Alternatives to meniscus transplantation outside the United States

Over the years, the surgical treatment of meniscal injury or damage has changed from total meniscectomy to partial meniscectomy or repair. The goal with arthroscopic methods is to preserve as much functional meniscal tissue as possible, rather than to remove it. During recent years, efforts have increasingly focused on the promotion of meniscal healing, as well as the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. This chapter will focus on three types of meniscal substitutes, their biological and biomechanical properties, and their clinical relevance. None are available for patient use in the USA at the time of this writing. These substitutes are: the biological MenaflexTM or collagen meniscal implant (CMI), the biomimetic ActifitTM meniscal scaffold, and the nonbiological NUsurface® meniscal substitute. In addition to the surgical techniques, clinical outcomes for the respective devices will be reviewed.