Meniscal Root Fixation Method for Meniscus Transplantation: is There a Superior Technique?

PURPOSE: Meniscal allograft transplantation (MAT) is a well-established option for young, active patients with symptomatic functional meniscal deficiency, aiming to restore knee function and delay the progression of degenerative changes. This review provides an overview of available root fixation techniques and contextualizes their clinical outcomes to help surgeons select the most suitable method for individual patients. RECENT FINDINGS: Multiple fixation approaches, including all–soft-tissue, bony fixation (bone plug or bone bridge), and hybrid techniques have demonstrated significant improvements in patient-reported outcomes and pain reduction. Bony fixation may reduce or equalize graft extrusion relative to soft-tissue methods, though the clinical significance of extrusion remains uncertain. While functional outcomes and long-term survivorship appear similar across techniques, soft-tissue fixation may carry a slightly higher rate of graft tears and complications. Long-term follow-up reveals that osteoarthritis progression and graft degeneration can still occur. Hybrid fixation techniques combine bony and all-soft-tissue root fixation to leverage the advantages of both methods. It is important to address related conditions such as bone malalignment and ligament instability. Overall, MAT provides durable improvements in knee function and quality of life regardless of fixation method. Optimal results depend not only on the fixation technique but also on addressing concomitant pathologies, such as ligamentous instability and malalignment, with osteotomy playing a key role in protecting the graft when necessary. As no single fixation method has proven superior, further research is required to clarify the ideal strategy and the true clinical impact of graft extrusion.