Meniscal allograft transplantation maintains function and activity beyond 10 years with moderate graft failure: a systematic review and meta-analysis.

PURPOSE: To evaluate long-term (≥10-year) clinical and patient-reported outcomes, return to sport, graft survival, and complication rates following meniscus allograft transplantation (MAT) in patients with symptomatic meniscal deficiency.

METHODS

A systematic review was conducted in accordance with PRISMA guidelines using MEDLINE, EMBASE, and PubMed from inception to September 7, 2025. Studies reporting clinical outcomes or patient reported outcome measures (PROMs) (e.g., Lysholm, Knee Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Tegner, Visual Analog Scale (VAS), return to sport, and/or graft failure after MAT with ≥10-year follow-up were included. Meta-analyses were performed for long-term PROMs and objective failure rates using random-effects models, with pooled estimates reported alongside 95% confidence intervals (CIs). Heterogeneity was quantified using the I2 statistic.

RESULTS

Twenty studies met inclusion criteria, comprising six level III and fourteen level IV studies. Across studies consisting of 1096 patients at mean follow-up time of 151.6 ± 38.5 months, PROMs consistently improved from preoperative to final follow-up with maintained improvements. Fifteen studies contributed to the meta-analysis of objective failure, yielding a pooled failure rate of 31% (95% CI, 27-34%; I2 = 80%), with nine studies reported failure defined by conversion to arthroplasty (total or unicompartmental knee arthroplasty), with rates ranging from 2% to 25% and a pooled arthroplasty rate of 17% (95% CI, 15.0%-21.0%; I2 = 59%). Four studies reported subjective failure defined as Lysholm score <65, with reported rates ranging from 3% to 37% and a pooled subjective failure rate of 22% (95% CI, 15.0%-30.0%; I2 = 0%).

CONCLUSION

Meniscal allograft transplantation demonstrates sustained improvements in pain, function, and activity levels at long-term follow-up in patients with symptomatic meniscal deficiency. However, the overall pooled failure rate of 31% highlights the need for careful patient selection and appropriate counselling regarding expected outcomes. The consistent direction of results across studies supports MAT as a valuable joint-preserving intervention for meniscus-deficient knees in patients.

LEVEL OF EVIDENCE: Level III.