Meniscal allograft transplantation: a review of indications, techniques, and outcomes
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Meniscal allograft transplantation: a review of indications, techniques, and outcomes Parker A. Cavendish2 · Alex C. DiBartola1 · Joshua S. Everhart1 · Scott Kuzma1 · Walter J. Kim1 · David C. Flanigan1,3 Received: 18 March 2020 / Accepted: 10 May 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
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. Keywords Meniscus · Allograft transplant · Meniscal tear
Introduction The medial and lateral menisci are essential in absorbing shock, stabilizing the knee, and distributing and sharing the load. In an intact knee, the medial and lateral meniscus bear approximately 50% and 70% of the load, respectively [13]. Studies evaluating the biomechanical importance of the menisci have found that total meniscectomy increases contact stress in the tibial-femoral joint by over 130% [23], emphasizing the importance of the menisci in load bearing Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-020-06058-6) contains supplementary material, which is available to authorized users. * David C. Flanigan [email protected] 1
Division of Sports Medicine, Department of Orthopaedics, Wexner Medical Center, OSU Sports Medicine Center, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221, USA
2
College of Medicine, The Ohio State University, Columbus, USA
3
Department of Orthopaedics, Team Physician and Director of the Cartilage Restoration Program, The Ohio State University, Columbus, USA
and stress reduction on the articular surfaces of the femur and tibia. As our understanding of the functional importance of the menisci has progressed, so to have treatment options for meniscal pathology. Up until as recent as the 1980s, any insult to the structural integrity of the meniscus would result in the patient undergoing total meniscectomy, and while meniscectomy may provide patients with short term relief of pain and mechanical symptoms, it substantially increases their risk of joint instability, cartilage damage, and subsequent onset of osteoarthritis [13]. Meniscal allograft transplantation (MAT) may serve as one of
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