Meniscal transplant return to sport

https://pubmed.ncbi.nlm.nih.gov/41144796/

Evidence base

Ahmed I, Khatri C, Davidescu A, Spalding T, Smith N. Returning to competitive sport after meniscal allograft transplant is associated with sustained graft survival and improved patient-reported outcomes. Knee Surg Sports Traumatol Arthrosc. 2025 Oct 27. doi: 10.1002/ksa.70137. Epub ahead of print. PMID: 41144796.

Key points

  • Returning to competitive sport after meniscal transplantation does not increase the risk of graft failure
  • Around 94 percent of patients who returned to sport still had a functioning transplant at 5 years
  • Outcomes were better in patients who returned to sport compared to those who did not
  • Knee function scores were around 15 to 20 points higher in those returning to sport
  • Patients can safely return to high-level sport once fully rehabilitated

Why is this important?

There has traditionally been concern about returning to sport after meniscal transplantation due to the risk of damaging the graft.

Previous expert opinion advised caution, particularly with high-impact and pivoting sports.

This study helps answer an important question for active patients: can you safely return to sport after surgery?

What did the study involve?

We analysed 422 patients who underwent meniscal transplantation:

  • 51 patients returned to competitive sport
  • 371 patients did not return to this level

Return to sport was defined as a high level of activity, including sports such as football, tennis, and basketball.

Patients were followed for up to 10 years, assessing:

  • graft survival
  • pain and function
  • activity levels

What were the results?

Graft survival

Returning to sport did not increase the risk of failure.

  • At 5 years, 94 percent of patients who returned to sport still had a functioning transplant
  • This compared to around 89 percent in those who did not return to sport

As shown in the survival curve (page 5), early outcomes were actually slightly better in the return-to-sport group, with no long-term disadvantage.

Function and outcomes

Patients who returned to sport had consistently better outcomes at all time points.

For example:

  • IKDC score at 10 years was around 80 in the return-to-sport group compared to around 61 in those who did not return
  • Lysholm scores were around 10 to 15 points higher at all time points
  • KOOS scores for pain, sport, and quality of life were also higher

These differences are clinically meaningful and reflect better overall knee function.

What do the graphs show?

The graphs (pages 6 to 8) demonstrate that:

  • Patients who returned to sport achieved higher function early after surgery
  • These improvements were maintained long term
  • There was no drop-off in outcomes despite returning to high-level activity

What does this mean for you?

This study provides reassurance that returning to sport after meniscal transplantation is safe in appropriately selected patients.

In particular:

  • Returning to high-level sport does not appear to damage the transplant
  • Patients who return to sport often have better function and outcomes
  • Restricting activity purely to protect the knee may not be necessary

Return to sport is typically considered at around 12 months after surgery, once strength, control, and function have been restored.

Key considerations

  • Not all patients will be suitable for high-level sport
  • A structured rehabilitation programme is essential
  • Decisions should be individualised based on symptoms, goals, and knee condition