Meniscus allograft transplantation in revision ACL reconstruction

The combination of anterior cruciate ligament (ACL) reconstruction and meniscal allograft transplantation (MAT) may produce a synergistic effect for chondroprotection and knee stability. The menisci have an important role in knee stability via load-sharing with the ACL. This role may be particularly relevant in the setting of revision ACL reconstruction, as meniscus loss is often present and can lead to increased strain on an ACL graft. Since the failure rates are generally higher in revision ACL surgery compared to primary reconstruction, careful consideration of meniscus status is prudent. A thorough preoperative history, physical examination, and radiographic evaluation should be performed to ascertain the contributors to ACL reconstruction failure. Careful patient selection and counseling regarding the potential long-term patient outcome including increased risk for arthrosis should be performed. Young patients with ACL and meniscal deficiency and minimal chondral injury represent a unique situation in which MAT and ACL reconstruction can be extremely beneficial. Consideration of these factors is crucial for optimizing the outcome following revision ACL reconstruction.