Fresh meniscus allograft transplantation using a double‐bone‐plug technique results in an overall high (>90%) 2‐to‐7‐year functional survival rate

Abstract Purpose To analyze meniscus allograft failure rates, timing, and mechanisms to characterize risk factors and identify modifiable variables that could be addressed to optimize outcomes after meniscus allograft transplantation (MAT). Methods Using prospectively collected registry data, patients who underwent primary fresh MAT at a single institution between 2016 and 2023 with a minimum follow‐up of 2 years were analyzed. Initial treatment failure was defined as re‐operation, including partial or complete allograft removal, revision MAT, or conversion to unicompartmental or total knee arthroplasty. Treatment failure mechanisms included joint disease progression, meniscus tearing, meniscus extrusion, graft shrinkage, malunion/nonunion, and fixation failure. Treatment failure and nonfailure cohorts were compared, as well as failure mechanism subcohorts, based on patient sex, age, body mass index, laterality, nicotine use, concomitant procedures, graft preservation method, MAT technique, and adherence. Results A total of 61 patients with a mean age of 33 years (range, 15–62 years) and mean follow‐up of 47.2 months (range, 24–88 months) were included. Thirteen patients underwent medial MAT and 44 patients underwent lateral MAT. Seven patients (11.5%) were found to have initial treatment failure at a mean of 18.1 months versus 54 patients (88.5%) who had functional graft survival. All failures involved medial MAT. Patients were more likely to experience treatment failure if they used nicotine (odds ratio [OR], 19.5) or had concomitant OCAT (OR, 8.8). The most common mechanism of failure was the progression of degenerative joint disease ( n = 5, 71.4%), followed by meniscus tears ( n = 2, 28.6%). Four failures underwent revision MAT, while three underwent TKAs. Two of the patients who underwent revision MAT remained as nonfailures at >2 years after revision surgery, resulting in a 91.8% overall MAT functional survival. Conclusion Fresh MAT resulted in a high (92%) short‐ to mid‐term functional survival rate, with nicotine use and concomitant cartilage restoration procedure(s) being significant risk factors for treatment failure; joint disease progression and meniscus allograft tears were the primary mechanisms of failure. Level of Evidence Level III, cross‐sectional analysis of prospectively collected registry data.