Medial Meniscus Allograft Transplantation in the Setting of Revision Anterior Cruciate Ligament Reconstruction

  • Trevor Gulbrandsen
  • Katie Freeman
  • Seth L. ShermanEmail author


While the reasons for ACL reconstruction failure can be multifactorial, medial meniscus deficiency remains a major contributor. The posterior horn of the medial meniscus acts as an important secondary restraint to anterior tibial translation. Functional or subtotal meniscectomy increases forces on the ACL graft, leading to attritional graft laxity and symptomatic recurrent instability. Additionally, loss of medial meniscal tissue increases the contact pressures in the medial compartment and may contribute to the development of post-meniscectomy syndrome. This chapter presents a complex case involving a three-time ACL reconstruction failure in the setting of medial meniscus deficiency. The chapter highlights the decision-making process required to identify and treat risk factors that contributed to failure of previous ACL reconstruction. As will be demonstrated, the addition of medial MAT contributes to functional stability and reduces painful medial symptoms. Medial MAT is a useful adjunct to revision ACL reconstruction during salvage intervention.


Anterior cruciate ligament Reconstruction Meniscal allograft transplantation Quadriceps autograft Suspensory fixation Ligament restoration 


  1. 1.
    Śmigielski R, Becker R, Zdanowicz U, et al. Medial meniscus anatomy—from basic science to treatment. Knee Surg Sports Traumatol Arthrosc. 2015;23:8.CrossRefGoogle Scholar
  2. 2.
    Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res. 2000;18(1):109–15.CrossRefGoogle Scholar
  3. 3.
    Deledda D, Rosso F, Cottino U, Bonasia DE, Rossi R. Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction. Joints. 2015;3(3):151–7.CrossRefGoogle Scholar
  4. 4.
    van Arkel ER, de Boer HH. Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up. J Bone Joint Surg Br. 1995;77:589–95.CrossRefGoogle Scholar
  5. 5.
    Sekiya JK, Giffin JR, Irrgang JJ, Fu FH, Harner CD. Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction. Am J Sports Med. 2003;31:896–906.CrossRefGoogle Scholar
  6. 6.
    Graf KW Jr, Sekiya JK, Wojtys EM. Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study. Arthroscopy. 2004;20:129–40.CrossRefGoogle Scholar
  7. 7.
    Saltzman BM, Meyer MA, Weber AE, Poland SG, Yanke AB, Cole BJ. 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. 2017;45:550–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Trevor Gulbrandsen
    • 1
  • Katie Freeman
    • 2
  • Seth L. Sherman
    • 3
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  2. 2.Department of Orthopedic Surgery and RehabilitationUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of MissouriColumbiaUSA
  4. 4.Missouri Orthopaedic InstituteColumbiaUSA

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