AANA/SOMOS Course Materials (August 2021)-Meniscus Transplant_Can We Really Get Them Back

Meniscus Transplant_Can We Really Get Them Back_

Pdf Summary

This presentation by Dr. John D. Kelly IV from Penn Perelman School of Medicine discusses the current state, principles, and outcomes of meniscal allograft transplantation (MAT) as a treatment after significant meniscectomy in the knee.<br /><br />Key principles highlighted include selecting the right patient—those who are symptomatic after losing over 50% of their meniscus, with minimal cartilage damage (grade 3 or less), corrected alignment or instability, and strong motivation to return to activity. Surgical technique considerations involve leg positioning, medial collateral ligament release, and sometimes opting for smaller grafts to reduce extrusion.<br /><br />The 2015 International Meniscus Reconstruction Experts Forum (IMREF) consensus advises against surgery in asymptomatic knees and urges caution in patients with advanced arthritis (Kellgren-Lawrence grade 3). Nonirradiated frozen or viable grafts with intact peripheral attachments are preferred; no clear advantage of bone versus soft tissue fixation exists, and biologics lack sufficient evidence.<br /><br />Alignment evaluation should go beyond static X-rays, incorporating biomechanical assessments, as forces during gait affect joint loading. Osteotomy combined with meniscal transplant can reduce pressure on medial compartments, improving outcomes.<br /><br />Long-term survivorship varies: approximately 56% at 20 years; half may require further surgery. Shorter-term follow-ups show 74-88% survivorship at 5-10 years. Return to sport rates vary from 74% to 92% depending on study and sport, with systematic reviews showing about 77% return to play, but only 68% at same or higher levels.<br /><br />Studies in active-duty military populations indicate lower success: only 13% return to unrestricted duty, and nearly half have permanent activity restrictions.<br /><br />In summary, meniscal transplantation can restore function and allow return to sport, but success is time-limited. Careful patient selection, proper surgical technique, correction of alignment, and realistic counseling about outcomes are critical to optimize results. The procedure offers symptomatic relief and functional improvement but is not a panacea, especially for high-demand military personnel.

Keywords

meniscal allograft transplantation

meniscectomy

knee surgery

patient selection

surgical technique

meniscus graft

alignment correction

long-term outcomes

return to sport

military populations