Arthroscopy - 2026-07-22 - Journal Article
Suture-Only Fixation of Meniscal Allograft Is Associated With a Higher Reoperation Rate Than Bone Plug or Bone Bridge-in-Slot Fixation Techniques.
Gosnell GG, Sundaram V, Chen L, Jazrawi IB, Gould HP, Alaia MJ, Gonzalez-Lomas G, Strauss EJ
Topics
Key Takeaway
Suture-only MAT fixation carries a 31.3% meniscus-specific reoperation rate versus 8.9% (bone bridge-in-slot) and 10.9% (bone plug), a statistically significant difference (P=.006) over mean 6.6-year follow-up.
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Summary
This single-institution retrospective study compared meniscus-specific reoperation rates across three MAT fixation techniques in 139 patients over a mean 6.6 years. Suture-only fixation (n=48) had a 31.3% reoperation rate versus 8.9% for bone bridge-in-slot (n=45) and 10.9% for bone plug (n=46), with meniscectomy (42.9% of reoperations) and repair (20.0%) as the dominant subsequent procedures. Both TKAs occurred in the suture-only cohort, suggesting progressive joint deterioration without bony fixation.
Key Limitation
The 12-year enrollment window means suture-only cases likely cluster in earlier years, introducing a temporal confound where surgical technique maturation—not fixation method alone—may partly explain outcome differences.
Original Abstract
PURPOSE
To compare meniscus-specific reoperation rates among various meniscal allograft transplantation (MAT) fixation techniques including bone plug, bone bridge-in-slot, and suture-only fixation.
METHODS
A retrospective review was conducted of patients who underwent MAT at a single academic institution between 2011 and 2023. Patients were included if they had documented fixation technique and a minimum of 1-year follow-up. Demographics, fixation techniques (bone plug, bone bridge-in-slot, and suture-only), and subsequent ipsilateral knee surgeries were recorded. Statistical analyses assessed the influence of fixation techniques and other factors on meniscus-specific reoperation rates defined as subsequent ipsilateral meniscectomy, meniscus repair, revision MAT, or knee arthroplasty.
RESULTS
The study included 139 patients (54% male patients; mean age: 29.4 ± 10.0 years; body mass index: 27.3 ± 5.6) with a mean follow-up of 6.6 ± 3.1 years. Lateral compartment MAT was performed in 51.1% of cases. Patients undergoing suture-only fixation had significantly higher meniscus-specific reoperation rates (15/48, 31.3%) compared with bone bridge-in-slot (4/45, 8.9%) and bone plug (5/46, 10.9%) fixation (P = .006). Meniscectomy (15/35, 42.9%) and meniscal repair (7/35, 20.0%) were the most common reoperations. Other reoperations included 2 total knee arthroplasties within the suture-only cohort and a single MAT revision in the bone bridge-in-slot cohort.
CONCLUSIONS
This study reveals that MAT using suture-only fixation exhibits significantly higher reoperation rates than bone plug and bone bridge-in-slot techniques, with meniscectomy and meniscal repair representing the predominant subsequent surgeries.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.