Long-term Survival Analysis of Meniscus Allograft Transplantation With Bone Fixation

Published:September 27, 2016DOI:


      To investigate the long-term clinical results and clinical survival rate of meniscus allograft transplantation (MAT) with bone fixation.


      The inclusion criteria of this study were previous MAT with bone fixation technique in our institution and minimum follow-up duration of 8 years. Potential subjects were identified using the medical records and database that was prospectively collected from December 1996 to December 2005. The exclusion criteria were diffuse International Cartilage Repair Society grade IV articular cartilage degeneration that was not treated with a concomitant or staged cartilage repair procedure. Surgical indication for MAT was previous total or subtotal meniscectomy followed by persistent swelling and pain in involved compartment. Recommendations to return to contact sports or strenuous activities were not made. Clinical outcomes were evaluated using the modified Lysholm score, and comparison between preoperative and final Lysholm score was done using Student t-test. During the follow-up period, failure was defined as (1) subtotal resection of the allograft, (2) conversion to total knee arthroplasty, or (3) a modified Lysholm score less than 65 or that of the preoperative status. Survival analysis was performed using the Kaplan-Meier method.


      During the study period, 52 knees underwent MAT in our institution and 49 knees were eligible for this study. Three knees were excluded because they had diffuse grade IV cartilage degeneration in the respective compartment. Among the 49 knees enrolled, 34 underwent lateral and 15 underwent medial MAT. Two patients had bilateral lateral MAT. Of those 47 patients, 37 were male and 10 were female. Mean patient age at the time of the MAT was 30.4 ± 8.6 years. The median follow-up period was 11.5 years (8 to 17 years). The preoperative mean modified Lysholm score was 73.2 ± 10.6, which significantly increased to 89.4 ± 13.2 at the time of the final follow-up (P < .001). There were 2 failures noted at 6 months and 11.3 years, respectively, after MAT. All of the other allografts were surviving at the time of the latest follow-up. The 10-year survival rate was 98.0% (95% confidence interval [CI], 94.1%-100%), and the 15-year survival rate was 93.3% (95% CI, 83.7%-100%) according to the Kaplan-Meier analysis.


      MAT using the bone fixation techniques demonstrated a high clinical survival rate according to the long-term observation.

      Level of Evidence

      Level IV, therapeutic case series.
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        • Baratz M.E.
        • Fu F.H.
        • Mengato R.
        Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report.
        Am J Sports Med. 1986; 14: 270-275
        • Fairbank T.J.
        Knee joint changes after meniscectomy.
        J Bone Joint Surg Br. 1948; 30: 664-670
        • Kurosawa H.
        • Fukubayashi T.
        • Nakajima H.
        Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci.
        Clin Orthop Relat Res. 1980; 149: 283-290
        • Lanzer W.L.
        • Komenda G.
        Changes in articular cartilage after meniscectomy.
        Clin Orthop Relat Res. 1990; 252: 41-48
        • Levy I.M.
        • Torzilli P.A.
        • Gould J.D.
        • Warren R.F.
        The effect of lateral meniscectomy on motion of the knee.
        J Bone Joint Surg Am. 1989; 71: 401-406
        • Jeong H.J.
        • Lee S.H.
        • Ko C.S.
        Knee Surg Relat Res. 2012; 24: 129-136
        • Milachowski K.A.
        • Weismeier K.
        • Wirth C.J.
        Homologous meniscus transplantation. Experimental and clinical results.
        Int Orthop. 1989; 13: 1-11
        • van Arkel E.R.
        • de Boer H.H.
        Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up.
        J Bone Joint Surg Br. 1995; 77: 589-595
        • Stollsteimer G.T.
        • Shelton W.R.
        • Dukes A.
        • Bomboy A.L.
        Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients.
        Arthroscopy. 2000; 16: 343-347
        • Rath E.
        • Richmond J.C.
        • Yassir W.
        • Albright J.D.
        • Gundogan F.
        Meniscal allograft transplantation. Two- to eight-year results.
        Am J Sports Med. 2001; 29: 410-414
        • Ryu R.K.
        • Dunbar V.W.
        • Morse G.G.
        Meniscal allograft replacement: a 1-year to 6-year experience.
        Arthroscopy. 2002; 18: 989-994
        • Sekiya J.K.
        • Giffin J.R.
        • Irrgang J.J.
        • Fu F.H.
        • Harner C.D.
        Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction.
        Am J Sports Med. 2003; 31: 896-906
        • Noyes F.R.
        • Barber-Westin S.D.
        • Rankin M.
        Meniscal transplantation in symptomatic patients less than fifty years old.
        J Bone Joint Surg Am. 2004; 86: 1392-1404
        • Verdonk P.C.
        • Demurie A.
        • Almqvist K.F.
        • Veys E.M.
        • Verbruggen G.
        • Verdonk R.
        Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.
        J Bone Joint Surg Am. 2005; 87: 715-724
        • Kim J.G.
        • Lee Y.S.
        • Lee S.W.
        • Kim Y.J.
        • Kong D.H.
        • Ko M.S.
        Arthroscopically assisted medial meniscal allograft transplantation using a modified bone plug to facilitate passage: surgical technique.
        J Knee Surg. 2009; 22: 259-263
        • Lee B.S.
        • Kim J.M.
        • Sohn D.W.
        • Bin S.I.
        Review of meniscal allograft transplantation focusing on long-term results and evaluation methods.
        Knee Surg Relat Res. 2013; 25: 1-6
        • Vundelinckx B.
        • Bellemans J.
        • Vanlauwe J.
        Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation.
        Am J Sports Med. 2010; 38: 2240-2247
        • Cameron J.C.
        • Saha S.
        Meniscal allograft transplantation for unicompartmental arthritis of the knee.
        Clin Orthop Relat Res. 1997; 337: 164-171
        • Gonzalez-Lucena G.
        • Gelber P.E.
        • Pelfort X.
        • Tey M.
        • Monllau J.C.
        Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients.
        Arthroscopy. 2010; 26: 1633-1640
        • Noyes F.R.
        • Barber-Westin S.D.
        • Rankin M.
        Meniscal transplantation in symptomatic patients less than fifty years old.
        J Bone Joint Surg Am. 2005; 87: 149-165
        • Ha J.K.
        • Shim J.C.
        • Kim D.W.
        • Lee Y.S.
        • Ra H.J.
        • Kim J.G.
        Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation.
        Am J Sports Med. 2010; 38: 2448-2455
        • van der Wal R.J.
        • Thomassen B.J.
        • van Arkel E.R.
        Long-term clinical outcome of open meniscal allograft transplantation.
        Am J Sports Med. 2009; 37: 2134-2139
        • Hommen J.P.
        • Applegate G.R.
        • Del Pizzo W.
        Meniscus allograft transplantation: ten-year results of cryopreserved allografts.
        Arthroscopy. 2007; 23: 388-393
        • Stone K.R.
        • Adelson W.S.
        • Pelsis J.R.
        • Walgenbach A.W.
        • Turek T.J.
        Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage: a prospective two- to 12-year follow-up report.
        J Bone Joint Surg Br. 2010; 92: 941-948
        • Vundelinckx B.
        • Vanlauwe J.
        • Bellemans J.
        Long-term subjective, clinical, and radiographic outcome evaluation of meniscal allograft transplantation in the knee.
        Am J Sports Med. 2014; 42: 1592-1599
        • McDermott I.D.
        • Lie D.T.
        • Edwards A.
        • Bull A.M.
        • Amis A.A.
        The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 553-560
        • Kim J.M.
        • Lee B.S.
        • Kim K.H.
        • Kim K.A.
        • Bin S.I.
        Results of meniscus allograft transplantation using bone fixation: 110 cases with objective evaluation.
        Am J Sports Med. 2012; 40: 1027-1034
        • Pollard M.E.
        • Kang Q.
        • Berg E.E.
        Radiographic sizing for meniscal transplantation.
        Arthroscopy. 1995; 11: 684-687
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of knee ligament injuries.
        Clin Orthop Relat Res. 1985; 198: 43-49
        • Zaffagnini S.
        • Grassi A.
        • Marcheggiani Muccioli G.M.
        • et al.
        Survivorship and clinical outcomes of 147 consecutive isolated or combined arthroscopic bone plug free meniscal allograft transplantation.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1432-1439
        • Stone K.R.
        • Walgenbach A.W.
        • Turek T.J.
        • Freyer A.
        • Hill M.D.
        Meniscus allograft survival in patients with moderate to severe unicompartmental arthritis: a 2- to 7-year follow-up.
        Arthroscopy. 2006; 22: 469-478
        • Verdonk P.C.
        • Verstraete K.L.
        • Almqvist K.F.
        • et al.
        Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 694-706
        • von Lewinski G.
        • Milachowski K.A.
        • Weismeier K.
        • Kohn D.
        • Wirth C.J.
        Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1072-1082
        • Potter H.G.
        • Rodeo S.A.
        • Wickiewicz T.L.
        • Warren R.F.
        MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes.
        Radiology. 1996; 198: 509-514
        • Yoldas E.A.
        • Sekiya J.K.
        • Irrgang J.J.
        • Fu F.H.
        • Harner C.D.
        Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2003; 11: 173-182
        • Graf Jr., K.W.
        • Sekiya J.K.
        • Wojtys E.M.
        Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study.
        Arthroscopy. 2004; 20: 129-140
        • Cole B.J.
        • Dennis M.G.
        • Lee S.J.
        • et al.
        Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up.
        Am J Sports Med. 2006; 34: 919-927
        • Sekiya J.K.
        • West R.V.
        • Groff Y.J.
        • Irrgang J.J.
        • Fu F.H.
        • Harner C.D.
        Clinical outcomes following isolated lateral meniscal allograft transplantation.
        Arthroscopy. 2006; 22: 771-780
        • Farr J.
        • Rawal A.
        • Marberry K.M.
        Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year follow-up.
        Am J Sports Med. 2007; 35: 1459-1466
        • Rue J.P.
        • Yanke A.B.
        • Busam M.L.
        • McNickle A.G.
        • Cole B.J.
        Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2-year follow-up.
        Am J Sports Med. 2008; 36: 1770-1778
        • LaPrade R.F.
        • Wills N.J.
        • Spiridonov S.I.
        • Perkinson S.
        A prospective outcomes study of meniscal allograft transplantation.
        Am J Sports Med. 2010; 38: 1804-1812
        • Rodeo S.A.
        Meniscal allografts—where do we stand?.
        Am J Sports Med. 2001; 29: 246-261