Editorial Commentary: Meniscus Allograft Transplantation With Concomitant High Tibial Osteotomy and Cartilage Restoration Risks Reoperations and Potential Worsening Outcomes Following Subsequent Total Knee Arthroplasty.

The management of the 25- to 45-year-old patient with meniscal deficiency, chondral degeneration, and pain remains challenging. With the potential of a knee replacement in the future, the question I wrestle with is, "When is enough enough?" Meniscus allograft transplantation, when combined with osteotomy and/or cartilage restoration procedures, improves functional outcomes compared to preoperative levels but has not been demonstrated to delay progression of osteoarthritis and often leads to reoperations. Moreover, concomitant procedures do not show improved survivorship of the meniscal allograft. While many undergoing these procedures return to active lifestyles, many do not return to preinjury levels. Balanced clinical-patient discussions are needed about the benefits, limitations, and expectations of meniscus allograft transplantation and associated procedures on not only the current condition of the knee but also the future implications, including reoperations and potential worsening outcomes following total knee arthroplasty. Notably, meniscal allograft transplantation and concomitant procedures lead to additional surgeries, with up to a 59% reoperation rate at an average of 43 months. In some, more surgery does not necessarily lead to improved outcomes, and caution should be exercised; only 44% return to preinjury activity level after meniscus allograft transplantation and high tibial osteotomy. Forty percent are disappointed by level and type of sports participation following meniscus allograft transplantation, but only 14% of those patients would not undergo the procedure again.