AANA Lab Course 913 - Advanced Knee Course-Meniscus Transplantation_ Indications, Techniques & Outcomes Faculty Lecture

Meniscus Transplantation_ Indications, Techniques & Outcomes Faculty Lecture_ John C. Richmond, MD

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This presentation by Dr. John C. Richmond reviews the history, indications, techniques, and outcomes of meniscal allograft transplantation (MAT) as a salvage procedure for patients with meniscus deficiency. Historical perspectives show the evolving understanding of meniscal function, with early 20th-century views considering menisci as functionless structures, and mid-century recognition of damage caused by meniscectomy.<br /><br />Modern advances emphasize meniscal preservation, partial meniscectomy, arthroscopic repair, and ultimately allograft transplantation as a means to restore joint function and reduce pain. Indications for MAT include young patients experiencing joint line pain and tenderness after total or near-total meniscectomy, with stable, well-aligned knees, and minimal cartilage damage. Arthroscopic evaluation is essential before proceeding to ensure no exposed bone or advanced osteoarthritis.<br /><br />Accurate graft sizing typically relies on radiographic techniques such as the Pollard method, with MRI less reliable. Surgical implantation differs between medial and lateral menisci; medial side implantation focuses on preserving the meniscal rim and placing anterior and posterior bone plugs via tunneling, while lateral side transplantation often uses a bone bridge technique. Fixation methods have evolved from open procedures to arthroscopic-assisted hybrid techniques combining sutures and meniscal fasteners.<br /><br />Reducing meniscal extrusion—an issue leading to joint space narrowing—is an ongoing challenge. Strategies include capsulodesis and bracing postoperatively. Postoperative care involves non-weight bearing with restricted range of motion initially, gradual progression to partial weight bearing in braces, and avoidance of running or cutting activities for 6-12 months or longer.<br /><br />Outcomes show promising pain relief and healing, though some grafts may tear. Long-term follow-ups indicate that while MAT is not curative, it is a viable salvage option lasting 10-20 years, even in select patients over 50 seeking activity preservation. Proper patient selection, surgical technique, and addressing alignment issues are critical for success. MAT remains an important tool in joint preservation for symptomatic meniscus-deficient knees without advanced arthritis.

Keywords

meniscal allograft transplantation

meniscus deficiency

meniscectomy

arthroscopic repair

joint preservation

graft sizing

meniscal extrusion

postoperative care

surgical techniques

long-term outcomes