(v) Meniscal allograft transplantation and meniscal scaffolds; where are we up to now?

Abstract

Abstract The meniscus has an important function in protecting the joint surfaces within its compartment whilst facilitating joint lubrication and contributing to stability of the knee. It is now well recognized that meniscal loss leads to degenerative change. This paper details the options to reconstruct the meniscus. While the evidence is not conclusive for a chondroprotective effect, there is growing evidence that meniscal reconstruction gives significant functional and symptomatic improvement. Meniscal scaffolds are indicated for segmental loss of meniscal tissue, and provide a framework for regeneration of tissue. Two types are in current use, and medium-to long-term results indicate efficacy and durability, provided that strict indications are followed. Meniscal allograft transplantation has been around for over 30 years, with an evolution in technique from open surgery to arthroscopic-assisted methods. Graft complications are low with advances in tissue bank provision and infection control. Analysis of patient-reported outcomes show maintenance of clinical benefit in the long-term, recognizing an early failure rate of approximately 10% in the first 18 months. Indications for transplantation are being extended as results improve, with combined surgery involving ligament reconstruction, osteotomy and cartilage repair. Meniscal scaffolds and meniscal allograft transplantation should no longer be considered ‘experimental', and further research on evaluating the chondroprotective effect is awaited.