Meniscal Lesions: Diagnosis and Treatment

Robert S. P. Fan, MD, Richard K. N. Ryu, MD

Disclosures
In This Article

Current Concepts

Meniscal Allograft Reconstruction

Meniscal transplantation has evolved over the past 10 years as a promising technique. The recognition that meniscal sacrifice leads to late onset of degenerative arthritis has led investigators to search for techniques to alter the long-term consequences of complete or subtotal meniscectomy. Meniscal allograft transplantation intends to restore meniscal function through increase of contact area, decrease in contact stress, joint stabilization, shock absorption, and lubrication.

The indications for meniscal reconstruction continue to evolve. Generally speaking, patients who have undergone a subtotal or total meniscectomy with a stable knee resulting and no evidence of mal-alignment are candidates for meniscal replacement. Among patients with articular cartilage chondromalacia, the procedure should ideally be limited to those with grades 1 or 2. The meniscal allograft is harvested and procured according to standards established by the American Association of Tissue Banks[64] and is typically fresh frozen. Precise sizing of the meniscal allograft is correlated by true lateral x-ray measurement of the anterior posterior width of the tibial plateau.[65] The procedure is performed arthroscopically. Techniques with and without use of bone plugs or a bone bridge have been described. The presence of bone plugs or bridge provides the advantage of improved stability and bone to bone healing. This theoretically results in improved hoop stress transfer and meniscal stability. The remainder of the graft fixation is then performed with the meniscal repair technique of choice.

Follow-up studies have shown that meniscal allografts healed to the periphery in a similar manner as typical meniscal repairs[66,67,68] (Figure 17). To date, the function of the transplanted tissue has not been established. Long-term studies that examine the ability of the transplanted tissue to alter the progression of degenerative changes in the postmeniscectomized knee in a prospective fashion are needed in order to determine the long-term benefit of this specific procedure.

Completed meniscal replacement.

Meniscal Regeneration

Currently, the search is under way for a synthetic meniscal replacement. The biomechanical properties of the naturally occurring meniscus provide an enormous challenge for any synthetic material to match. One meniscal replacement strategy focuses on regeneration of meniscal tissue. The theory of meniscal regeneration is based on similar scenarios for skin regeneration in burn patients, as well as nerve regeneration. In the case of meniscal regeneration, a collagen scaffold acts as a resorbable regeneration template, where the scaffold resorbs at a controlled rate to allow for meniscal regeneration. Clinical studies investigating this technique are ongoing.[69,70]

Currently, meniscal allograft transplantation, as well as meniscal regeneration, remain areas of clinical research. As such, these topics remain controversial and there is no consensus opinion with regard to their widespread clinical application.

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