Meniscal reconstruction: Present and future

Our treatment of meniscal pathology has changed dramatically over the last 30 years. What began with totalmeniscectomy is now ending with meniscal replacement. Basic science investigation of the preservation, healing, and function of meniscal replacement substitutes has shown that meniscal reconstruction is feasible and successful by various limited criteria. Clinical studies seem to suggest that the ideal candidate may be a young individual with early cartilage wear (grade I or II) who is ligamentously stable without articular incongruity. Surgical techniques using fresh-frozen and cryopreserved meniscal allograft have included open and arthroscopically assisted insertion techniques. Anchoring of the meniscal horns has been described using soft tissue, bone plugs or blocks, or a bony bridge connecting the anterior and posterior horns. Attempting to draw conclusions by comparing the results of the few preliminary studies that have been published is exceptionally difficult. Differences in patient selection, concomitant procedures, meniscal substitute selection, surgical technique, graft fixation, rehabilitation, and length of follow-up make this nearly impossible. Standardized methods for patient selection, operative technique, rehabilitation, and length of follow-up need to be determined to further define meniscal replacement techniques. It remains cautiously optimistic that meniscal replacement remains a treatment for the postmeniscectomy knee.