Name: Segmental MAT: Scientific Rationale and Clinical Approach
Uploaded: 2026-08-24T00:00:00Z
Channel: Arthrex
Description: Jonathan A. Godin, MD (Vail, CO), reviews recent scientific evidence supporting segmental meniscal allograft transplantation (MAT) procedures. Dr. Godin also presents a knee preservation case in which he applied his segmental MAT technique with a favorable patient outcome.

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Jonathan A. Godin, MD (Vail, CO), reviews recent scientific evidence supporting segmental meniscal allograft transplantation (MAT) procedures. Dr. Godin also presents a knee preservation case in which he applied his segmental MAT technique with a favorable patient outcome.

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VID1-009963-en-US | A | Segmental MAT: Scientific Rationale and Clinical Approach

Jonathan A. Godin, MD (Vail, CO)

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Segmental MAT: Scientific Rationale and Clinical Approach

Speaker  Hi, this is John Gordon from the Steadman Clinic in Vail, Colorado. Today we're going to be discussing both the scientific rationale as well as the clinical approach to segmental meniscal allograft transplantation. I'd like to start with a study that we did with a cadaveric model using our biomechanical lab. We used ten matched paired specimens, and we were measuring meniscal extrusion using ultrasound, as well as contact area mean and peak contact pressures in the medial compartment of the knee. And you can see the native state with the deficient posterior half of the medial meniscus, followed by either a segmental meniscus transplantation or a full meniscal transplantation. And I would note that the root repair was done in both of these in similar fashion using a SutureLoc anchor. And the inside out technique was the same with both. Looking at our results, you can see based on the knee flexion angle, the amount of meniscal extrusion as well as the contact area was able to be changed with our deficient state and then restored with both the segmental and the full m.a.t. techniques, without any significant difference between the segmental and the full m.a.t. in terms of outcome on that contact area and the amount of meniscal extrusion. Furthermore, if we look at both the mean and the peak contact pressures in the medial compartment, you can again see the intact state increases in both of those pressures with a deficient state that is then nicely restored with both a segmental and a full m.a.t. Speaker  without significant difference between the two techniques. Here is our tech scan slides showing on the left, the intact, and then a significant change in those pressures with the segmental deficiency that is nicely restored to a similar amount compared to a full m.a.t. using a segmental m.a.t. technique. It also note, in addition to the posterior medial segmental m.a.t., the segmental m.a.t. can be done in other locations. This is a video we put together that was an award winner for the fellows challenge of an anterolateral segmental meniscus transplant. And you can see on the MRI slides in both the coronal and sagittal planes, the deficiency of the anterior one third to 40% of this patient's lateral meniscus. And you can see from our arthroscopy photo here the amount of meniscus and where that native meniscus stops. And we're just left with capsule from a previous partial meniscectomy this patient underwent. Here we are introducing the graft through a PassPort. And then we're using PDS for an outside in repair. We also did suture anchor for the root and then the inside out for the radial repair to the native tissue. This has also been described for a midbody medial meniscus using three fixation techniques, those being transtibial inside out and all inside. And you can see in this study that we highlighted the patient had again a previous partial meniscectomy. Speaker  We're sizing the defect with the SCR ruler. Intraoperatively here and then on the back table we size it appropriately and then introduce it. And here you can see both superior and inferior vertical mattress stitches that were placed in inside out fashion. You can see on the back table our prep with luggage tag to feed this in through the capsule and for stabilization. And then again after it's tied down, we're augmenting the radial repairs using an all inside technique, both posteriorly and anteriorly. I'd like to highlight a case example. This is a 37 year old, very active professional athlete, female with a history of a prior partial meniscectomy done at outside facility. She came in to me for for evaluation of acute on chronic medial knee pain and instability after a pickleball injury, and she denied any mechanical symptoms. You can see from her radiographs that she's in some physiologic valgus. So that is going to actually be in our favor for her medial meniscus. But the joint spaces medially laterally and as well as the Patellofemoral joint, are well preserved. Some of the select MRI cuts here you can see the full ACL tear, and then the difference in the amount of meniscal volume on all three of the coronal sagittal and the axial cuts showing where the partial meniscectomy had been done in the past. Speaker  Here's the video going through all of those different MRI cuts. And again, I would just note that while the root of the posterior medial meniscus is intact, it's been diminutive due to the previous partial meniscectomy. And then the anterior half of that meniscus is intact as well as the lateral meniscus. And so I had a lengthy conversation with this patient. She was all about preserving as much of her native tissue as possible. So in addition to a planned ACL reconstruction using bone patellar tendon bone autograft, we planned for a segmental meniscus transplantation with a full as backup when we got into the joint, you can see her cartilage surfaces of both the femur and the tibia are well maintained. Again, that root is somewhat intact, but been partially debrided all the way up to the midbody, and then the anterior horn and anterior root route are completely intact. We then prep the graft after sizing it. At the time, this was several years ago. Was still using a transtibial technique, and since then, biomechanical studies that we've done have shown that the SutureLoc can also be used in this instance, and then a combination of all inside and inside out to secure the graft to both the capsule and the native anterior horn. Post-operatively you can see the radiographs showing the button for the meniscus root fixation as well as our ACL screws. Speaker  I'd highlight on both a coronal and axial cut, the intact root and the intact junction that is healed between the native anterior horn and the graft midbody. Here are some of the slides showing this as we scroll through both the coronal and sagittal cuts, demonstrating the intact root attachment and the junction where we've had the healing of the repair between the graft and the patient's native meniscus. This patient subsequently developed new symptoms anteriorly, and had to go in for a second look, a year and a half post-operatively. And you can see that the graft has healed to the native meniscus. And it even looks like there was some vascularization at that area, as noted by these intraoperative arthroscopic photos. I would also note the cartilage still looks to be very good shape on both the femur and the tibia. So when selecting patients for a segmental meniscal allograft transplantation, it's very similar to those indications for a full Matty Young active individuals with a history of a prior subtotal meniscectomy joint line pain that's limiting their activities. The key is that the cartilage has to be intact. I would specifically say Outerbridge grade 1 or 2, where at most ligamentous stable. You always want to check the alignment. Either has to be neutral or physiologically off loading or correctable with a concomitant osteotomy. Bmi ideally under 30, but certainly under 35.

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Segmental MAT: Scientific Rationale and Clinical Approach

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