Purpose
To systematically summarize the medial meniscus allograft transplantation (MAT) reported
outcomes and evaluate whether the surgical technique is associated with allograft
extrusion and knee function.
Methods
Systematic review was conducted according to PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were English-language
clinical studies involving arthroscopically assisted medial MAT that reported the
surgical technique and the presence of graft extrusion or functional outcomes after
surgery. Studies in which outcomes for medial MAT could not be separated from lateral
MAT were excluded. Surgical technique, allograft-related characteristics, and clinical
outcomes were extracted.
Results
Twenty-four studies with 328 medial MAT were included, 58.3% studies qualified as
level 4 of evidence, 29.2% as level 3, and 12.5% as level 2. Allograft fixation techniques
were bone plug (235/328 [71.6%]), bone bridge/trough (55/328 [16.8%]), and soft-tissue
suture fixation only (38/328 [11.6%]). Relative percentage of extrusion after surgery
ranged from 24.8% to 53.7%. Major extrusion (>3 mm) ranged from zero to 78%. Overall,
functional scores improved after medial MAT. None of surgical techniques were associated
with poor functional outcomes or extruded meniscus; however, nonanatomical placement
of the anterior and posterior horns appeared to increase meniscus extrusion.
Conclusion
Medial MAT provides favorable outcomes, with acceptable rates of complication and
failure regardless of surgical technique. Although allograft extrusion appears equivalent
for both bone plug and soft-tissue fixation techniques, positioning allograft horns
at the native meniscal footprint may be critical for preventing extrusion. However,
the heterogeneity and low level of evidence of the studies included in this review
prevent decisive conclusions regarding optimal MAT fixation techniques, clinical significance
of allograft extrusion, or comparative clinical outcomes after medial MAT.
Level of Evidence
Level IV - systematic review of Level II to IV studies.
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Article info
Publication history
Published online: December 07, 2022
Accepted:
November 25,
2022
Received:
June 3,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: G.M. reports grants from JRF Ortho and personal fees from JRF Ortho. E.M.F. reports other from Kairos Surgical. S.G. reports personal fees from JRF Ortho; non-financial support from Smith & Nephew and Vericel; and other from Kairos Surgical, Goode Surgical Inc., and Arthros. C.L. reports personal fees from Arthrosurface, Vericel, Biomet, Aastrom Biosciences, Sanofi-Aventis, Flexion Therapeutics, and Samumed; non-financial support from Arthrosurface, Vericel, and Aesculap. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2022 by the Arthroscopy Association of North America
