A Rare Meniscus Transplant Surgery Gives A Young Girl A New Lease On Life
Most surgeons are well versed in treatments for the painful damaged knee cartilage that typically affects older adults after years of wear and tear. When a young patient suffers cartilage damage, treatment is delicate and requires the specialized expertise offered at Summit Orthopedics.
“Children aren’t supposed to have joint problems,” observes Dr. Jack Skendzel. “But by the time I examined the swollen, painful knee of our young patient, she had undergone three knee surgeries with other surgeons—without improvement. She had a rare congenital condition called discoid meniscus, which made the cushioning cartilage in her knee thicker than normal and more prone to injury.”
Although corrective arthroscopic surgery procedures can reshape and repair a discoid meniscus, multiple attempts to repair and then trim out torn tissue left this patient with very little healthy meniscus remaining in her knee. “Meniscal cartilage has a limited blood supply, which complicates the healing process,” Dr. Skendzel explains. “After three surgeries, the meniscus was in poor shape. Our young patient was still in pain, and in danger of developing early arthritis.”
Dr. Skendzel and Dr. James Gannon collaborated to develop a treatment plan; the options require patients to weigh some complicated risks and benefits—especially in this case, where the patient was so young, and had so many potentially active years ahead of her.
Total knee replacement is an excellent option for older patients with significant cartilage damage, but it’s not an ideal option for younger, active individuals. A knee replacement has a limited life span. This is not a significant concern for a 65-year-old, but Drs. Skendzel and Gannon knew that their young patient would probably need a new joint replacement in her 30s or earlier; they also knew that secondary replacements are rarely as successful.
Another option was to consider a meniscus transplant, but delay it until the age of 15 or 16, when their patient had stopped growing. In this procedure, a meniscus that matches the size and shape of the patient’s knee is transplanted to restore the shock-absorbing effect of the meniscus and help prevent early damage to the smooth articular cartilage. Waiting would reduce the risk of growth plate damage. Growth plates are the areas of bone tissue at the ends of long bones that are still developing in childhood. A surgical delay would protect the growth plates, but meant years of additional pain. In addition, if arthritis developed in the meantime, their patient would be ineligible for a transplant.
Drs. Skendzel and Gannon discussed the options with their patient, and decided to proceed with a meniscus transplant. The surgery carried risks, as every surgery does. Even if the transplant was successful, the transplanted tissue may tear. There is a risk of knee stiffness and failure of the graft to heal. Rehabilitation takes time and involves commitment to a long program of physical therapy to reclaim mobility.
“In this case,” Dr. Gannon says, “a transplant was the right option. Our patient is no longer in pain, the transplant and rehabilitation have gone beautifully, and this young woman can look forward to a full and active life. She is delighted, and so are we.”
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