Editorial Commentary: Combined Anterior Cruciate Ligament Reconstruction and Medial Meniscal Transplantation Improve Functional Outcomes When Properly Indicated

Abstract

The anterior cruciate ligament (ACL) and medial meniscus both contribute to anteroposterior translation of the tibia. Biomechanical studies have found increased translation at both 30° and 90° when transecting the posterior horn of the medial meniscus, and clinically, medial meniscal deficiency has been shown to have a 46% increase in ACL graft strain at 90°. Medial meniscal deficiency is a risk factor for failure after ACL reconstruction, with a hazard ratio of 15.1. The combination of meniscal allograft transplantation and ACL reconstruction is technically demanding but results in mid- to long-term clinical improvement in well-indicated patients. Patients with medial meniscal deficiency and failed ACL reconstruction or with ACL deficiency and medial-sided knee pain due to meniscal deficiency are candidates for combined procedures. On the basis of our experience, acute meniscal injury is not an indication for primary meniscal transplantation in any setting. Surgeons should repair the meniscus if reparable or perform partial meniscectomy and see how the patient responds. There is insufficient evidence to show that early meniscal transplantation will be chondroprotective. We reserve this procedure for the indications previously described. Severe osteoarthritis (Kellgren-Lawrence grades III and IV) and Outerbridge grade IV focal chondral defects of the tibiofemoral compartment that are not amenable to cartilage repair are absolute contraindications to the combined procedure.