Meniscal transplant outcomes in patients with cartilage damage

https://pubmed.ncbi.nlm.nih.gov/39506549/

Evidence base

Ahmed I, Khatri C, Spalding T, Smith N. Meniscal allograft transplantation in patients with substantial cartilage disease led to a sustained long-term improvement in patient-reported outcome measures. Knee Surg Sports Traumatol Arthrosc. 2025 Aug;33(8):2771-2780. doi: 10.1002/ksa.12536. Epub 2024 Nov 7. PMID: 39506549.

Key points

  • Meniscal transplantation improves pain and function for up to 10 years
  • Patients with cartilage damage improve as much as those without
  • Around 8 out of 10 transplants are still functioning long term in patients with cartilage damage
  • Around 9 out of 10 are functioning in patients without cartilage damage
  • Patients with cartilage damage have a higher risk of further surgery
  • Earlier treatment may lead to better long-term outcomes

Why is this important?

Traditionally, meniscal transplantation has been recommended for patients with relatively healthy cartilage.

However, many patients present later, once cartilage damage has already developed. These patients often:

  • are too young for knee replacement
  • may not be suitable for osteotomy
  • have limited treatment options

This study helps answer whether meniscal transplantation is still beneficial in this more complex group.

What did the study involve?

We reviewed 422 patients who underwent meniscal transplantation:

  • 281 patients had little or no cartilage damage
  • 129 patients had full-thickness cartilage damage

Patients were followed for an average of just over 6 years, with outcomes measured for up to 10 years after surgery.

We assessed:

  • pain and function using validated knee scores
  • activity levels
  • graft survival, meaning whether the transplant remained in place or required further surgery

What were the results?

Improvement in symptoms

Both groups improved significantly after surgery.

Patients with cartilage damage improved just as much as those without, and this improvement was maintained for up to 10 years.

As shown in the results (see graphs on page 8 of the paper), knee scores improved from around the low 40s before surgery to approximately 65 to 75 after surgery, with sustained benefit over time.

Graft survival

There was a difference in how long the transplant lasted:

  • Approximately 94 percent of transplants were still functioning in patients without cartilage damage
  • Approximately 81 percent were still functioning in patients with cartilage damage

This shows that the operation is still effective in patients with cartilage damage, although there is a higher chance of needing further surgery over time.

Complications

Patients with cartilage damage:

  • were more likely to need additional procedures
  • had a higher rate of further surgery related to the knee

This reflects the more advanced nature of their condition rather than a failure of the treatment itself.

What does this mean for you?

Meniscal transplantation can still be a very effective treatment even if there is already cartilage damage in the knee.

It can:

  • improve pain and function in the long term
  • help delay the need for knee replacement in younger patients

However:

  • the risk of further surgery is higher
  • outcomes are generally more predictable when surgery is performed earlier