Review| Volume 40, P227-237, January 2023

Download started.


Does laterality matter? a systematic review and meta-analysis of clinical and survival outcomes of medial versus lateral meniscal scaffolds

Published:December 10, 2022DOI:



      Meniscal scaffold implants have gained interest as a therapeutic alternative for irreparable partial meniscal defects and post-meniscectomy syndrome. However, the effect of laterality on outcomes is unclear. This study aims to assess the hypothesis that lateral meniscal scaffold implants have worse clinical or survival outcomes compared with medial scaffold implants.


      The study was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO. Three databases (PubMed, Embase, Scopus) were searched from date of database establishment to 21 January 2022. Human studies reporting clinical or survival outcome data specific to the medial or lateral meniscal scaffold implant were included. Random-effects model was used to analyse survival outcome data.


      Ten studies comprising 568 patients (mean age 29.2–40 years, follow up duration 1–14 years) were included. There were 483 medial and 85 lateral meniscal scaffold implants. Amongst two studies directly comparing the survival rate of medial and lateral meniscal scaffolds, there was no significant difference in survival rates between medial and lateral meniscus scaffolds (hazard ratio = 1.24, 95 % confidence interval: 0.51–3.03, P = 0.63). There were no consistent statistically significant differences between medial and lateral meniscal scaffolds in terms of postoperative Visual Analog Scale pain, Tegner Activity, Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, and Knee Society Scores.


      Despite anatomical and biomechanical differences between the medial and lateral meniscus, there are no significant differences in clinical outcomes or survival rates between medial and lateral meniscal scaffold implants for irreparable partial meniscal defects at short- or mid-term follow up. Lateral meniscal scaffold implants are therefore non-inferior to medial meniscal scaffold implants.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Knee
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Toanen C.
        • Dhollander A.
        • Bulgheroni P.
        • Filardo G.
        • Zaffagnini S.
        • Spalding T.
        • et al.
        Polyurethane meniscal scaffold for the treatment of partial meniscal deficiency: 5-year follow-up outcomes – a European multicentric study.
        Am J Sports Med. 2020; 48: 1347-1355
        • Fetzer G.
        • Spindler K.
        • Amendola A.
        • Andrish J.
        • Bergfeld J.
        • Dunn W.
        • et al.
        Potential market for new meniscus repair strategies – evaluation of the MOON cohort.
        J Knee Surg. 2009; 22: 180-186
        • Kurosawa H.
        • Fukubayashi T.
        • Nakajima H.
        Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci.
        Clin Orthop. 1980; 149: 283-290
        • Englund M.
        • Guermazi A.
        • Lohmander L.S.
        The meniscus in knee osteoarthritis.
        Rheum Dis Clin North Am. 2009; 35: 579-590
        • Pujol N.
        • Beaufils P.
        Save the meniscus again!.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 341-342
        • Reguzzoni M.
        • Manelli A.
        • Ronga M.
        • Raspanti M.
        • Grassi F.A.
        Histology and ultrastructure of a tissue-engineered collagen meniscus before and after implantation.
        J Biomed Mater Res. 2005; 74: 808-816
        • Filardo G.
        • Petretta M.
        • Cavallo C.
        • Roseti L.
        • Durante S.
        • Albisinni U.
        • et al.
        Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold.
        Bone Joint Res. 2019; 8: 101-106
        • Grassi A.
        • Lucidi G.A.
        • Filardo G.
        • Agostinone P.
        • Macchiarola L.
        • Bulgheroni P.
        • et al.
        Minimum 10-year clinical outcome of lateral collagen meniscal implants for the replacement of partial lateral meniscal defects: Further results from a prospective multicenter study.
        Orthop J Sports Med. 2021; 9
        • Reale D.
        • Previtali D.
        • Andriolo L.
        • Grassi A.
        • Candrian C.
        • Zaffagnini S.
        • et al.
        No differences in clinical outcome between CMI and Actifit meniscal scaffolds: a systematic review and meta-analysis.
        Knee Surg Sports Traumatol Arthrosc. 2022; 30: 328-348
        • Grassi A.
        • Lucidi G.A.
        • Agostinone P.
        • di Paolo S.
        • dal Fabbro G.
        • Zaffagnini S.
        Lateral collagen meniscus implant (CMI): Techniques and outcomes – a narrative review.
        Ann Joint. 2021; 7: 18
        • Fox A.J.
        • Bedi A.
        • Rodeo S.A.
        The basic science of human knee menisci: structure, composition, and function.
        Sports Health. 2012; 4: 340-351
        • Grassi A.
        • Dal Fabbro G.
        • Di Paolo S.
        • Stefanelli F.
        • Macchiarola L.
        • Lucidi G.A.
        • et al.
        Medial and lateral meniscus have a different role in kinematics of the ACL-deficient knee: a systematic review.
        J ISAKOS. 2019; 4: 233-241
        • McNicholas M.J.
        • Rowley D.I.
        • McGurty D.
        • Adalberth T.
        • Abdon P.
        • Lindstrand A.
        • et al.
        Total meniscectomy in adolescence: a thirty-year follow-up.
        J Bone Joint Surg Br. 2000; 82: 217-221
        • Guyot P.
        • Ades A.
        • Ouwens M.J.
        • Welton N.J.
        Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves.
        BMC Med Res Methodol. 2012; 12: 1-13
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): development and validation of a new instrument.
        Aust N Z J Surg. 2003; 73: 712-776
        • Horner N.S.
        • Moroz P.A.
        • Bhullar R.
        • Habib A.
        • Simunovic N.
        • Wong I.
        • et al.
        Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies.
        BMC Musculoskelet Disord. 2018; 19
        • Linke R.D.
        • Ulmer M.
        • Imhoff A.B.
        Replacement of the meniscus with a collagen implant (CMI).
        Eur J Trauma Emerg Surg. 2007; 33: 435-440
        • Rodkey W.G.
        • DeHaven K.E.
        • Montgomery W.H.
        • Baker C.L.
        • Beck C.L.
        • Hormel S.E.
        • et al.
        Comparison of the collagen meniscus implant with partial meniscectomy: a prospective randomized trial.
        J Bone Joint Surg Am. 2008; 90: 1413-1426
        • Akkaya M.
        • Şimşek M.E.
        • Gürsoy S.
        • Çay N.
        • Bozkurt M.
        Medial meniscus scaffold implantation in combination with concentrated bone marrow aspirate injection: minimum 3-year follow-up.
        J Knee Surg. 2020; 33: 838-846
        • Hirschmann M.T.
        • Keller L.
        • Hirschmann A.
        • Schenk L.
        • Berbig R.
        • Lüthi U.
        • et al.
        One-year clinical and MR imaging outcome after partial meniscal replacement in stabilized knees using a collagen meniscus implant.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 740-747
        • Monllau J.C.
        • Gelber P.E.
        • Abat F.
        • Pelfort X.
        • Abad R.
        • Hinarejos P.
        • et al.
        Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years' follow-up.
        Arthroscopy. 2011; 27: 933-943
        • Bulgheroni P.
        • Murena L.
        • Ratti C.
        • Bulgheroni E.
        • Ronga M.
        • Cherubino P.
        Follow-up of collagen meniscus implant patients: Clinical, radiological, and magnetic resonance imaging results at 5 years.
        Knee. 2010; 17: 224-229
        • Schüttler K.F.
        • Haberhauer F.
        • Gesslein M.
        • Heyse T.J.
        • Figiel J.
        • Lorbach O.
        • et al.
        Midterm follow-up after implantation of a polyurethane meniscal scaffold for segmental medial meniscus loss: maintenance of good clinical and MRI outcome.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1478-1484
        • Akkaya M.
        • Gursoy S.
        • Ozberk N.
        • Simsek M.
        • Korkusuz F.
        • Bozkurt M.
        Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application.
        Musculoskelet Surg. 2022; 106: 145-153
        • Zaffagnini S.
        • Marcheggiani Muccioli G.M.
        • Lopomo N.
        • Bruni D.
        • Giordano G.
        • Ravazzolo G.
        • et al.
        Prospective long-term outcomes of the medial collagen meniscus implant versus partial medial meniscectomy: a minimum 10-year follow-up study.
        Am J Sports Med. 2011; 39: 977-985
        • Peña E.
        • Calvo B.
        • Martinez M.A.
        • Palanca D.
        • Doblaré M.
        Why lateral meniscectomy is more dangerous than medial meniscectomy. a finite element study.
        J Orthop Res. 2006; 24: 1001-1010
        • Willinger L.
        • Foehr P.
        • Achtnich A.
        • Forkel P.
        • Voss A.
        • Liska F.
        • et al.
        Effect of lower limb alignment in medial meniscus- deficient knees on tibiofemoral contact pressure.
        Orthop J Sports Med. 2019; 7