Review Question - QID 4900

The most common long-term complication after meniscal transplantation is meniscal graft tear. Graft failure that results from graft tears is thought to be related to the acellularity of graft tissue.

Meniscal allograft transplantation is considered a salvage treatment option for young patients (<50 years old) with symptomatic meniscal deficiencies. The overall complication rate ranges from 4-36%, which include meniscal tearing, acute immune rejection, superficial and deep infection, chronic knee pain, etc. Graft tears make up >50% of these complications.

Rath et al. evaluated 18 of 23 patients who had underwent meniscal allograft transplantation. They showed that 8 of 22 allograft menisci (36%) tore during the 8-year study period. They believe the decreased biologic activity of the graft over time may be a major factor that contributes to the high frequency of graft re-tearing.

Sekiya et al. reviewed meniscal allograft transplantation. They concluded that meniscal allograft transplantation may partially restore native meniscal function. Data has also shown that the progression of degenerative arthritic changes in transplanted meniscus-deficient knee compartments is slowed with this procedure.

Illustration A shows a basic schematic of meniscal transplantation. Here the graft is secured by anterior + posterior bone plugs and sutures to secure the transplanted meniscus into its native anatomical position.

Incorrect Answers:
Answer 1: Late immune rejection of the meniscal graft has not been documented in literature. Graft rejection occurs most commonly in the acute phase, at an incidence of <1%.
Answer 2: Graft incorporation into the surrounding tissue occurs 8-12 weeks after surgery. Loss of fixation would most commonly occur acutely, at an incidence of ~1-2%.
Answer 3: Meniscal transplantation has been shown to be protective against the progression of osteoarthritis in the knee.
Answer 5: Chronic infections from cadaveric graft tissue are extremely rare, at an incidence of <1%.