Meniscus TransplanTaTion

Any significant loss of meniscal function through injury or menisectomy alters the biomechanical and biological environment of the normal knee, eventually resulting in pain, recurrent swelling, and effusions. Overt secondary osteoarthritis is often the endpoint.1,2 Recognition of these consequences has led to a strong commitment within the orthopedic community to meniscal-sparing interventions. However, there are cases in which meniscal preservation is not possible. In carefully selected patients, meniscal allografts can restore near-normal knee anatomy and biomechanics, providing excellent pain relief and improved function.3,4 Several techniques exist for allograft meniscus transplantation including bone-plug and bone-bridge techniques, the latter comprising variants such as the keyhole, dove-tail, and bridge-in-slot techniques. We prefer the latter because of its simplicity and secure bony fixation; the ability to more easily perform concomitant procedures, such as osteotomy and ligament reconstruction; and the advantages of maintaining the relationship of the native anterior and posterior horns of the meniscus.5