Meniscal Transplant Surgery

Young, active patients with symptoms of meniscal deficiency may be eligible candidates for meniscal transplant surgery. When the partial or complete loss of the meniscus has already lead to the development of osteoarthritis, a meniscal transplant will not be effective. However, for a select group of patients, this procedure can offer pain relief and prevent joint space narrowing as well as bone misalignment.

A meniscal transplant surgery is an arthroscopic procedure that replaces the partial or absent meniscus with donor cartilage. It typically requires a two to four inch incision in order to anchor the new meniscus into the shinbone. Before placing the donor meniscus, any remaining fragments of the original fibrocartilage will be removed and the joint area prepped for the new tissue.

Though not common, this procedure has been being performed for over 20 years and is considered to be both safe and effective in the appropriate situations.

Benefits

For patients who are deemed eligible, meniscal transplant surgery can provide significant benefits. The goal of this procedure is to replace the meniscus - the knee’s shock absorber - in order to protect the joint from articular cartilage damage. A secondary benefit relates to knee biomechanics. With a healthy meniscus in place, the bones of the knee joint are supported and stabilized, preventing the eventual misalignment that often occurs in the absence of the meniscal cushion.

Of course, a primary and immediate goal of meniscal transplant surgery is pain relief for the patient.

Recovery

While some people stay in the hospital for a day or two, many meniscal transplant procedures can be done on an outpatient basis.

Following surgery, patients wear a brace and use crutches for a four to six week period while the donor meniscus becomes firmly and permanently attached. Once the required immobilization period is over, the patient can begin physical therapy to restore range of motion and build strength in the joint and its surrounding muscles.

Meniscal transplant patients often need a minimum of two weeks before returning to some basic daily activities. For those with active, demanding jobs, a longer period of two to three months may be required for total rehabilitation after surgery. Patients can usually return to playing sports within six months. Because each case is unique, our physicians work with each patient individually to design a specific timeline for their recovery.

Potential Complications

Although there are very few risks related to this procedure, it is helpful to be aware of the potential complications. Stiffness and incomplete healing are the most commonly cited. Both of those can usually be avoided by following proper rehabilitation procedures.

Other risks are those standard to any surgery: bleeding, infection, clotting, and nerve injury.

These potential complications are extremely rare.

What to Discuss With Your Surgeon

Am I an eligible candidate?

Your physician can speak with you about whether you meet the criteria for meniscal transplant surgery, which usually include:

Younger than 55 years
Generally healthy and physically active
Partial or Absent meniscus
Persistent activity-related pain
Knee alignment is still normal
No or minimal knee arthritis

How will the donor meniscus be matched for my knee?

Although there are no live cells and therefore no need for a tissue match, there is still a critical component to choosing the right donor meniscus - the issue is size.

In order for the new meniscus to be effective, it is imperative that the donor meniscus is the correct size for your knee. Ask your surgeon about how this will be determined.

In addition to being matched for size, the tissue is, of course, also rigorously screened for infections.

What are my instructions for the first few days post-surgery? It’s important to discuss the details of your rehabilitation with your surgeon before the day of your procedure. You will get thorough discharge instructions when you leave the hospital, but you will want to have previously set up the appropriate accommodations.

Your surgeon will share important instructions with you, including information on diet, medication, bandaging, showering, use of crutches and ice, bracing, and the removal of stitches.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00381

http://orthodoc.aaos.org/freedmansports/Meniscus-Allograft-Transplantation.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714576/