Meniscus Transplant: Donor Selection, Surgery, and Recovery

Axial view of fractured tibia and torn meniscus
Axial view of fractured tibia and torn meniscus. Lauren Shavell / Design Pics / Getty Images

The meniscus is a complex structure that provides both cushioning and stability to the knee. If the meniscus is damaged and it can't be surgically repaired, a meniscus transplant may be an option.

Orthopedic surgeons attempt to preserve the meniscus when surgically treating a torn meniscus. Unfortunately, despite advances in arthroscopy, not all meniscus tears are able to be repaired. In some cases, in order to best treat the damaged meniscus, the entire structure must be removed. When the meniscus is removed, you're left without much of the joint cushion. Initially, this tends not to be a problem. But over time, pain often develops and you can go on to develop accelerated arthritis in that part of the knee joint.

Reasons for a Meniscus Transplant

The ideal candidate for a meniscus transplant is someone who already had his or her meniscus removed but subsequently begins to develop knee pain; is too young and too active to be considered for a joint replacement, yet all the other usual treatments such as anti-inflammatory medicationsphysical therapy, Synvisc, cortisone, and joint supplements just aren't doing the trick to handle the pain. You're a good candidate for a meniscus transplant if the following apply to you:

  • You're under the age of 55
  • You have undergone a prior meniscectomy (removal of meniscus) and have none or less than half of your meniscus left
  • You have normal or limited damage to the articular cartilage (bone lining) of the joint
  • You have pain or instability in your knee
  • Your symptoms are consistent with the absence of a meniscus
  • You're prepared for a difficult recovery

Who Is Not a Good Candidate?

Patients who have undergone a meniscectomy and have persistent symptoms related to the removal of the meniscus have probably already developed damage to the cartilage that remains in the knee. People who have this accelerated degenerative change in their knee joint are not good candidates for meniscus transplant surgery. Other reasons why a meniscus transplant won't work for you include:

  • You still have a significant portion of the meniscus remaining (this procedure is only for patients who had the bulk of the meniscus removed).
  • You have degenerative changes within the joint (early arthritis).
  • You have instability or malalignment of the knee joint.
  • You're obese.
  • You're unwilling to perform the lengthy rehabilitation from meniscus transplant surgery.

Another important thing to consider is your expectations. Some patients are looking for solutions that surgeons cannot necessarily offer. The goal of a meniscus transplant surgery is to reduce pain associated with normal activities. The goal is not to give you a "normal" knee, but rather to make it better. It's possible that you may not be able to resume competitive athletics despite a successful meniscus transplant. If you're expecting more than the reduction of pain, you may want to consider other options as you may be disappointed in the results of a meniscus transplant.

Types of Donors

The meniscus used for your transplant will come from a cadaver. When the transplanted tissue comes from another person, it is called an allograft transplant. Donor menisci (the plural of meniscus) may be fresh, frozen, or cryopreserved, with frozen being the most common option. Fresh menisci are only viable for 14 days after being removed from a cadaver. The meniscus used for your transplant must also be the appropriate size for your body. Before your surgery, the donated meniscus will be screened for any signs of infection.

Before Surgery

Your healthcare provider will ask you which medications you take and may want you to stop taking certain ones, such as blood thinners, prior to your surgery. You’ll also need to stop eating and drinking after midnight on the day of your procedure. Additional imaging tests, such as MRIs or X-rays, may be necessary as well.

Make sure you have arrangements in place for going home and recovering after the surgery. For example, someone will need to drive you home. You may be able to go home the day of the procedure, but it's possible you'll need to stay in the hospital for a day or two. You will be using crutches for several weeks and will most likely need help at home for a while.

Surgical Process

An orthopedic surgeon will perform the surgery arthroscopically, which will take a couple of hours. Here is what you can expect:

  • An anesthesiologist will administer medication to put you to sleep during the operation. In some cases, you may receive spinal anesthesia and a tranquilizer instead of general anesthesia. If you have general anesthesia, you may have a breathing tube inserted in your throat to help you breathe. Your vital signs will be monitored during the operation.
  • After cleaning the affected area, your surgeon will make a small incision through the skin and muscle of your knee and then insert a very small camera through this incision, using it to help guide the surgery.
  • Your surgeon will remove any remaining parts of your meniscus. Next, they will surgically sew the donated meniscus into the joint space, possibly using crews or other medical devices to hold it in place.
  • The surgeon will then close the layers of skin and muscle around your knee.

Once the surgery is complete, you will be taken to the recovery room, where you'll be monitored as the anesthesia wears off.

Complications 

Meniscal transplant surgery is generally safe, though there are always risks. In addition to the risks inherent in any surgical procedure, possible complications include:

  • Stiffness of the joint after surgery
  • Incomplete healing, possibly requiring another surgery
  • Excess bleeding
  • Infection
  • Damage to nearby nerves
  • Getting an infection from the donated tissue (This is extremely rare.)

After Surgery

Unlike with other tissue transplantations, there is little risk that a meniscal graft will be rejected; therefore, anti-rejection medications are not necessary. You will be be given a prescription for painkillers, however.

Once you are cleared to go home (which might be the same day or a day or two later), you will begin your recovery and rehabilitation. Initially, you may have some fluid draining from your incision, which is normal. Let your healthcare provider know right away if you see an increase in redness, swelling, or draining, or if you have a high fever, chills, or severe pain.

You will need to wear a knee brace and use crutches for a few weeks. Your doctor will give you instructions about how you can move your knee while you recover and when you can begin to resume your daily activities as well as exercise. To help you maintain strength and range of motion during the recovery period, you will likely need physical therapy. It may be several months before you can return to all your previous activities. In general, strenuous weight bearing activities are not recommended in order to preserve the transplanted graft. If you previously engaged in high-impact exercise or competitive sports, you may have to avoid them and find alternative activities (such as swimming) that put less stress on your knee.

Prognosis

The goal of a meniscus transplant is to restore the normal joint support and cushioning of the meniscus so that the pain will be alleviated. However, although it does help alleviate pain, studies show that meniscus transplants don't slow down or prevent osteoarthritis in the knee and more surgeries and/or a knee replacement will likely eventually be needed. The overall 10-year success rate for meniscal transplantation is approximately 70%.

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