Professional Statements and Societal Positions Guidelines
Practice Guidelines and Position Statements
International Meniscus Reconstruction Experts Forum
The International Meniscus Reconstruction Experts Forum (2015) published consensus statements on the practice of MAT (see Table 10). The Forum's statements included guidance on indications, graft procurement and preparation, surgical technique, and rehabilitation.
Table. Select Consensus Statements on the Practice of MAT
Indications for MAT:
- Unicompartmental pain post-meniscectom
- In combination with anterior cruciate ligament reconstruction when meniscus deficient
- In combination with articular cartilage repair if meniscus deficient
MAT not recommended for asymptomatic meniscus deficient individual.
Potentially poorer outcomes expected in individuals with moderate to severe OA (Kellgren-Lawrence grade ≥3).
Non-irradiated fresh frozen or fresh viable grafts are recommended.
Mechanical axis alignment should be performed prior to MAT; if mechanical axis deviation present, consider realignment osteotomy.
Based on current evidence, the superiority of 1 surgical technique over another (all-suture vs bone) is not established.
Outcome scores should include:
- Disease-specific: Western Ontario Meniscal Evaluation Tool
- Region-specific: Knee injury and Osteoarthritis Outcome Score
- Activity: Marx Activity Rating Scale
- Qualityof life/utility: EuroQoL 5 dimensions questionnaire
MAT: meniscal allograft transplantation; OA: osteoarthritis.
National Institute for Health and Care Excellence
The guidance from the National Institute for Health and Care Excellence (2012) stated that the evidence on "partial replacement of the meniscus of the knee using a biodegradable scaffold raises no major safety concerns," but evidence for any advantage of the procedure over standard surgery was limited.
American Academy of Orthopaedic Surgeons
The American Academy of Orthopaedic Surgeons (2009) updated its position in 2014, still recommending MAT for active people younger than 55 years old, with the goal of replacing the meniscus cushion before the articular cartilage is damaged. The website also notes that "synthetic (artificial) meniscal tissue has been tried, but there is conflicting information at this time."