Meniscal Transplantation (Treatment)
The menisci are C-shaped fibrocartilaginous rings that provide shock absorption between the end of the thigh bone (femur) and shin bone (tibia) within the knee. There are two menisci cartilages, one medially and another laterally. Meniscal tears are among the most common orthopedic injuries, and are associated with ligament damage such as an ACL tear.
The menisci serve a critically important role in the knee to provide stability, to act as a cushion against compressive loads, and to ensure overall joint health. In most cases, the surgeon should repair a meniscal tear whenever possible. In some circumstances,however, the menisci may be irreparable and a large part is removed. Meniscal transplantation is a reasonable option in young, active patients with symptomatic meniscal deficiency after a large portion of the meniscus has been removed
How do I know if I need this particular treatment?
The patient’s history is taken into consideration, including previous surgeries and whether previous meniscal repair or meniscectomy was performed. Previous operative reports or arthroscopic images should be brought to clinic for review by Dr. Skendzel. Dr. Skendzel will complete a physical examination to test motion, strength, and the stability of knee ligaments.
Plain x-rays are taken to ensure that there is no arthritis. Long-standing x-rays are performed to evaluate the patient’s mechanical alignment—this is done to ensure that the patient is not too “knock-kneed” or “bowlegged” before transplantation is considered; or, if another surgery, an osteotomy, is needed to correct the malalignment. MRI provides information about the menisci, cartilage and ligaments.
What is the treatment?
Meniscal transplantation is indicated in patients < 40 years old with an absent or non-functioning meniscus. These patients have pain on the side of the deficient meniscus, swelling, and have difficulty with activities of daily living or sports. This procedure is not recommended for patients with the following conditions: malalignment, ligament instability, or significant damage to the cartilage.
If transplantation is indicated, either a medial or lateral meniscal allograft is obtained from a cadaver. The graft is sized specifically to the patient pre-surgically and is deep-frozen after harvest. The surgical procedure is performed arthroscopically. The bony portion of the graft is attached to the patient’s knee through either bone plugs or a bony trough. The meniscus is then sutured into place.
What can I expect after surgery?
Patients are partial weight-bearing for 6 weeks after surgery and are expected to meet with a physical therapist for 4-6 months after surgery to work on motion, strength, and neuromuscular control. This procedure can predictably relieve pain and restore knee stability. Recent studies have shown high graft survival at an average of 5 years after transplantation. Return to sports usually occurs 6-9 months after surgery.
Summit sports medicine surgeon Brian Walters, M.D., discusses cartilage injury, its causes, and treatment options.