Page 33 - ISAKOS 2018 Newsletter Volume 2

With regard to clinical outcomes, no differences have been found between medial MAT and lateral MAT, between isolated MAT and MAT with concomitant procedures, between soft-tissue and osseous fixation, or between procedures performed with a bone plug technique and those performed with a bone bridge technique. No technique is associated with better outcomes. Soft tissue fixation is associated with a higher rate of extension. There is no consensus with regard to the rehabilitation protocol or the use of a brace following MAT. Most authors advocate partial weight-bearing and restricted ROM at first, followed by full weight-bearing and full ROM by 6 weeks. Return to sports following MAT remains controversial. There is a paucity of literature on this topic, with only a few small case series in the literature. Limited low-quality evidence suggests that return to the pre-injury level of play is possible after MAT; however, the durability of the transplant in terms of its ability to resist repetitive supraphysiological loads is unknown. The chondroprotective effects of MAT remain controversial. Animal models have demonstrated some protective effects, but human studies have shown mixed results as a result of small sample sizes and lack of standardized outcomes. Level-IV evidence suggests that MAT may prevent the progression of cartilage degeneration, with slight or no progressive loss of joint space in most patients. MAT has not been shown to prevent the development of OA in patients with normal cartilage at the time of the index procedure.
Conclusion
Meniscal allograft transplantation has been shown to be to be a safe procedure with good to excellent clinical outcomes and high rates of patient satisfaction. Careful patient selection and appropriate patient counseling are critical. In general, MAT should be approached as a salvage intervention intended to improve quality of life. Sports-related goals are secondary and may not be achievable. It is important to emphasize that the results of this procedure will not last forever and that the patient will require further surgery.
Recommended Literature
1. Sherman S, Nuelle C, Latterman C. AAOS Let’s Discuss Series: Meniscal Allograft Transplantation. May 2015. 2. Hergan D, Thut D, Sherman O, Day MS. Meniscal allograft transplantation. Arthroscopy. 2011;27(1):101-112. 3. Rosso F, Bisicchia S, Bonasia DE, Amendola A. Meniscal allograft transplantation: a systematic review. Am J Sports Med. 2015;43(4):998-1007. 4. Lee BS, Kim HJ, Lee CR, Bin SI, Lee DH, Kim NJ, Kim CW. Clinical outcomes of meniscal allograft transplantation with or without other procedures: a systematic review and meta-analysis. Am J Sports Med. 2017 [Epub ahead of print] PMID: 28945482. 5. Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T; IMREF Group. International Meniscus Reconstruction Experts Forum (IMREF) 2015 consensus statement on the practice of meniscal allograft transplantation. Am J Sports Med. 2016 [Epub ahead of print] PMID: 27562342.
03 Photographs illustrating the technique used for arthroscopic MAT involving anatomical bone sockets and suspensory cortical fixation. A: Graft preparation. P = posterior, and A = anterior. B: Cadaveric model demonstrating suspensory cortical root fixation
with use of a 4-point knotless locking system to provide strong
cortical fixation.
04 Images of the knee of a patient who underwent medial MAT. A:
Preoperative MRI demonstrating medial meniscal deficiency. B, C, and D: Arthroscopic images made before (B) and after (C, D) medial MAT.
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