Meniscal Transplants and Scaffolds: A Systematic Review of the Literature

Abstract

The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal allograft transplantation (MAT) and implants or scaffolds may be considered. The goal of this review was to compare the success and failure rates of two techniques, MAT and meniscal scaffolds, and make an inference which treatment is more preferable at the present time and future. Studies that met inclusion criteria were assessed for technique used, type of transplant used, number of procedures included in the study, mean age of patients, mean follow-up time, number of failures, failure rate, and reported reoperation rate. Fifteen studies for the MAT group and 7 studies for the meniscal scaffold group were identified. In this selection of studies, the average failure rate in the MAT group was 18.7% and average reoperation rate was 31.3%. The average failure rate in the meniscal scaffold group was 5.6%, and average reoperation rate was 6.9%. It appears that although MAT is associated with high reoperation and failure rates, the limited number of studies on both MAT and scaffolds and mainly short-term results of scaffold studies make it difficult to make an objective comparison.

Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics

“…Meniscal allograft transplantation is a promising surgical treatment option for relatively young patients with knee pain after total meniscectomy who are not candidates for knee arthroplasty . Nevertheless, current literature is limited because of different available allograft preservation and surgical techniques, resulting in high variability in outcomes . Meniscal allograft transplantation also has limited use in the setting of osteoarthritis and typically requires concurrent surgical procedures to correct malalignment or instability of the knee joint.…”

“…All included studies were limited by a lack of controlled comparison. Reported transplant failure and reoperation rates also vary considerably, averaging 18.7% and 31.3%, respectively . Meniscal allograft transplantation also is not considered curative in the long term because 15‐year failure rates were reported to be as high as 81% .…”

“…Long‐term prospective cohort studies have shown statically significant improvements in VAS, IKDC, and Tegner index scores at 10 years compared with partial meniscectomy alone . However, the current literature supporting the use of meniscal scaffolding is limited because of the few available independent studies but remains a promising option for patients with large meniscal lesions.…”

The implications of non-anatomical positioning of a meniscus prosthesis on predicted human knee joint biomechanics

“…For a meniscus prosthesis, the geometry, material properties, fixation type, and prosthesis positioning are believed to be crucial factors [6][7][8], which need to be assessed thoroughly before clinical implementation. The influence of geometrical specifications of the medial meniscus prosthesis [9][10][11] and the material properties of the prosthesis [12][13][14] on the knee biomechanics have previously been studied, as have different meniscus prosthesis fixation types [15,16].…”

Meniscal Allograft Transplantation With Soft-Tissue Fixation Including the Anterior Intermeniscal Ligament

“…[3][4][5] Meniscal allograft transplantation (MAT) has been introduced as a treatment for symptomatic patients after subtotal or total meniscectomy to reduce knee pain and improve clinical outcomes. 1,2,[5][6][7][8][9][10] Successful allograft fixation has been reported using bone block fixation or soft-tissue fixation, although it remains unclear which technique is better. 1,2,[11][12][13][14][15][16][17][18] However, graft extrusion after MAT can remain a factor in postoperative failure, and various surgical techniques are still being introduced to reduce extrusion.…”