Failure of Meniscus Allograft Transplantation

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. (C) 2019 Elsevier Inc. All rights reserved.