Abstract
Meniscus allotransplantation represents the biological solution for the symptomatic, meniscus-deficient patient who has not developed advanced osteoarthritis. A growing body of evidence suggests that pain relief and functional improvement may reliably be achieved at short- and medium-term follow-up, and even, in some cases, at long-term (>10 years) follow-up. Future research must address the issue of optimal timing of the procedure and whether meniscal transplantation results in demonstrable long-term benefits, especially with regard to protection of articular cartilage.
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Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B:664–670
Cole BJ, Carter TR, Rodeo SA (2003) Allograft meniscal transplantation: background, techniques, and results. Instr Course Lect 52:383–396
Locht RC, Gross AE, Langer F (1984) Late osteochondral resurfacing for tibial plateau fractures. J Bone Joint Surg Am 66:328–335
Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscal transplantation: Experimental and clinical results. Int Orthop 13:1–11
Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64:883–888
Helfet AJ (1959) Mechanism of derangements of the medial semilunar cartilage and their management. J Bone Joint Surg Br 41:319–336
Levy IM, Torzilli PA, Gould JD, Warren RF (1989) The effect of lateral meniscectomy on motion of the knee. J Bone Joint Surg Am 71:401–406
MacConaill MA (1931) The function of intra-articular fibrocartilages, with special reference to the knee and inferior radiolunar joints. J Anat 66:210–227
Simon WH, Friedenberg S, Richardson S (1973) Joint congruence: a correlation of joint congruence and thickness of articular cartilage in dogs. J Bone Joint Surg Am 55:1614–1620
Walker PS, Erkman MJ (1975) The role of the menisci in force transmission across the knee. Clin Orthop 109:184–192
Simonian PT, Sussmann PS, van Trommel M, Wickiewicz TL, Warren RF (1997) Popliteomeniscal fasciculi and lateral meniscal stability. Am J Sports Med 25:849–853
Staubli HU, Birrer S (1990) The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency. Arthroscopy 6:209–220
Thompson WO, Thaete FL, Fu FH, Dye SF (1991) Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Am J Sports Med 19:210–216
Arnoczky SP, McDevitt CA (2000) The meniscus: structure, function, repair and replacement. In: Buckwalter JA, Einhorn TA, Simon SR (eds) Orthopaedic basic science: biology and biomechanics of the musculoskeletal system. 2nd ed American Academy of Orthopaedic Surgeons, Rosemont, pp 531–545
Arnoczky SP, Warren RF (1982) Microvasculature of the human meniscus. Am J Sports Med 10:90–95
Fithian DC, Kelly MA, Mow VC (1990) Material properties and structure–function relationships in the menisci. Clin Orthop 252:19–31
Favenesi JA, Shaffer JC, Mow VC (1983) Biphasic mechanical properties of knee meniscus. Trans Orthop Res Soc 7:264–265
Rijk PC (2004a) Meniscal allograft transplantation—part I: background, results, graft selection and preservation, and surgical considerations. Arthroscopy 20:728–743
Rodeo SA (2001) Meniscal allografts—where do we stand? Am J Sports Med 29:246–261
Arnoczky SP, DiCarlo EF, O’Brien SJ, Warren RF (1992) Cellular repopulation of deep-frozen meniscal autografts: an experimental study in the dog. Arthroscopy 8:428–436
Day B, Mackenzie WG, Shim SS, Leung G (1985) The vascular and nerve supply of the human meniscus. Arthroscopy 1:58–62
Zimny ML, Albright DL, Dabeziew E (1988) Mechanoreceptors in the human medial meniscus. Acta Anat 133:35–40
Jackson DW, Whelan J, Simon TM (1993) Cell survival after transplantation of fresh meniscal allografts: DNA probe analysis in a goat model. Am J Sports Med 21:540–550
Verdonk R (1997) Alternative treatment for meniscal injuries. J Bone Joint Surg 79B:866–873
Verdonk R, Van Daele P, Claus B et al (1994) Viable meniscus transplantation (in German). Orthopade 23(2):153–159
Arnoczky SP, Milachowski KA (1990) Meniscal allografts: where do we stand? In: Ewing JW (ed) Articular cartilage and knee joint function: basic science and arthroscopy. Raven, New York, pp 129–136
Siegel MG, Roberts CS (1993a) Meniscal allografts. Clin Sports Med 12:59–80
Brown KL, Cruess RL (1982) Bone and cartilage transplantation in orthopaedic surgery. A review. J Bone Joint Surg Am 64:270–279
Khoury MA, Goldberg VM, Stevenson S (1994) Demonstration of HLA and ABH antigens in fresh and frozen human menisci by immunohistochemistry. J Orthop Res 12:751–757
Milachowski KA, Weismeier K, Erhardt W, Remberger K (1987) Transplantation of the meniscus: an experimental study in sheep. Sportverletzung Sportschaden 1:20–24
Garrett JC, Stevensen RN (1991) Meniscal transplantation in the human knee. A preliminary report. Arthroscopy 7:57–62
Jackson DW, Windler GE, Simon TM (1990a) Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med 18:1–11
Rijk PC (2004b) Meniscal allograft transplantation—part II: alternative treatments, effects on articular cartilage, and future directions. Arthroscopy 20:851–859
Rodeo SA, Seneviratne A, Suzuki K, Felker K, Wickiewicz TL, Warren RF (2000) Histological analysis of human meniscal allografts: a preliminary report. J Bone Joint Surg Am 82:1071–1082
Jackson DW, McDevitt CA, Simon TM, Arnoczky SP, Atwell EA, Silvino NJ (1992) Meniscal transplantation using fresh and cryopreserved allografts: an experimental study in goats. Am J Sports Med 20:644–656
Noyes FR, Barber-Westin SD (1995) Irradiated meniscus allografts in the human knee: a two to five year follow-up study. Orthop Trans 19:417
Alhalki MM, Hull ML, Howell SM (2000a) Contact mechanics of the medial tibial plateau after implantation of a medial meniscal allograft. A human cadaveric study. Am J Sports Med 28:370–376
Noyes FR, Barber-Westin SD, Rankin M (2005) Meniscal transplantation in symptomatic patients less than fifty-years old. J Bone Joint Surg Am 87:149–165
Bos GD, Goldberg VM, Zika JM, Heiple KG, Powell AE (1983) Immune responses of rats to frozen bone allografts. J Bone Joint Surg Am 65:239–246
Stevenson S (1987) The immune response to osteochondral allografts in dogs. J Bone Joint Surg Am 69:573–582
Wada Y (1993) Meniscal transplantation using fresh and cryopreserved allografts. An experimental study in the genetically defined rat. J Jpn Orthop Assoc 67:677–683
Zukor DJ, Cameron JC, Brooks PJ et al (1990) The fate of human meniscal allografts. In: Ewing JW (ed) Articular cartilage and knee joint function. Raven, New York, pp 147–152
Hamlet W, Liu SH, Yang R (1997) Destruction of a cryopreserved meniscal allograft: a case for acute rejection. Arthroscopy 13:517–521
van Arkel ERA, van den Berg-Loonen EM, van Wersch JW, de Boer HH (1997) Human leukocyte antigen sensitization after cryopreserved human meniscal transplantations. Transplantation 64:531–533
Buck BE, Resnick L, Shah SM, Malinin TI (1990) Human immunodeficiency virus cultured from bone. Implications for transplantation. Clin Orthop 251:249–253
Nemzek JA, Arnoczky SP, Swenson CL (1994) Retroviral transmission by the transplantation of connective-tissue allografts: an experimental study. J Bone Joint Surg Am 76:1036–1041
Conway B, Tomford W, Mankin HJ, Hirsch MS, Schooley RT (1991) Radiosensitivity of HIV-I: potential application to sterilization of bone allografts. AIDS 5:608–609
Yahai L, Zukor D (1994) Irradiated meniscal allotransplants of rabbits: study of the mechanical properties at six months post-operation. Acta Orthop Belg 60:210–215
Jackson DW, Windler GE, Simon TM (1990b) Intra-articular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med 18:1–11
Barber FA (1994) Accelerated rehabilitation for meniscus repairs. Arthroscopy 10:206–210
Johnson DL, Bealle D (1999) Meniscal allograft transplantation. Clin Sports Med 18:93–108
Dye SF, Chew MH (1993) The use of scintigraphy to detect increased osseous metabolic activity about the knee. J Bone Joint Surg Am 75:1388–1406
Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB (1998a) Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 81:1349–1350
Garrett JC (1993) Meniscal transplantation: a review of 43 cases with 2- to 7- year follow-up. Sports Med Arthrosc Rev 1:164–167
Aagaard H, Jorgenssen U, Bojsen-Moller F (1999) Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep. Knee Surg Sports Traumatol Arthrosc 7:184–191
Siegel MG, Roberts CS (1993b) Meniscal allografts. Clin Sports Med 12:59–80
Cole BJ, Cohen B (2000) Chondral injuries of the knee. A contemporary view of cartilage restoration. Orthop Spec Ed 6:71–76
Goble EM (2004) Arthroscopic meniscus transplantation: plug and slot technique. In: Miller M, Cole BJ (eds) Textbook of arthroscopy. WB Saunders, Philadelphia, pp 536–546
Rosenberg TD, Paulos LE, Parker RD et al (1988) The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 70:1479–1483
Potter HG, Linklater JM, Allen AA et al (1998b) Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 80:1276–1284
Berlet GC, Fowler PJ (1998) The anterior horn of the medial meniscus. An anatomic study of its insertion. Am J Sports Med 26:540–543
Verdonk R, Kohn D (1999) Harvest and conservation of meniscal allografts. Scand J Med Sci Sports 9:158–159
Wilcox TR, Goble EM, Doucette SA (1996) Goble technique of meniscus transplantation. Am J Knee Surg 9:37–42
Kohn D (1994) Meniscus transplantation. In: Fu FH (ed) Advances in operative orthopaedics. Mosby-Year Book, Chicago, 2:49–76
Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394
Garrett JC (1992) Meniscal transplantation. In: Aichroth PC, Canon WD, Patel DV (eds) Knee surgery: current practice. Raven, New York, pp 95–103
Johnson DL, Swenson TM, Harner CD (1994) Meniscal reconstruction using allograft tissue: an arthroscopic technique. Oper Tech Sports Med 2:223–231
Shaffer B, Kennedy S, Klimkiewicz J, Yao L (2000) Preoperative sizing of meniscal allografts in meniscus transplantation. Am J Sports Med 28:524–533
Haut TL, Hull ML, Howell SM (2000) Use of roentgenography and magnetic resonance imaging to predict meniscal geometry determined with a three-dimensional coordinate digitizing system. J Orthop Res 18:228–237
Pollard ME, Kang Q, Berg EE (1995) Radiographic sizing for meniscal transplantation. Arthroscopy 11:684–687
Chen MI, Branch TP, Hutton WC (1996) Is it important to secure the horns during lateral meniscal transplantation? A cadaveric study. Arthroscopy 12:174–181
Paletta GA Jr, Manning T, Snell E, Parker R, Bergfeld J (1997) The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee: a biomechanical study. Am J Sports Med 25:692–698
Alhalki MM, Howell SM, Hull ML (1999) How three methods for fixing a medial meniscal autograft affect tibial contact mechanics. Am J Sports Med 27:320–328
Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2006) Transplantation of viable meniscal allograft. J Bone Joint Surg Am 88(1 Suppl 1):109–118
Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11:96–103
Kuhn JE, Wojtys EM (1996) Allograft meniscal transplantation. Clin Sports Med 15:537–556
Goble EM, Kohn D, Verdonk R, Kane SM (1999) Meniscal substitutes-human experience. Scand J Med Sci Sports 9:146–157
Cameron JC, Saha S (1997) Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop 337:164–171
Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F (2001) Meniscal allograft transplantation. Two-to-eight-year results. Am J Sports Med 29:410–414
Shelton WR, Dukes AD (1994) Meniscus replacement with bone anchors: a surgical technique. Arthroscopy 10:324–327
Mikic ZD, Brankov MZ, Tubic MV, Lazetic AB (1993) Allograft meniscus transplantation in the dog. Acta Orthop Scand 64:329–332
Rijk PC, Van Noorden CJF (2002) Structural analysis of meniscal allografts after immediate and delayed transplantation in rabbits. Arthroscopy 18:995–1001
Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL (2000) Meniscal allograft transplantation: a 1-to-5 year follow-up of 22 patients. Arthroscopy 16:343–347
Fritz JM, Irrgang JJ, Harner CD (1996) Rehabilitation following allograft meniscal transplantation: a review of the literature and case study. J Orthop Sports Phys Ther 24:98–106
Anderson DR, Gershuni DH, Nakhostine M, Danzig LA (1993) The effects of non-weight-bearing and limited motion on the tensile properties of the meniscus. Arthroscopy 9:440–445
Dowdy PA, Miniaci A, Arnoczky SP, Fowler PJ, Boughner DR (1995) The effect of cast immobilization on meniscal healing: an experimental study in the dog. Am J Sports Med 23:721–728
Van Arkel ERA, Goei R, de Ploeg I, de Boer HH (2000) Meniscal allografts: evaluation with magnetic resonance imaging and correlation with arthroscopy. Arthroscopy 16:517–521
Alford W, Cole BJ (2005) The indications and technique for meniscal transplant. Orthop Clin N Am 36:468–484
Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen, Verdonk R (2005) Transplantation of viable meniscal allograft: survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am 87:715–724
Van Arkel ERA, De Boer HH (2002) Survival analysis of human meniscal transplantation. J Bone Joint Surg Br 84:227–231
Potter HG, Rodeo SA, Wickiewicz TL et al (1996) MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes. Radiology 198:509–514
Szomor ZL, Martin TE, Bonar F, Murrell GAC (2000) The protective effects of meniscal transplantation on cartilage: an experimental study in sheep. J Bone Joint Surg Am 82:80–88
Messner K (1999) Meniscal regeneration or meniscal transplantation? Scand J Med Sci Sports 9:162–167
Aagaard H, Jorgensen U, Bojsen-Moller F (2003) Immediate versus delayed meniscal allograft transplantation in sheep. Clin Orthop 406:218–227
Rijk PC, Tigchelaar-Gutter W, Bernoski FP, Van Noorden CJF (2004) Histologic changes of articular cartilage after meniscus replacement in rabbits. Arthroscopy 20:911–917
Cummins JF, Mansour JN, Howe Z, Allan DG (1997) Meniscal transplantation and degenerative articular change: an experimental study in the rabbit. Arthroscopy 13:485–491
Elliott DM, Jones R, Setton LA, Sully SP, Vail TP, Guilak F (2002) Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage. Knee Surg Sports Traumatol Arthrosc 10:109–118
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 (Epublication ahead of print)
Messner K, Fahlgren A, Persliden J, Andersen BM (2001) Radiographic joint space narrowing and histologic changes in a rabbit meniscectomy model of early knee osteoarthrosis. Am J Sports Med 2:151–160
Thomas RH, Resnick D, Alazraki NP, Daniel D, Greenfield R (1975) Compartmental evaluation of osteoarthritis of the knee. A comparative study of available diagnostic modalities. Radiology 116:585–594
Christensen SB (1983) Localization of bone-seeking agents in developing experimentally induced osteoarthritis in the knee joint of the rabbit. Scand J Rheumatology 12:343–349
Rijk PC, Van Eck-Smit BLF, Van Noorden CJF (2003) Scintigraphic assessment of rabbit knee joints after meniscal allograft transplantation. Arthroscopy 19:506–510
Bylski-Austrow DI, Meade T, Malumed J et al (1992) Irradiated meniscal allografts: mechanical and histological studies in the goat. Trans Orthop Res Soc 17:175
Paletta GA Jr, Manning T, Snell E, Parker R, Bergfeld J (1997) The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med 25(5):692–698
Alhalki MM, Hull ML, Howell SM (2000) Contact mechanics of the medial tibial plateau after implantation of a medial meniscal allograft: a human cadaveric study. Am J Sports Med 28:370–376
Chen MI, Branch TP, Hutton WC (1996b) Is it important to secure the horns during lateral meniscal transplantation? A cadaveric study. Arthroscopy 12(2):174–81
von Lewinski G, Hurschler C, Allmann C, Wirth CJ (2006) The influence of pre-tensioning of meniscal transplants on the tibiofemoral contact area. Knee Surg Sports Traumatol Arthrosc 14(5):425–436
Moon MS, Woo YK, Kin YI (1988) Meniscal regeneration and its effects on articular cartilage in rabbit knees. Clin Orthop 227:298–304
Elmer RM, Moskowitz RW, Frankel VH (1977) Meniscal regeneration and postmeniscectomy degenerative joint disease. Clin Orthop 124:304–310
Ghosh P, Taylor TKF, Pettit GD, Horsburgh BA, Bellanger CR (1983) Effect on postoperative immobilization of the regrowth of the knee joint semilunar cartilage: an experimental study. J Orthop Res 1:153–164
Stone KR, Rodkey WG, McKinney LA, Steadman JR (1995) Autogenous replacement of the meniscal cartilage: analysis of results and mechanics of failure. Arthroscopy 11:395–400
Bruns J, Kahrs J, Kampen J, Behrens P, Plitz W (1998) Autologous perichondral tissue for meniscal replacement. J Bone Joint Surg Br 80:918–923
Kohn D, Wirth CJ, Reiss G, Plitz W, Maschek H, Erhardt W, Wulker N (1992) Medial meniscus replacement by a tendon autograft. Experiments in sheep. J Bone Joint Surg Br 74(6):910–917
Pressel T, v Lewinski G, Kohn D, Wirth CJ (2005) Der Meniskusersatz mit autologer Quadrizepssehne - eine Langzeitanalyse. Z Orthop Ihre Grenzgeb 143(1):42–47
Yannas IV (1992) Tissue regeneration by use of collagen-glycosaminoglycan copolymers. Clin Mater 9:179–187
Yannas IV, Burke JF (1980) Design of artificial skin: 1. design principles. J Biomed Mater Res 14:65–81
Klompmaker J, Veth RP, Jansen HW, Nielsen HK, De Groot JH, Penning AJ (1996) Meniscal replacement using a porous polymer prosthesis: a preliminary study in the dog. Biomaterials 17:1169–1175
Stone KR, Rodkey WG, Webber R, McKinney L, Steadman JR (1992) Meniscal regeneration with copolymeric collagen scaffolds. In vitro and in vivo studies evaluated clinically, histologically, and biochemically. Am J Sports Med 20:104–111
Steadman JR, Rodkey WG (2005) Tissue-engineered collagen meniscus implants: 5- to 6-year feasibility study results. Arthroscopy 21(5):515–525
Van Arkel ERA, De Boer HH (1995) Human meniscal transplantation: preliminary results at 2 to 5-year follow-up. J Bone Joint Surg Br 77:589–595
Carter TR (1999) Meniscal allograft transplantation. Sports Med Arthrosc Rev 7:51–62
Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30:174–181
Ryu RK, Dunbar VWH, Morse GG (2002) Meniscal allograft replacement: a 1-year to 6-year experience. Arthroscopy 18:989–994
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Lubowitz, J.H., Verdonk, P.C.M., Reid , J.B. et al. Meniscus allograft transplantation: a current concepts review. Knee Surg Sports Traumatol Arthrosc 15, 476–492 (2007). https://doi.org/10.1007/s00167-006-0216-5
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DOI: https://doi.org/10.1007/s00167-006-0216-5