Meniscal Injuries, Meniscal Tear, Meniscus Lesion
Conditions
Keywords
meniscal allograft, autologous tendon graft, Post-meniscectomy syndrome, Meniscus deficiency
Brief summary
This multicenter, stratified, partially randomized clinical trial aims to compare autologous semitendinosus tendon graft and meniscal allograft transplantation (MAT) in young adults with post-meniscectomy syndrome. The meniscus plays a critical role in load distribution, shock absorption, and joint stability. After meniscectomy, insufficient meniscal tissue often leads to persistent pain, swelling, and functional decline, increasing the risk of early osteoarthritis. Two reconstructive strategies are clinically available: MAT provides immediate biomechanical function but requires donor matching and carries higher costs, while autologous tendon graft offers stable supply and no immunologic risk but lacks long-term clinical validation. In this study, 40 patients aged 18-45 years will be enrolled. Participants will be allocated into four groups (randomized MAT, randomized autograft, patient-preference MAT, patient-preference autograft). All procedures will use a two-tunnel fixation technique with additional internal brace support. The primary endpoint is the improvement in KOOS (Knee Injury and Osteoarthritis Outcome Score) at 24 months postoperatively. Secondary endpoints include MRI-based assessment of graft morphology and extrusion, reoperation rate, complications, patient satisfaction, and return-to-sport time. This trial will provide critical evidence regarding the comparative effectiveness and feasibility of tendon autograft versus meniscal allograft in real-world clinical settings, potentially informing surgical decision-making and future treatment guidelines for post-meniscectomy syndrome.
Detailed description
Post-meniscectomy syndrome represents a challenging condition in young adults, characterized by persistent pain, swelling, and functional impairment after partial or subtotal meniscectomy. The lack of sufficient meniscal tissue predisposes patients to abnormal tibiofemoral loading and early onset osteoarthritis. Current reconstructive options remain limited, and there is no consensus on the optimal surgical strategy. Meniscal allograft transplantation (MAT) has been the most widely accepted method, offering immediate restoration of meniscal morphology and load-distributing capacity. However, MAT is constrained by donor availability, graft costs, and local regulations. In contrast, autologous tendon grafts-most commonly using semitendinosus-are readily available, carry no risk of rejection, and reduce cost barriers. Early biomechanical and translational studies suggest that autologous tendon grafts may adapt to meniscal-like properties, yet long-term clinical data remain scarce. This trial employs a stratified, partially randomized design to balance methodological rigor with patient autonomy and ethical feasibility. Participants are assigned to autologous tendon graft or MAT either through randomization or patient preference, allowing assessment of outcomes under both controlled and real-world conditions. All procedures are standardized across participating centers, utilizing a two-tunnel fixation technique and augmented with an internal brace (Fibertape) to enhance graft stability. Outcomes will be assessed over 24 months, including validated patient-reported measures (KOOS, IKDC, Tegner), MRI-based graft evaluation (volume, signal, extrusion, morphology), reoperation rates, complications, satisfaction, and return-to-sport. By integrating randomized comparison with pragmatic elements, this study aims to generate clinically applicable evidence on the relative benefits and limitations of autologous tendon graft versus MAT. The findings are expected to inform surgical decision-making, optimize patient outcomes, and guide future treatment recommendations for young patients suffering from post-meniscectomy syndrome.
Interventions
PROCEDUREAutologous Semitendinosus Tendon Graft
Meniscal reconstruction will be performed using autologous semitendinosus tendon harvested from the ipsilateral leg. The graft diameter must be at least 6 mm. A two-tunnel fixation technique will be employed, securing the graft to the tibial plateau at the anatomic meniscal root sites. The graft will be shaped and positioned to mimic the native meniscal contour. Fibertape internal brace augmentation will be added to enhance fixation strength and graft stability. If concomitant anterior cruciate ligament reconstruction is indicated, the graft choice and ACL technique will be determined by the surgeon, without restriction. Postoperative rehabilitation will follow a standardized protocol across all centers.
PROCEDUREMeniscal Allograft Transplantation (MAT)
Meniscal allograft transplantation will use size-matched, fresh-frozen allograft menisci prepared according to institutional tissue bank standards. Grafts will be fixed using a two-tunnel bone plug technique, restoring the anatomic root insertions. The allograft will be centrally positioned within the tibiofemoral compartment, and centralization sutures may be added at the discretion of the operating surgeon. All procedures will be standardized across participating centers, and postoperative rehabilitation protocols will be identical to those used in the autologous graft arm.
Sponsors
Karolinska University Hospital
Chang Gung Memorial Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Postoperative MRI and patient-reported outcome measures (PROMs) will be evaluated by independent assessors blinded to treatment allocation. Participants, surgeons, and investigators will be aware of the intervention due to the surgical nature of the study.
Intervention model description
This study uses a stratified, partially randomized parallel assignment model. Eligible patients are allocated into four groups: randomized autologous semitendinosus tendon graft, randomized meniscal allograft transplantation, patient-preference autologous tendon graft, and patient-preference meniscal allograft transplantation. Even in the randomized groups, participants retain the option to switch to their preferred treatment after allocation, ensuring both methodological rigor and ethical feasibility. This design allows assessment of comparative outcomes under randomized conditions as well as in real-world preference-based clinical practice.
Eligibility
Sex/Gender
ALL
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 to 45 years History of partial meniscectomy \> 6 months prior to enrollment Symptomatic post-meniscectomy syndrome (knee pain, swelling, or functional decline) MRI showing cartilage status ≤ Outerbridge grade 2 Knee joint stability (or stabilized during the index surgery) Body mass index (BMI) \< 30 Willingness to provide written informed consent
Exclusion criteria
Tibial slope \> 16° Radiographic or arthroscopic evidence of advanced cartilage degeneration (Outerbridge \> 2 or ICRS ≥ 3) Presence of inflammatory arthritis or systemic inflammatory joint disease History of cartilage repair surgery Malalignment \> 5° not corrected Untreated ligamentous instability Any other condition judged by the investigator to compromise study participation or outcomes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Knee Injury and Osteoarthritis Outcome Score | Baseline, 6, 12, and 24 months after surgery (primary analysis at 24 months) | The KOOS questionnaire evaluates knee-related symptoms, pain, activities of daily living, sports/recreation function, and knee-related quality of life. The primary endpoint is the change in KOOS total score from baseline to 24 months postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| IKDC (International Knee Documentation Committee) Subjective Knee Evaluation | Baseline, 6, 12, and 24 months after surgery | Patient-reported outcome questionnaire assessing symptoms, daily and sports activities, and knee function |
| Tegner Activity Scale | Baseline, 6, 12, and 24 months after surgery | Patient-reported physical activity level, ranging from daily living to competitive sports participation. |
| Reoperation Rate | Up to 24 months postoperatively | Incidence of revision surgery or additional procedures related to meniscal reconstruction |
| MRI-Based Graft Evaluation | 12 and 24 months postoperatively | MRI assessment of graft morphology including volume, signal distribution, shape, and extrusion, evaluated by blinded radiologists |
| Patient Satisfaction | 12 and 24 months postoperatively | Self-reported satisfaction with surgical outcomes, measured using a 5-point Likert scale (very dissatisfied to very satisfied) |
| Return to Sport Time | Up to 24 months postoperatively | Time (in months) until patients resume pre-injury level of sports participation, recorded through follow-up interviews |
| Complications | Within 24 months after surgery | Adverse events related to the surgical intervention, including infection, graft failure, or hardware complications |
Countries
Taiwan
Contacts
Primary ContactCheng-Pang Yang
Outcome results
None listed