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The meniscus plays a vital role in chondroprotection, shock absorption, load distribution, proprioception, joint lubrication, and secondary stabilization. If a patient with meniscal deficiency becomes symptomatic, meniscal allograft transplantation (MAT) is one surgical option. Understanding the unique anatomic and biomechanical characteristics of the medial and lateral meniscus is essential when considering a meniscal transplantation. MAT is currently indicated for younger (up to age 50) symptomatic patients with meniscal deficiency following previous subtotal or functional meniscectomy. Surgeons must also correct any concomitant pathology, such as high-grade cartilage defects, ligament insufficiency, and limb malalignment, as failure to correct these comorbidities leads to less optimal outcomes and are often associated with early transplant failure. Each of the three standard MAT techniques will be discussed in detail: bone plug, bone bridge-in-channel (e.g., slot, trough, dovetail, keyhole, etc.), and soft tissue only fixation. [ABSTRACT FROM AUTHOR]

Meniscal allograft transplantation (MAT) is performed in the United States in ever-increasing numbers. Various techniques have been described since the initial transplantation was performed more then 20 years ago. Decreased pain and improved knee function are attainable with proper patient selection, identification, and correction of all concomitant malalignment and instability, and intervention earlier in the disease process. This article reviews the indications for MAT and offers a basic treatment algorithm for managing concomitant cartilage lesions, instability, and misalignment. The author’s preferred arthroscopic technique using individual bone plugs for both medial and lateral MAT and fresh-frozen allograft is described. This technique stresses the low morbidity of the approach and the re-establishment of the anatomic bony attachments of the anterior and posterior horns of the meniscus. [Copyright &y& Elsevier]

Meniscus allograft transplantation (MAT) has emerged as an acceptable surgical therapy in relieving pain and restoring function in young patients with symptomatic meniscal deficiency without severe osteoarthritis. Despite its early success, at long-term follow-up MAT has been associated with significant rates of graft failure, requiring repeat interventions and often progression to arthroplasty. In select patients who previously benefited from a primary MAT and have an identified, treatable cause of failure, revision meniscus allograft transplantation may be considered. Careful identification and treatment of concomitant pathologies known to cause failure, including ligamentous instability, cartilage injury and limb malalignment, should be addressed at the time of revision surgery. Acute tears should be assessed for whether they are amenable to repair or replacement with a new graft is required. The author's preferred approach is to perform the bone-slot technique for both primary and revision cases. Literature on outcomes following revision meniscus allograft transplantation are limited but favorable, with higher failure rates than primary MAT but significant functional outcome improvement in most patients. [ABSTRACT FROM AUTHOR]