Clinical Report: Autologous Semitendinosus Tendon Grafts as Meniscal Transplants

Overview

This study explores the use of autologous semitendinosus tendon grafts as meniscal transplants following subtotal or total meniscectomy. Early clinical outcomes suggest potential improvements in knee function and symptom relief, with graft integration observed on MRI and arthroscopy.

Background

Meniscal injuries often lead to compromised knee function and increased osteoarthritis risk after meniscectomy. While meniscal repair is preferred, it is not always feasible, and meniscus allograft transplantation (MAT) has limitations including availability and cost. Autologous tendon grafts, such as the semitendinosus tendon, offer a biologically favorable alternative due to their remodeling and revascularization potential in intraarticular environments. Previous animal and pilot studies have shown mixed results, prompting investigation into semitendinosus tendon grafts as neomenisci.

Data Highlights

Seven patients aged 20–50 years with previous subtotal or total meniscectomy and minimal osteoarthritic changes were treated with semitendinosus tendon graft meniscal transplants. Patient-reported outcome measures (PROMs) including KOOS, Lysholm, and Tegner scores were collected preoperatively and at 3, 6, 12, and 24 months postoperatively. MRI and arthroscopic evaluations assessed graft integrity and revascularization. Due to the small sample size, results are descriptive without inferential statistics.

Key Findings

• Autologous semitendinosus tendon grafts were successfully implanted as meniscal transplants in seven patients with post-meniscectomy symptoms.
• Grafts were prepared by folding and suturing the tendon to create a double-stranded loop, then fixed anatomically via root tunnels.
• Postoperative rehabilitation included partial weight bearing and progressive range of motion bracing over several weeks.
• Arthroscopic evaluation at 6 months demonstrated capillary ingrowth along the neomeniscus circumference, indicating revascularization.
• MRI imaging confirmed graft positioning and integrity up to 24 months postoperatively.
• Patient-reported outcomes suggested improvements in knee function and quality of life, though detailed quantitative data were not provided.

Clinical Implications

Autologous semitendinosus tendon grafts may serve as a viable meniscal substitute in patients with subtotal or total meniscectomy where meniscal repair or allograft transplantation is not feasible. The graft’s biological properties support remodeling and revascularization, potentially reducing post-meniscectomy symptoms. Careful patient selection and adherence to a structured rehabilitation protocol are essential for optimal outcomes.

Conclusion

The use of autologous semitendinosus tendon grafts as meniscal transplants shows promise in improving knee function and graft integration post-meniscectomy. Further studies with larger cohorts and longer follow-up are needed to confirm efficacy and chondroprotective effects.

References

1. Kohn et al. 2016/2017 -- Chondroprotective effects of tendon autografts as meniscal transplants
2. Johnson and Feagin 2000 -- Pilot study on tendon autografts for lateral meniscal transplant
3. Karolinska Institutet 2016 -- Ethical approval for semitendinosus tendon meniscal transplant study