Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2016

01-09-2016 | Knee

Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes

Authors: Nick A. Smith, Benjamin Parkinson, Charles E. Hutchinson, Matthew L. Costa, Tim Spalding

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2016

Login to get access

Abstract

Purpose

The primary aim of this systematic review was to examine the hypothesis that meniscal allograft transplantation is chondroprotective by identifying and appraising studies that have assessed the progression of osteoarthritis following meniscal allograft transplantation. The secondary aim was to identify and appraise radiological measures of meniscal allograft integrity following surgery.

Methods

Clinical studies on human participants undergoing meniscal allograft transplantation with a minimum follow-up of 6 months were included. The primary outcome measure was any radiological osteoarthritis progression measure. Secondary outcomes included magnetic resonance measures of meniscal integrity including meniscal size, shape, healing, extrusion and signal intensity.

Results

Thirty-eight studies with 1056 allografts were included. The weighted mean joint space loss was 0.032 mm at 4.5 years across 11 studies. Other radiological classification systems were reported in small numbers and with variable progression rates. Meniscal extrusion was present in nearly all cases, but was not associated with clinical or other radiological outcomes. Meniscal healing rates were high, although the size, shape and signal intensity were commonly altered from that of the native meniscus. The quality of the included studies was low, with a high risk of bias.

Conclusion

There is some evidence to support the hypothesis that meniscal allograft transplantation reduces the progression of osteoarthritis, although it is unlikely to be as effective as the native meniscus. If this is proven, there may be a role for prophylactic meniscal allograft transplantation in selected patients. Well-designed randomised controlled trials are needed to further test this hypothesis.

Level of evidence

Systematic review of studies, Level IV.
Literature
1.
Abat F, Gelber PE, Erquicia JI, Pelfort X, Gonzalez-Lucena G, Monllau JC (2012) Suture-only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation. Am J Sports Med 40(7):1591–1596CrossRefPubMed
2.
Abat F, Gelber PE, Erquicia JI, Tey M, Gonzalez-Lucena G, Monllau JC (2013) Prospective comparative study between two different fixation techniques in meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21(7):1516–1522CrossRefPubMed
3.
Arnoczky SP, Cooper TG, Stadelmaier DM, Hannafin JA (1994) Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 10(5):552–557CrossRef
4.
Arnoczky SP, DiCarlo EF, O’Brien SJ, Warren RF (1992) Cellular repopulation of deep-frozen meniscal autografts: an experimental study in the dog. Arthroscopy 8(4):428–436CrossRefPubMed
5.
Baratz M, Fu F, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. Am J Sports Med 14:270–274CrossRefPubMed
6.
Bhosale AM, Myint P, Roberts S, Menage J, Harrison P, Ashton B, Smith T, McCall I, Richardson JB (2007) Combined autologous chondrocyte implantation and allogenic meniscus transplantation: a biological knee replacement. Knee 14(5):361–368CrossRefPubMed
7.
Black C, Clar C, Henderson R, MacEachern C, McNamee P, Quayyum Z, Royle P, Thomas S (2009) The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation. Health Technol Assess 13(52):1–148CrossRefPubMed
8.
Blumenkrantz G, Majumdar S (2007) Quantitative magnetic resonance imaging of articular cartilage in osteoarthritis. Eur Cell Mater 13:76–86PubMed
9.
Bruyere O, Richy F, Reginster JY (2005) Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study. Ann Rheum Dis 64(12):1727–1730CrossRefPubMedPubMedCentral
10.
Carter T, Economopoulos KJ (2013) Meniscal allograft shrinkage-MRI evaluation. J Knee Surg 26(3):167–171PubMed
11.
Carter T, Rabago M (2012) Meniscal allograft transplantation: 10 year follow-up. Arthroscopy 1:e17–e18CrossRef
12.
Chalmers PN, Karas V, Sherman SL, Cole BJ (2013) Return to high-level sport after meniscal allograft transplantation. Arthroscopy 29(3):539–544CrossRefPubMed
13.
Chan W, Stevens M, Lang P, Sack K, Majumdar S, Stoller D, Genant H (1990) Structural changes of osteoarthritis of the knee: radiography, CT, and MR imaging correlation. Radiology 177:183CrossRef
14.
Choi NH, Yoo SY, Victoroff BN (2011) Position of the bony bridge of lateral meniscal transplants can affect meniscal extrusion. Am J Sports Med 39(9):1955–1959CrossRefPubMed
15.
Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183(1):17–23CrossRefPubMed
16.
De Coninck T, Huysse W, Verdonk R, Verstraete K, Verdonk P (2013) Open versus arthroscopic meniscus allograft transplantation: magnetic resonance imaging study of meniscal radial displacement. Arthroscopy 29(3):514–521CrossRefPubMed
17.
Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H (1984) Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br 66(5):685–693PubMed
18.
Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B(4):664–670PubMed
19.
Graf KW Jr, Sekiya JK, Wojtys EM (2004) Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study. Arthroscopy 20(2):129–140CrossRefPubMed
20.
Guermazi A, Hayashi D, Roemer FW, Felson DT (2013) Osteoarthritis: a review of strengths and weaknesses of different imaging options. Rheum Dis Clin North Am 39(3):567–591CrossRefPubMed
21.
Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG (2010) Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. Am J Sports Med 38(12):2448–2455CrossRefPubMed
22.
Hardy PP, Roumazeille T, Klouche S, Rousselin B, Bongiorno V, Graveleau N, Billot N, Pansard E (2013) Arthroscopic meniscal allograft transplantation without bone blocks: evaluation with mr-arthrography. Arthroscopy 10(Suppl 1):106CrossRef
23.
Hommen JP, Applegate GR, Del Pizzo W (2007) Meniscus allograft transplantation: ten-year results of cryopreserved allografts. Arthroscopy 23(4):388–393CrossRefPubMed
24.
Hunter DJ, Zhang YQ, Tu X, Lavalley M, Niu JB, Amin S, Guermazi A, Genant H, Gale D, Felson DT (2006) Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis Rheum 54(8):2488–2495CrossRefPubMed
25.
Huston P, Moher D (1996) Redundancy, disaggregation, and the integrity of medical research. Lancet 347(9007):1024–1026CrossRefPubMed
26.
Irrgang JAA, Staubli HU (2000) The new IKDC form. In: Proceedings of the ninth congress of the European society of sports traumatology, knee surgery and arthroscopy, London, UK
27.
Jang SH, Kim JG, Ha JG, Shim JC (2011) Reducing the size of the meniscal allograft decreases the percentage of extrusion after meniscal allograft transplantation. Arthroscopy 27(7):914–922CrossRefPubMed
28.
29.
Kenny C (1997) Radial displacement of the medial meniscus and Fairbank’s signs. Clin Orthop Relat Res 339:163–173CrossRefPubMed
30.
Kim CW, Kim JM, Lee SH, Kim JH, Huang J, Kim KA, Bin SI (2011) Results of isolated lateral meniscus allograft transplantation: focus on objective evaluations with magnetic resonance imaging. Am J Sports Med 39(9):1960–1967CrossRefPubMed
31.
Kim J-M, Bin S-I (2006) Meniscal allograft transplantation after total meniscectomy of torn discoid lateral meniscus. Arthroscopy 22(12):1344–1350.e1341CrossRefPubMed
32.
Kim J-M, Lee B-S, Kim K-H, Kim K-A, Bin S-I (2012) Results of meniscus allograft transplantation using bone fixation: 110 cases with objective evaluation. Am J Sports Med 40(5):1027–1034CrossRefPubMed
33.
Koh YG, Moon HK, Kim YC, Park YS, Jo SB, Kwon SK (2012) Comparison of medial and lateral meniscal transplantation with regard to extrusion of the allograft, and its correlation with clinical outcome. J Bone Joint Surg Br 94B(2):190–193CrossRef
34.
Lee B-S, Chung J-W, Kim J-M, Cho W-J, Kim K-A, Bin S-I (2012) Morphologic changes in fresh-frozen meniscus allografts over 1 year: a prospective magnetic resonance imaging study on the width and thickness of transplants. Am J Sports Med 40(6):1384–1391CrossRefPubMed
35.
Lee D-H, Kim S-B, Kim T-H, Cha E-J, Bin S-I (2010) Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med 38(2):247–254CrossRefPubMed
36.
Lee DH, Kim TH, Lee SH, Kim CW, Kim JM, Bin SI (2008) Evaluation of meniscus allograft transplantation with serial magnetic resonance imaging during the first postoperative year: focus on graft extrusion. Arthroscopy 24(10):1115–1121CrossRefPubMed
37.
Lee DH, Lee BS, Chung JW, Kim JM, Yang KS, Cha EJ, Bin SI (2011) Changes in magnetic resonance imaging signal intensity of transplanted meniscus allografts are not associated with clinical outcomes. Arthroscopy 27(9):1211–1218CrossRefPubMed
38.
Lee SC, Chang WH, Park SJ, Kim TH, Sung BY (2014) Lateral meniscus allograft transplantation: an arthroscopically-assisted single-incision technique using all-inside sutures with a suture hook. Knee Surg Sports Traumatol Arthrosc 22(2):263–267CrossRefPubMed
39.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRefPubMedPubMedCentral
40.
Marcacci M, Zaffagnini S, Muccioli GM, Grassi A, Bonanzinga T, Nitri M, Bondi A, Molinari M, Rimondi E (2012) Meniscal allograft transplantation without bone plugs: a 3-year minimum follow-up study. Am J Sports Med 40(2):395–403CrossRefPubMed
41.
McDermott ID, Lie DT, Edwards A, Bull AM, Amis AA (2008) The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures. Knee Surg Sports Traumatol Arthrosc 16(6):553–560CrossRefPubMed
42.
McDermott ID, Sharifi F, Bull AM, Gupte CM, Thomas RW, Amis AA (2004) An anatomical study of meniscal allograft sizing. Knee Surg Sports Traumatol Arthrosc 12(2):130–135CrossRefPubMed
43.
Milachowski KA, Weismeier K, Wirth CJ (1989) Homologous meniscus transplantation. Experimental and clinical results. Int Orthop 13(1):1–11CrossRefPubMed
44.
Nepple JJ, Dunn WR, Wright RW (2012) Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am 94(24):2222–2227CrossRefPubMedPubMedCentral
45.
Noyes FR, Barber-Westin SD (2015) A systematic review of the incidence and clinical significance of postoperative meniscus transplant extrusion. Knee Surg Sports Traumatol Arthrosc 23(1):290–302CrossRefPubMed
46.
Noyes FR, Barber-Westin SD, Rankin M (2004) Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 86-A(7):1392–1404PubMed
47.
Noyes FR, Barber-Westin SD, Rankin M (2005) Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am 87(Suppl 1 Pt 2):149–165PubMed
48.
Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N (2011) Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull 99:89–106CrossRefPubMed
49.
Potter HG, Rodeo SA, Wickiewicz TL, Warren RF (1996) MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes. Radiology 198(2):509–514CrossRefPubMed
50.
Rankin M, Noyes FR, Barber-Westin SD, Hushek SG, Seow A (2006) Human meniscus allografts' in vivo size and motion characteristics: magnetic resonance imaging assessment under weightbearing conditions. Am J Sports Med 34(1):98–107CrossRefPubMed
51.
Rath E, Richmond JC, Yassir W, Albright JD, Gundogan F (2001) Meniscal allograft transplantation. Two- to eight-year results. Am J Sports Med 29(4):410–414PubMed
52.
Roos H, Lauren M, Adalberth T, Roos E, Jonsson K, Lohmander L (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693CrossRefPubMed
53.
Rosso F, Bisicchia S, Bonasia DE, Amendola A (2014) Meniscal allograft transplantation: a systematic review. Am J Sports Med
54.
Saltzman BM, Bajaj S, Salata M, Daley EL, Strauss E, Verma N, Cole BJ (2012) Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up. J Knee Surg 25(2):165–175CrossRefPubMed
55.
Samitier G, Alentorn-Geli E, Taylor DC, Rill B, Lock T, Moutzouros V, Kolowich P (2015) Meniscal allograft transplantation. Part 2: systematic review of transplant timing, outcomes, return to competition, associated procedures, and prevention of osteoarthritis. Knee Surg Sports Traumatol Arthrosc 23(1):323–333CrossRefPubMed
56.
Sekiya JK, Giffin JR, Irrgang JJ, Fu FH, Harner CD (2003) Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction. Am J Sports Med 31(6):896–906PubMed
57.
Sharma L, Eckstein F, Song J, Guermazi A, Prasad P, Kapoor D, Cahue S, Marshall M, Hudelmaier M, Dunlop D (2008) Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Arthritis Rheum 58(6):1716–1726CrossRefPubMed
58.
Smith NA, MacKay N, Costa M, Spalding T (2015) Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(1):270–279CrossRefPubMed
59.
Stollsteimer GT, Shelton WR, Dukes A, Bomboy AL (2000) Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients. Arthroscopy 16(4):33-347CrossRef
60.
Sugita T, Kawamata T, Ohnuma M, Yoshizumi Y, Sato K (2001) Radial displacement of the medial meniscus in varus osteoarthritis of the knee. Clin Orthop Relat Res 387:171–177CrossRefPubMed
61.
van Arkel ER, de Boer HH (1995) Human meniscal transplantation. Preliminary results at 2 to 5-year follow-up. J Bone Joint Surg Br 77(4):589–595PubMed
62.
van Arkel ER, Goei R, de Ploeg I, de Boer HH (2000) Meniscal allografts: evaluation with magnetic resonance imaging and correlation with arthroscopy. Arthroscopy 16(5):517–521CrossRefPubMed
63.
Verdonk P, Depaepe Y, Desmyter S, De Muynck M, Almqvist KF, Verstraete K, Verdonk R (2004) Normal and transplanted lateral knee menisci: evaluation of extrusion using magnetic resonance imaging and ultrasound. Knee Surg Sports Traumatol Arthrosc 12(5):411–419CrossRefPubMed
64.
Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2006) Transplantation of viable meniscal allograft surgical technique. J Bone Joint Surg Am 88(Suppl 1 Pt 1):109–118PubMed
65.
Verdonk PCM, Verstraete KL, Almqvist KF, De Cuyper K, Veys EM, Verbruggen G, Verdonk R (2006) Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc 14(8):694–706CrossRefPubMed
66.
Verdonk R, Verdonk P, Almqvist KF (2009) Viable meniscal transplantation. Rev Bras Med 66(8):37–41
67.
Verma NN, Kolb E, Cole BJ, Berkson MB, Garretson R, Farr J, Fregly B (2008) The effects of medial meniscal transplantation techniques on intra-articular contact pressures. J Knee Surg 21(1):20–26CrossRefPubMed
68.
Vundelinckx B, Bellemans J, Vanlauwe J (2010) Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sports Med 38(11):2240–2247CrossRefPubMed
69.
Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D (2002) Long-term results of meniscal allograft transplantation. Am J Sports Med 30(2):174–181PubMed
70.
Yoldas EA, Sekiya JK, Irrgang JJ, Fu FH, Harner CD (2003) Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 11(3):173–182PubMed
71.
Yoon KH, Lee SH, Park SY, Kim HJ, Chung KY (2014) Meniscus allograft transplantation: a comparison of medial and lateral procedures. Am J Sports Med 42(1):200–207CrossRefPubMed
72.
Yulish BS, Montanez J, Goodfellow DB, Bryan PJ, Mulopulos GP, Modic MT (1987) Chondromalacia patellae: assessment with MR imaging. Radiology 164(3):763–766CrossRefPubMed
73.
Zhang H, Liu X, Wei Y, Hong L, Geng XS, Wang XS, Zhang J, Cheng KB, Feng H (2012) Meniscal allograft transplantation in isolated and combined surgery. Knee Surg Sports Traumatol Arthrosc 20(2):281–289CrossRefPubMed
Metadata
Title
Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes
Authors
Nick A. Smith
Benjamin Parkinson
Charles E. Hutchinson
Matthew L. Costa
Tim Spalding
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3573-0

Other articles of this Issue 9/2016

Knee Surgery, Sports Traumatology, Arthroscopy 9/2016 Go to the issue

Knee

Anterior cruciate ligament reconstruction; is a tourniquet necessary? A randomized controlled trial

Knee

Measurement of the knee flexion angle with smartphone applications: Which technology is better?

Knee

The tibial–tubercle trochlear groove distance in patients with trochlear dysplasia: the influence of the proximally flat trochlea

Knee

Preparation techniques for all-inside ACL cortical button grafts: a biomechanical study

Knee

Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee

Erratum

Erratum to: Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site