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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.

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.
In the knee joint,…
ICRShttps://cartilage.org/content/uploads/icrs.jpg
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