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Meniscus Allograft Transplantation: A Comparison of Medial and Lateral Procedures

Kyoung Ho Yoon, Sang Hak Lee, Soo Yeon Park, Hwan Jin Kim and Kee Yun Chung
Am J Sports Med 2014 42: 200 originally published online November 8, 2013
DOI: 10.1177/0363546513509057

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Meniscus Allograft Transplantation
A Comparison of Medial and Lateral Procedures
Kyoung Ho Yoon,* MD, Sang Hak Lee,* MD, Soo Yeon Park,y PhD,
Hwan Jin Kim,* MD, and Kee Yun Chung,*z MD
Investigation performed at Kyung Hee University Hospital, Seoul, Korea

Background: Because of the anatomic and biomechanical differences between the lateral and medial menisci, it is believed that
the indications, combined injuries, techniques, and outcomes of the 2 meniscus allograft transplantation (MAT) procedures may
be different.
Hypothesis: Medial meniscus transplantation (medial group) usually combines concomitant surgeries, such as anterior cruciate
ligament (ACL) reconstruction, so the medial group will have worse clinical results than the lateral group (lateral meniscus
transplantation).
Study Design: Cohort study; Level of evidence, 3.
Methods: A retrospective study was conducted on 91 patients who underwent MAT (lateral group, n = 56; medial group, n = 35).
There were 33 patients with an absence of a concurrent injury (isolated group) and 58 patients with the presence of a concurrent
injury (combined group). The mean follow-up was 40 months (range, 24-125 months). Clinical outcomes for range of motion
(ROM), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, Lysholm
score, and Tegner activity score were evaluated, and an objective evaluation was performed using magnetic resonance imaging
(MRI) and second-look arthroscopic surgery.
Results: At final follow-up, the mean results for ROM, VAS score, IKDC subjective score, Lysholm score, Tegner activity score,
and patient subjective satisfaction were not statistically different between the lateral and medial groups (P . .05). The VAS and
Lysholm scores of the isolated group were significantly better than those of the combined group. Follow-up MRI was performed
on 35 patients (24 in the lateral group and 11 in the medial group). Mean graft extrusion was 1.7 mm in the lateral group and
2.6 mm in the medial group (P = .075). The relative percentage of extrusion was 19.4% in the lateral group and 32.0% in the
medial group (P = .011). Anterior cruciate ligament reconstruction occurred more commonly in the medial group, and cartilage
procedures occurred more commonly in the lateral group.
Conclusion: The clinical results of the lateral group were not different from those of the medial group. More graft extrusion was
found in the medial group on MRI, and second-look arthroscopic surgery results of the lateral group were not as good as those of
the medial group. The VAS and Lysholm scores of the combined group were worse than those of the isolated group. With regard
to concomitant surgery, ACL reconstruction was most common in the medial group and cartilage procedures in the lateral group.
Keywords: knee; meniscus allograft transplantation; lateral vs medial group; isolated vs combined group

The meniscus transmits loading across the knee joints,
improves articular congruency, and contributes to stability
z However, in irreparable cases, meniscectomy is usually
Address correspondence to Kee Yun Chung, MD, Department of
Orthopaedic Surgery, School of Medicine, Kyung Hee University, 1
Hoegi-Dong, Dongdaemoon-Gu, Seoul 130-702, Korea (e-mail: opus73
@hanmail.net).
*Department of Orthopaedic Surgery, School of Medicine, Kyung Hee
University, Seoul, Korea.
y
Department of Physical Education, Graduate School of Education,
Yongin University, Yongin, Korea.
The authors declared that they have no conflicts of interest in the
authorship and publication of this contribution.
The American Journal of Sports Medicine, Vol. 42, No. 1
DOI: 10.1177/0363546513509057
2013 The Author(s)
of the knee joints, but it also has roles in lubrication and
nutrition within the joint.13,15,16,26,29,31 Repair of the
meniscus is the first option if a torn meniscus is found.
necessary. If the meniscus is removed, then loading of
the articular cartilage is increased, and degenerative
changes may consequently be induced.7,20 Meniscectomy
can cause degenerative changes of the knee joint, and the
resected amount is proportional to the degeneration.
Thus, meniscectomy is an important factor in determining
clinical outcomes.6,18,28 As our understanding of the func-
tion of the meniscus has grown, meniscus allograft trans-
plantation (MAT) has become a treatment method for
symptomatic patients after meniscectomy.5,35 The aim of
MAT is to reconstruct the load transmission system and

200
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Vol. 42, No. 1, 2014
to restore the normal kinematics of the knee joints. Several
studies have reported that MAT increases the contact area
of the joints and reduces contact stress.22
The function and shape of the medial meniscus are dif-
ferent from those of the lateral meniscus. The medial
meniscus covers 64% of the medial tibial plateau, and it
transmits approximately 50% of the load. The lateral
meniscus covers 84% of the lateral tibial plateau, and it
transmits approximately 70% of the load.29 In addition,
the medial tibial plateau is concave, and the contact area
around the medial femoral condyle is relatively wide; how-
ever, the lateral tibial plateau is convex, and so in the
absence of the lateral meniscus, the load from the lateral
femoral condyle is concentrated in a small area. Clinically,
a defect in the lateral meniscus induces faster degenera-
tive changes and clinical symptoms than a defect in the
medial meniscus.16,25,30
Meniscus allograft transplantation can be performed in
both the medial and lateral menisci. In general, the pri-
mary complaint of patients as an indication for MAT is
pain.1 However, in the medial group, instability is another
important indication as well as pain.14,21 Some investiga-
tors have reported that the outcomes of lateral MAT may
be better than those of medial MAT, but this is still
unclear.30 Moreover, some investigators have reported
that lateral MAT may be relatively more advantageous
than medial MAT, and even preventive transplantation
has been considered.27
Our hypothesis was that medial MAT would have worse
clinical results than lateral MAT because of concomitant
surgery. Also, patients who underwent MAT only would
have better results than patients who underwent MAT
with other combined procedures for concurrent injuries in
the knee joint. Therefore, we compared and analyzed the
clinical results of lateral MAT and medial MAT. In addition,
the clinical results according to the presence or absence of
concurrent injuries were compared and analyzed.
MATERIALS AND METHODS
Patients
A total of 98 patients underwent MAT between March
2000 and February 2010 at our university hospital. Seven
patients were excluded for the following reasons: lost to
follow-up before 24 months postoperatively (5 patients)
and underwent revision surgery (2 patients). Patients
who had surgery for a concurrent injury were included.
Accordingly, 91 patients were evaluated retrospectively
(Figure 1). Ethical approval for the study was obtained
from the authors institutional review board.
There were 56 cases of lateral MAT (lateral group) and
35 cases of medial MAT (medial group). Twenty-seven
patients underwent only MAT (isolated group) in the lat-
eral group, and 6 patients underwent only MAT in the
medial group, and thus, there was a total of 33 patients
who underwent isolated MAT. There were 29 patients
who were treated for concurrent injuries in parallel with
MAT (combined group) in both the lateral group and
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Comparison of Medial and Lateral MAT 201
Figure 1. Flow chart of meniscus allograft transplantation.
medial group, for a total of 58 cases. The mean age of
patients in the lateral group was 33.9 years (range, 18-51
years), and there were 42 male patients and 14 female
patients in the lateral group. The mean age of patients in
the medial group was 32.9 years (range, 19-46 years),
and the group included 29 male patients and 6 female
patients. The mean interval from meniscectomy to MAT
was 41.0 months (range, 1-243 months) in the lateral
group, and that of the medial group was 30.3 months
(range, 1-194 months). The mean follow-up of the lateral
group was 3.3 years (range, 3-10 years), and that of the
medial group was 3.5 years (range, 2-10.5 years). The
demographics of the patients are summarized in Table 1.
There were no differences between the groups except for
the proportion of isolated and combined procedures in
each group. In the medial group, combined injuries were
more common (P = .003).
Preoperative Sizing and Operative Technique
Fresh-frozen meniscus allografts were used in all the
cases. The surgeries were performed by a single surgeon.
Concerning the surgical methods, the keyhole method in
the lateral group and the bone plug method in the medial
group were applied.
For sizing the graft, magnetic resonance imaging (MRI)
was performed before surgery. Sizing was performed in the
axial cut of the tibial plateau, which shows the meniscus.
The width of the lateral tibial plateau from the lateral tib-
ial spine to the edge of the tibial condyle was the same as
the width of the allograft. The length from the anterior
to posterior root of the medial meniscus was the same as
the length of the allograft. There was 5% of mismatching
that was allowed.
For lateral meniscus transplantation (LMT), prepara-
tion of the remnant was performed arthroscopically. About
1 to 2 mm of the peripheral rim of the meniscus was pre-
served for healing of the graft. After preparation of the
remnant, mini-arthrotomy for graft insertion was
202 Yoon et al
TABLE 1
Patient Demographics
Concurrent injury, isolated:combined, n
Sex, male:female, n
Age, mean (range), y
Operative technique
Follow-up, mean (range), y
Interval from total meniscectomy to meniscus transplantation, mean (range), mo
performed just beside the patellar tendon and below the
anterolateral portal in the fully extended knee. A tibial tun-
nel guide was inserted into the arthrotomy site, and a guide
wire was positioned under the C-arm image intensifier. A
bone tunnel with a 10-mm diameter was created using
a core reamer. The roof of the bone tunnel was removed
using a rongeur and bur to create a keyhole-shaped tunnel.
The tunnel was finally checked by a slot sizer. The joint cap-
sule was exposed by a posterolateral approach, and a pass-
ing wire was inserted from the posterolateral capsule to the
anterolateral arthrotomized opening. Nonabsorbable lead-
ing sutures were anchored to the posterior horn of the graft,
and the graft was inserted into the slot by a passing wire.
Traditional inside-out sutures for graft fixation using 8 to
10 double-arm needles were placed.
For medial meniscus transplantation (MMT), preservation
of the peripheral remnant was performed arthroscopically.
An anterior cruciate ligament (ACL) tibial guide was inserted,
and a guide pin was also inserted into the native posterior
horn of the medial meniscus through the posterolateral, post-
eromedial, and transseptal portals. The tunnel was created,
and the cartilage fragment was removed for firming fixation
and good healing of the graft. The anterior tunnel was created
in the same way. A passing wire was inserted from the poste-
rior bone tunnel to the anteromedial portal, and the anterior
portal was enlarged for passing the graft. The graft was pre-
pared to create a meniscus with bone plugs. The graft was
inserted using a passing wire through the enlarged anterome-
dial portal. Bone plugs were firmly inserted into the posterior
and anterior tunnels. Traditional inside-out sutures for graft
fixation using 8 to 10 double-arm needles were placed. The
anterior and posterior bone plug stitches were tied firmly
together and post-tied with staples.
There were no differences in rehabilitation between the
2 groups. A continuous passive motion machine was used
for range of motion (ROM) exercises from 1 day after sur-
gery: 0 to 60 during the first 3 weeks, up to 90 during
weeks 4 to 6, up to 120 until 12 weeks, and full flexion
after 3 months.
Ambulation was started with partial weightbearing
with the fully extended knee in a brace by 3 weeks after
surgery. Full weightbearing was possible by 4 to 6 weeks.
Crutches were used until 6 weeks after surgery. After 6
weeks, full weightbearing and noncrutch ambulation
were possible with the fully extended joint in a brace. After
3 months, ambulation without crutches and a brace was
possible.
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The American Journal of Sports Medicine
Lateral Group (n = 56) Medial Group (n = 35) P Value
27:29 6:29 .003
42:14 29:6 .443
33.9 (18-51) 32.9 (19-46) .563
Keyhole Bone plug
3.3 (3-10) 3.5 (2-10.5) .751
41.0 (1-243) 30.3 (1-194) .313
Clinical Assessment
Patients were followed up at 6 weeks, 6 months, and 12
months after surgery and then annually thereafter. For
evaluation of the clinical results, ROM, the visual analog
scale (VAS) for pain score, the International Knee Docu-
mentation Committee (IKDC) subjective score, the Lysholm
score, and the Tegner activity score before surgery and at
the time of the last follow-up were compared; subjective sat-
isfaction (completely satisfied, mostly satisfied, satisfied,
mostly unsatisfied, completely unsatisfied) was compared,
and the results of follow-up MRI were also compared.
Objective Assessment
Postoperative MRI was performed with the patient in
a nonweightbearing and supine position. All MRI examina-
tions were performed using a 3-T MRI scanner (Philips
Intera Achieva 3.0 T, Philips Healthcare, Best, the Nether-
lands) or a 1.5-T MRI scanner (GE Optima 1.5 T, GE
Healthcare, Little Chalfont, United Kingdom). Magnetic
resonance imaging was performed at least 1 year after sur-
gery. Extrusion was measured by absolute extrusion and
relative extrusion. Absolute extrusion was defined as
3-mm extrusion of the graft. The relative percentage of
graft extrusion was used to define relative extrusion of
the graft (Figure 2). Two independent investigators
(H.J.K. and K.Y.C.) checked the MRI scans. Intraobserver
and interobserver reliability was assessed using the intra-
class correlation coefficient. In this study, the intraclass
correlation coefficient of all measurements was .0.810
for both intraobserver and interobserver reliability.
Statistical Analysis
SPSS software (version 12.0, SPSS Inc, Chicago, Illinois)
was used for statistical analysis. Statistics are presented
as the mean 6 standard deviation. Paired t tests were
used for comparison of the preoperative results and the
results of the last follow-up. Student t tests and Pearson
x2 tests were used for comparing the results of the lateral
group with those of the medial group as well as comparing
the results of the isolated group with those of the combined
group. The Spearman correlation test was used for check-
ing the correlation between the relative percentage of
extrusion and clinical scores. P values \.05 were consid-
ered statistically significant.
Vol. 42, No. 1, 2014 Comparison of Medial and Lateral MAT 203

TABLE 2
Preoperative and Postoperative Clinical
Outcomes in All 91 Patientsa

Preoperative Last Follow-up

Outcome Score Score P Value

ROM, deg 141.0 6 10.7 138.2 6 11.6 .115

VAS 5.0 6 2.4 3.3 6 2.1 \.001
IKDC (subjective) 52.2 6 16.7 67.6 6 17.7 \.001
Lysholm 63.5 6 16.8 76.5 6 14.4 \.001
Tegner 2.4 6 1.0 4.2 6 1.6 \.001

a
Values are expressed as mean 6 standard deviation. IKDC,
International Knee Documentation Committee; ROM, range of
motion; VAS, visual analog scale.

a difference was not seen between the groups. Similarly,

Figure 2. Measurement of extrusion. (a) Absolute extrusion.
(b) Total length of the graft. Relative percentage of graft
extrusion (RPE) = (a/b) 3 100.
RESULTS
Overall Results
The mean ROM was slightly decreased from 141.0 6 10.7
preoperatively to 138.2 6 11.6 postoperatively, but it was
not significantly different (P = .115). The VAS score, IKDC
subjective score, Lysholm score, and Tegner activity score
improved, and differences were statistically significant.
The clinical results before surgery and at the last follow-
up are summarized in Table 2.
Comparison Between Lateral and Medial Groups
All the values measured before surgery and at the last
follow-up of the 2 groups were not significantly different
except the Lysholm and Tegner scores before surgery
(Table 3). The mean ROM at the last follow-up was slightly
lower than that before surgery, but the difference was not
statistically significant. The difference in ROM between
the lateral and medial groups was not statistically differ-
ent. The mean VAS score at the last follow-up decreased
significantly from the preoperative mean VAS score in
both groups; nevertheless, a difference between the 2
groups was not shown. The mean IKDC subjective score
improved from preoperatively to postoperatively in both
groups, but a statistical difference between the groups
was not shown. With regard to the mean Lysholm score,
there was a difference between the 2 groups preoperatively
(lateral, 66.9; medial, 58.0; P = .014). The score of
both groups significantly improved after surgery, but
there was a difference in the mean preoperative Tegner
activity score between the groups (lateral, 2.6; medial,
2.1; P = .017). The score of both groups significantly
improved at the last follow-up, but a difference between
the 2 groups was not observed.
With regard to surgery for the treatment of concurrent
injuries, there were 21 cases of ACL reconstruction, 10
cases of autologous chondrocyte implantation, 5 cases of
simultaneous autologous chondrocyte implantation and
ACL reconstruction, 2 cases of high tibial osteotomy, and
4 cases of microfracture in the medial group. In the lateral
group, there were 11 cases of ACL reconstruction, 2 cases
of posterior cruciate ligament reconstruction, 11 cases of
autologous chondrocyte implantation, and 12 cases of
microfracture (Table 4).
Comparison Between Isolated and Combined Groups
The results of the isolated group and the combined group
are summarized in Table 5. The mean ROM at the last
follow-up was slightly lower than that before surgery in
both groups, but the difference was not statistically
significant.
The mean VAS score significantly decreased in both
groups at the last follow-up. A difference between the
groups was not seen in the mean preoperative score, but
it was significantly different at the last follow-up (isolated,
2.7; combined, 3.7; P = .039; observed power a = .693). The
mean IKDC subjective score significantly improved in the
2 groups. A significant difference between the 2 groups
was seen in the mean preoperative score (isolated, 57.6;
combined, 49.1; P = .019; a = .768), but no significant dif-
ference was seen at the last follow-up. The mean Lysholm
score significantly improved in both groups at the last
follow-up. A difference between the groups was not seen
in the mean preoperative score, but it was significantly dif-
ferent at the last follow-up (isolated, 80.5; combined, 74.2;
P = .022; a = .700). The mean Tegner activity score signif-
icantly improved in the 2 groups. A significant difference
between the 2 groups was seen in the mean preoperative
score (isolated, 2.8; combined, 2.1; P = .010; a = .89), but
no significant difference was seen at the last follow-up.

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204 Yoon et al The American Journal of Sports Medicine

TABLE 3
Comparison of Outcome Scores Between the Lateral Group and Medial Groupa

Preoperative Score Last Follow-up Score

Outcome Lateral Medial P Value Lateral Medial P Value

ROM, deg 140.3 6 10.1 142.3 6 11.7 .386 137.3 6 11.7 139.6 6 11.5 .372
VAS 4.8 6 2.4 5.3 6 2.4 .339 3.1 6 2.0 3.6 6 2.4 .243
IKDC (subjective) 53.2 6 16.0 50.6 6 17.9 .467 69.2 6 18.1 65.1 6 16.9 .273
Lysholm 66.9 6 16.0 58.0 6 17.0 .014 76.6 6 14.3 76.2 6 14.6 .887
Tegner 2.6 6 1.1 2.1 6 0.6 .017 4.1 6 1.6 4.2 6 1.5 .885

a
Values are expressed as mean 6 standard deviation. IKDC, International Knee Documentation Committee; ROM, range of motion; VAS,
visual analog scale.

TABLE 4
Concomitant Proceduresa

ACL PCL ACI Microfracture HTO Isolated MAT

Medial group 21 (60) 0 (0) 10 (28) 4 (11) 2 (6) 6 (17)

Lateral group 11 (20) 2 (3) 11 (20) 12 (21) 0 (0) 27 (48)

a
Values are expressed as n (%). ACI, autologous chondrocyte implantation; ACL, anterior cruciate ligament reconstruction; HTO, high
tibial osteotomy; MAT, meniscus allograft transplantation; PCL, posterior cruciate ligament reconstruction.

TABLE 5
Comparison of Outcome Scores Between the Isolated Group and Combined Groupa

Preoperative Score Last Follow-up Score

Outcome Isolated Combined P Value Isolated Combined P Value

ROM, deg 143.5 6 5.5 139.6 6 12.6 .102 137.4 6 12.7 138.6 6 11.0 .640
VAS 4.2 6 2.3 5.2 6 2.4 .169 2.7 6 1.9 3.7 6 2.3 .039
IKDC (subjective) 57.6 6 16.1 49.1 6 16.5 .019 69.8 6 18.1 66.3 6 17.5 .362
Lysholm 60.2 6 19.6 65.3 6 14.9 .194 80.5 6 9.8 74.2 6 16.0 .022
Tegner 2.8 6 1.3 2.1 6 0.7 .010 4.3 6 1.5 4.2 6 1.6 .736

a
Values are expressed as mean 6 standard deviation. IKDC, International Knee Documentation Committee; ROM, range of motion; VAS,
visual analog scale.

Follow-up MRI in the lateral group and in 4 of 11 cases (36.4%) in the

Follow-up MRI was performed between 6 months and 10
years after surgery in 35 cases (24 cases in the lateral
group and 11 cases in the medial group) (Figure 3). Mean
extrusion of the transplanted allograft was 1.7 mm in the
lateral group and 2.6 mm in the medial group, but it was
not statistically different (P = .075). The relative percent-
age of graft extrusion was 32.0% in the medial group and
19.4% in the lateral group, and it was statistically signifi-
cant (P = .011; a = .807). The correlations between the rel-
ative percentage of graft extrusion and clinical scores were
assessed (Table 6). The Lysholm score was significantly
correlated in both groups (lateral, 0.445; medial,
0.670), and the Tegner activity score was significantly
correlated in the medial group (0.816). Absolute extrusion
(ie, extrusion .3 mm) was present in 6 of 24 cases (25.0%)
medial group, but the difference was not statistically sig-
nificant (P = .689).
Complications and Second-Look
Arthroscopic Surgery
Second-look arthroscopic surgery was performed in 27
cases (14 cases in the lateral group and 13 cases in the
medial group) between 3 months and 7 years after surgery.
The indications for second-look arthroscopic surgery were
a painful knee with a suspected meniscus tear and removal
of the staple for post-tie. In 4 cases that underwent simul-
taneous autologous chondrocyte implantation and lateral
MAT, the complex tear could not be repaired, and thus,
the transplanted allograft was removed.

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Vol. 42, No. 1, 2014
Figure 3. Magnetic resonance imaging at follow-up: extrusion (white arrow) of the transplanted (A) lateral meniscus allograft and
(B) medial meniscus allograft.
TABLE 6
Correlation Between Relative Percentage of
Graft Extrusion and Clinical Scoresa
VAS IKDC Lysholm Tegner
b year. Kim et al11 reported MRI and arthroscopic results
Lateral group 0.354 0.145 0.445 0.029
Medial group 0.033 0.506 0.670b 0.816b
a
IKDC, International Knee Documentation Committee; VAS,
visual analog scale.
b
Statistically significant (P \ .05).
DISCUSSION
According to observations at a minimum 2-year follow-up,
MAT is an effective method to reduce the pain caused by
meniscus deficiency and to improve the function of the
knee joint. The clinical results of lateral MAT and medial
MAT were equivalent. The follow-up MRI findings of lat-
eral MAT showed less extrusion of the graft than that of
the medial graft. The clinical results of the isolated group
were better than those of the combined group. For the inci-
dence of concomitant surgery, ACL reconstructions were
more frequent in the medial group, and cartilage proce-
dures were more frequent in the lateral group.
Since Milachowski et al17 reported an 86% success rate
of isolated MAT, good results at 2- to 3-year short-term
follow-up have been reported, and particularly, it is known
to effect pain relief.4,5,8,19 Cole et al4 have reported notice-
able pain relief in 88% of their patients and functional
improvement in 95% of the patients after MAT using
fresh-frozen dried allografts at 2 years follow-up. van
Arkel and de Boer34 have also reported an 87% success
rate at 2- to 5-year follow-up.
Magnetic resonance imaging or arthroscopic surgery
has been used to evaluate objective results of MAT. Potter
et al24 reported meniscus degeneration in 63% of patients.
All patients in their series with graft extrusion were
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Comparison of Medial and Lateral MAT 205
symptomatic. In a similar study, Lee et al12 compared
the clinical outcomes of extruded and nonextruded menis-
cus allografts. They reported a mean extrusion of 3 mm but
no effect of meniscus extrusion on knee function. The
degree of meniscus extrusion remained stable after 1
of MAT, and 89% of their patients had fair to satisfactory
results.
The difference in the clinical outcomes of lateral and
medial MAT has not been firmly established. Cole et al5
reported that for 40 cases of MAT that were followed up
for longer than 2 years, when comparing the medial group
with the lateral group, the 2 groups were not statistically
different; but there was a tendency for the results of the
lateral group to be better. Farr et al8 reported that when
comparing the medial group with the lateral group, the
preoperative Lysholm score of the medial group was lower,
but the postoperative results were not different. They also
reported that the VAS score of the lateral group showed
a tendency to be high. Verdonk et al35,36 found a 72% suc-
cess rate for medial meniscus allografts but a 63% success
rate for lateral grafts. However, in this study, significant
differences in the clinical results were not observed
between the lateral group and the medial group, but the
lateral group showed a tendency to have a better IKDC
subjective score at last follow-up, which is believed to be
because the postoperative VAS score was relatively lower
in the lateral group. Nonetheless, in the medial group,
the number of isolated procedures was small, and interpre-
tation was difficult because of the difference in the type
and number of concurrent injuries between the 2 groups.
In this study, the primary indication of LMT was pain.
However, in cases of MMT, instability was also an impor-
tant indication (not only pain as in LMT). There were
almost 2 times the number of ACL reconstructions in the
medial group than in the lateral group. However, cartilage
procedures were more common in the lateral group than in
the medial group (Table 4). Instability after meniscectomy
has been well defined,9,13,33 and Spang et al32 reported
206 Yoon et al
restored kinematics after MMT. Lubowitz et al14 also rec-
ommended concomitant ACL reconstruction and MAT for
menisectomized ACL-deficient knees.
The operative techniques were different between LMT
and MMT. In LMT, keyhole methods are usually used, so
it is possible to fix the graft firmly in the tibial plateau.
However, for anatomic reasons, the bone plug technique
and pull-out fixation are usually used in MMT. Isolated
surgeries were more frequent in LMT. In MMT, combined
injuries were common, and they were usually combined
with an ACL injury. Thus, a comparison of MMT and
LMT is difficult.
We used MRI for evaluating the objective results. In
MRI findings, extrusion of the graft was more common in
the medial group. The pitfalls of this study are that it
was a small group of patients and the number of objective
studies such as MRI and second look arthroscopy was not
enough. Not all patients were examined on MRI because
of the costs, and second-look arthroscopic surgery was an
invasive procedure, so the patients did not agree to the pro-
cedure when they were asymptomatic.
In this study, the number of isolated procedures in the
medial group was relatively small (n = 6), so we could not
obtain adequate power. This is probably a weakness of this
study, and the results were inevitable because of its retro-
spective design. Lateral meniscectomy has a more harmful
effect on the knee joint than medial meniscectomy,2,23,37
but the long-term results of medial meniscectomy are quite
fair.3 When a patient with a medial meniscectomized knee
has pain after surgery, this may be an indication for high tib-
ial osteotomy as opposed to MAT because of older age. There
were 2 patients older than 45 years who did not meet the cri-
teria for MAT under national health insurance (\45 years
old). However, both the patients belonged to the isolated
group; they had no cartilage or ligamentous defect, so we per-
formed meniscus transplantation. In the future, studies on
the difference in results according to concurrent injuries
may be required together with comparing the isolated groups
of the medial and lateral groups.
Several studies have reported that MAT reduces pain
and improves the function of the knee joint. Verdonk
et al36 and Kelly et al10 evaluated MAT using MRI, and
they reported that MAT protects the articular cartilage.
Yet, it is not clear whether MAT has roles in preventing
arthritis or delaying progression. However, from the aspect
that the possibility of developing degenerative changes is
high in patients who undergo meniscectomy and the fact
that MAT reduces pain in the knee joint and improves its
function, it is believed to be a useful treatment method,
possibly reducing the need for arthroplasty.
CONCLUSION
According to observations at a minimum 2-year follow-up,
MAT is an effective method to reduce the pain caused by
meniscus deficiency and to improve the function of the knee
joint. The clinical results of medial MAT and lateral MAT
were equivalent. The follow-up MRI findings of medial MAT
showed more extrusion of the graft than that of the lateral
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The American Journal of Sports Medicine
graft. For the incidence of concomitant surgery, ACL recon-
structions were more frequent in the medial group. The clini-
cal results of the isolated group were better than those of the
combined group in terms of VAS and Lysholm scores.
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