grassi A, Macchiarola L, Stefanelli F, Coco V, Marcacci M et al (2019) Meniscal allograft transplantation is an effective treatment in patients older than 50 years but yields inferior results compared with younger patients: a case-control study. Arthroscopy 35:2448–2458

    Google Scholar 

  48. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Benzi A, Roberti di Sarsina T, Signorelli C et al (2016) Is sport activity possible after arthroscopic meniscal allograft transplantation? Midterm results in active patients. Am J Sports Med 44:625–632

    Google Scholar 

  49. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Benzi A, Serra M, Rotini M et al (2016) Survivorship and clinical outcomes of 147 consecutive isolated or combined arthroscopic bone plug free meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 24:1432–1439

    Google Scholar 

  50. Zaffagnini S, Grassi A, Romandini I, Marcacci M, Filardo G (2019) Meniscal allograft transplantation combined with anterior cruciate ligament reconstruction provides good mid-term clinical outcome. Knee Surg Sports Traumatol Arthrosc 27:1914–1923

    Google Scholar 

Download references

Funding

David C. Flanigan receives consulting income from Ceterix Orthopaedics, Depuy Synthes, Linvatec Corp., Smith and Nephew, Vericel, and Zimmer Biomet. The authors received no funding for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David C. Flanigan.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

This study did not require approval from the Biomedical Institutional Review Board of The Ohio State University.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

A. Cavendish, P., DiBartola, A.C., Everhart, J.S. et al. Meniscal allograft transplantation: a review of indications, techniques, and outcomes. Knee Surg Sports Traumatol Arthrosc 28, 3539–3550 (2020). https://doi.org/10.1007/s00167-020-06058-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06058-6

Keywords

Navigation