Welcome to the ICRS Patient & Public Education Site

If you suffer from joint pain, you’re not alone. Each year, more than 50 million people visit their doctors because of joint pain — half of them with a damage of the articular cartilage.

On this website, you can find useful, updated information on specific cartilage-related conditions and possible treatments options, written by world-renowned experts in this field, helpful patient information to read and download, and other useful resources

The choice of procedures depends on the size and location of cartilage defect. Larger defects are typically treated with autologous chondrocyte transplantation, osteochondral allograft transplantation, or newer synthetic or natural scaffolds which may require open incisions. Smaller defects in specific locations may be treated with enhanced bone marrow stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer which may be completed through the arthroscope. There is also a chapter for conservative treatments options and rehabilitation after cartilage repair.

Intended Audience for this Website

People of all ages can suffer from cartilage complications, whether due to ‘wear and tear’ or injury. While the former is much more common in middle-aged patients, and even more so in women, injuries to the joints, such as trauma or accidents during active sports, can affect any age group or gender. Careers requiring repetitive or intense motion can increase the risk of developing cartilage problems, but there are several other risk factors, including age, weight and genetic predisposition.

What is Cartilage Repair?

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities – abnormalities a person is born with (for instance misalignment) – that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans (OCD). There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

What is not covered in this Website?

There are several types of bone and joint pain, each with many potential sources or etiologies. This site is not intended for people who suffers from rheumatoid arthritis (RA), gout, avascular necrosis (AVN), and cancer within bones, osteoporosis and other inflammatory or autoimmune diseases.

Acknowledgements

To the Mäxi Foundation: 
This website project would not have been possible without the substantial support of the Swiss “Mäxi Foundation”. The ICRS would like to express a deep gratitude for this very generous contribution to the International Cartilage Repair Society and the respective patient community, making it possible to provide updated information about cartilage damage and cartilage repair technologies free of charge to all interested persons.

To the Authors & Contributors:
The following world-renowned experts in cartilage repair & cartilage research have contributed to the extensive content of this website: Stephen Abelow (USA), William Bugbee (USA), Susan Chubinskaya (USA), Brian Cole (USA), Stefano Della Villa (IT), Chris Erggelet (CH), Jack Farr (USA), Ralph Gambardella (USA), Michael Gerhardt (USA), Wayne Gersoff (USA), Alan Getgood (CA), Alberto Gobbi (IT), Laszlo Hangody (HU), Oliver Kessler (CH), Elizaveta Kon (IT), Jos Malda (NL), Bert Mandelbaum (USA), Tom Minas (USA), Kai Mithoefer (USA), Stefan Nehrer (AT), Lars Peterson (SE), Scott Gillogly (USA), Holly Silvers (USA), Jason Theodosakis (USA) and Kenneth Zaslav (USA)

To anyone else who contributed to this important project
ICRS Office Staff, Medical Writers, Committees, Illustrators and Web Developers, etc.

Terms of Use

These terms of use, together with our Privacy Policy collectively, these “Terms of Use”, governs access to and any use of the website cartilage.org and any sub-sites (the “Website“), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree to bound and abide by the Terms of Use on behalf of all users of the respective computer. Visitors who do not agree with these Terms of Use must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page from time to time so that you are aware of any changes, as they are binding on you.

The information on the Website is not intended to treat, diagnose, cure or prevent any cartilage related issues. Always seek the advice of a physician or other qualified health care provider with any questions you have regarding your medical condition.

Privacy Policy

This privacy policy (“Privacy Policy”), together with the Terms of Use for the patient website section, applies to any use of the website cartilage.org and any sub-sites (the “Website”), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree on behalf of all users of the respective computer to be bound and abide by the Terms of Use and this Privacy Policy. Visitors who do not agree with the Terms of Use and this Privacy Policy must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) is committed to protecting your privacy and ensuring that your personal information is protected. This Privacy Policy explains the types of personal information we collect and how we use, disclose and protect that information.

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Meniscus Transplant

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Meniscus Transplant

In the knee joint, the meniscus are basically C-shaped discs that act as a ‘shock absorber’ and stabiliser between the thigh bone and the shin bone. The knee has two menisci, one on the ‘medial’ side, or inside, and one on the ‘lateral’ side, or outside.

The primary job of the meniscus is to distribute the load evenly across the cartilage when people walk, run or do anything that involves impact. The menisci perform some other secondary roles, which include aiding in the stability of the knee along with the cruciate and collateral ligaments.

When someone injures their meniscus and it reduces in size by over 50%, the shock absorbency patterns of the knee joint become compromised. If people are not careful, this may lead to the early development of arthritis.

Intended audience

This article is intended for anyone suffering from damage to their meniscus and articular cartilage and their families who would like to find out about meniscus transplant, as well as anyone interested in cartilage problems.

What is Meniscus Transplant?

When a patient has had a serious enough injury to their meniscus in which they lose the majority of the meniscal tissue, it may not function very effectively any more. This can result in pain and the entire meniscus can then be replaced.

When the meniscus is replaced, or transplanted, donated tissue known as an ‘allograft’, is used. For example, when people donate their hearts, livers, kidneys, they also donate their bones, tendons, and meniscal tissue.

One of the nice things when tissue of this type is donated is that there is time to make sure it is in good condition and test it for different types of bacteria, fungi and viruses. Unlike a kidney or a liver, which has to be used within the first 24–48 hours, this kind of tissue does not have to be used as quickly. It can therefore be tested and quarantined until all the tests come back negative.

When the orthopaedic surgeon sees a patient whom may need a meniscal transplant, they take X-rays with markers on so that the top of the tibial plateau can be measured. Those measures are then sent to the tissue bank company, and they find a match. For example, if it is a right knee and they are looking for the medial meniscus to match the patient’s tissue, they will usually match the tissue to within 1%–2% of the size, both front to back and side to side. Alternatively, an MRI scan of the opposite knee may be used to measure it.

Once there is a size matched meniscal allograft found, the meniscus is implanted into the patient via an arthroscopy or mini open incision. The meniscus allograft is then anchored in place, which will then heal and become the new meniscus.

Figures

Torn Meniscus

What outcomes can patients expect from meniscus transplant?

From a functional standpoint, people can get back to a fairly active lifestyle after a meniscus transplant.

Although the meniscus transplant works very well, it is certainly not as good as the original. It is therefore probably not going to last forever, and people should understand that this may not be their last operation.

The majority of the studies suggest that good or excellent results can be expected in around 85% of patients. Like everything else, it is not going to last forever, but the procedure may delay the knee becoming significantly arthritic.

3D Animation (Meniscus Problems - Meniscus Transplant)

What are the advantages and disadvantages of Meniscus Transplant?

What are the advantages of Meniscus Transplant?

The unfortunate result of losing the meniscus, particularly if you are young is that it significantly increases the risk of developing degenerative joint disease or osteoarthritis of the knee. It may also result in pain, which can affect your activity level and quality of life.

This is because all the impact load that was previously absorbed by the meniscus is taken up by the cartilage that covers the joints. This just is not as strong and durable as the meniscus, and is not designed to absorb that level of shock.

The advantage of a meniscus transplant is that it can relieve pain and, although you may not be able to prevent the gradual development of arthritis, you may slow it down.

What are the disadvantages of Meniscus Transplant?

Meniscal transplant is not a perfect procedure and is not as good as having your own meniscus. However, it does work extremely well.

It is a big operation and probably takes about around 6 months to make a full recovery, therefore rehabilitation is a key component of success.

However, meniscus transplant does not work for everybody. Sometimes it perhaps does not heal correctly or simply does not heal at all, although the risk of that is fairly minimal.

The risk of tissue rejection or disease transmission is also extremely small. Overall, it’s a fairly low-risk procedure.

Frequently Asked Questions (FAQs)

What will happen if I don’t have a transplant?

The decision as to whether or not to have a meniscus transplant comes down to quality of life and pain. If you do not have a transplant, pain may persist.

If you do not have pain and do not have any swelling, and you want to do very low or no-impact activities such as biking and swimming, you might do okay without having a meniscus transplant. On the other hand, if you are constantly on your feet, or you’re young and want to be active, then a meniscus transplant is probably a good thing for you to consider.

Should I have a meniscus transplant?

The ideal patient for a meniscus transplant is someone who has injured/lost a significant amount of his or her meniscus, and has pain. A transplant may also be indicated to protect a cartilage repair/restoration procedure.

There is some debate as to whether someone who is very young – for example, in their teenage years – should have a transplant before developing pain, if they lose their meniscus. This is particularly important on the lateral side in females as the rate of development of osteoarthritis can be fairly quick. There is some debate as to whether to treat those before symptoms develop, because if an individual starts to develop symptoms, the assumption is that they have already started developing some wear in their joint.

Further reading
  • Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc. 2011;19:147-157.
  • Lee BS, Kim JM, Sohn DW, Bin SI. Review of Meniscal Allograft Transplantation Focusing on Long-term Results and Evaluation Methods. Knee Surg Relat Res. 2013;25:1-6.
  • Saltzman BM, Bajaj S, Salata M et al. Prospective long-term evaluation of meniscal allograft transplantation procedure: a minimum of 7-year follow-up. J Knee Surg. 2012;25:165-175.
  • Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am. 2005;87:715-724.
  • Verdonk R, Almqvist KF, Huysse W, Verdonk PC. Meniscal allografts: indications and outcomes. Sports Med Arthrosc. 2007;15:121-125.
Keywords

knee, meniscus, transplant

In the knee joint,…
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