Semitendinosus Autograft vs Meniscal Allograft in Post-Meniscectomy Syndrome

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.

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