Meniscus Transplant

Meniscus transplant is a highly skilled procedure involving accurate diagnosis, acquisition of the perfect donor tissue, complex surgery, and specialized rehabilitation. International Knee & Joint Centre is one of the few entities in the Middle East specialized in performing this procedure.

In the past, if a meniscus was damaged beyond repair, it was simply removed. Nothing replaced it. Now we know better. Replacing a meniscus with donor tissue can delay or prevent the need for a knee replacement and possibly even prevent the onset of osteoarthritis. Long-term data confirms that a meniscus transplant relieves pain, improves function, and returns people to sports, even if they already have arthritis.

What is the meniscus & its importance?

Your knee has 2 wedge-shaped pieces of cartilage, 1 on each side of your knee. Each one of these pieces is called a “meniscus.” These 2 rubbery menisci act as shock absorbers between your thighbone (femur) and your shinbone (tibia). A different type of cartilage capping the tibia and femur also helps your bones move smoothly. These 2 menisci help protect the ends of your femur and tibia as they move together.

Sometimes, a twisting injury may severely damage your meniscus. If the damage is severe enough, your surgeon may need to remove your meniscus. Without this meniscus cushion, the ends of your tibia and femur may start to rub together abnormally. Over time, this can cause persistent knee pain. Eventually, it may cause arthritis. Your cartilage “cap” degrades and the bones beneath start to scrape together.

Meniscal transplant surgery provides another choice for you. Your surgeon makes a very small incision in your knee. He or she uses special instruments and cameras to access the joint space between your femur and tibia. Next, your surgeon surgically sews the donated meniscus into your joint space.

Who gets a meniscus replacement?

A meniscus replacement isn’t right for everyone. To determine if you qualify for this procedure, your provider will consider several factors, including:

• Age, activity level and overall health: Surgeons usually perform this procedure on active people under age 40 or 50 who do not have knee arthritis. Teenagers can have the surgery, but providers usually recommend waiting until the bones finish growing. The surgery is more successful in people who are physically active and maintain a healthy weight.
• Anatomy of the knee: To be eligible for a meniscus transplant, you must be missing part of the meniscus or have a severe meniscus tear. But the other parts of your knee should not have damage. Your provider will examine your knee to check for proper alignment and stability in the ligaments (soft tissues that connect bones to bones).
• Arthritis: If you have arthritis, you may not qualify for a meniscus transplant. If cartilage in the knee has worn away too much, the procedure might not be successful.

Knee injuries in adolescents are common, especially during sports. Usually, the meniscus tears when someone twists the knee suddenly. If the damage is severe, providers may recommend removing the torn meniscus and replacing it with a healthy one.

What are the advantages of meniscus replacement?

Because a meniscus transplant is a minimally invasive procedure, it requires less recovery time than traditional (open) surgery. A meniscus transplant can help younger, physically active people return to activities without pain. It can also help prevent osteoarthritis from developing as a result of a damaged meniscus.

What does a meniscus replacement treat?

Your provider may recommend this procedure if your meniscus is severely damaged or if you had your meniscus removed (meniscectomy) after a previous injury. Sometimes providers remove a meniscus if the damage is so severe that they can’t repair it. Living without a meniscus can increase your risk of osteoarthritis and chronic (long-term) knee pain.

A torn or injured meniscus can also lead to osteoarthritis. This condition happens when other cartilage in the knee wears away, causing pain and stiffness. A meniscal transplant can prevent or delay osteoarthritis from developing. But this procedure will not help people who already have knee pain from arthritis.

What are the risks of meniscal transplant surgery?

Most people have meniscal transplant surgery without any problems. Rarely, complications happen, like:

• Stiffness of the joint after surgery (more common)
• Incomplete healing. This might need another surgery.
• Excess bleeding
• Infection
• Damage to nearby nerves
• Complications from anesthesia
• Getting an infection from the donated tissue (extremely rare)

Your own risks may vary according to your age, your other medical conditions, and the specific anatomy of your knee. Talk with your surgeon about your concerns. Make sure you include the risks that most apply to you.

How do I get ready for a meniscal transplant surgery?

Talk with your healthcare provider about how to prepare for your meniscal transplant surgery. Ask whether you should stop taking any medicines ahead of time, like blood thinners. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines like aspirin. You’ll need to avoid food and drink after the midnight before your procedure.

Before your procedure, you may need additional imaging tests, like X-rays and magnetic resonance imaging (MRI).

You may need to rearrange your living arrangements as you recover because you’ll need to use crutches for several weeks.

You may be able to go home on the day of your surgery. It’s also possible you’ll need to stay in the hospital for a day or two. Talk with your healthcare provider ahead of time so that you can make the necessary arrangements for your recovery period.

Before your surgery, a healthcare provider will carefully screen the donated meniscus for any signs of infection.

What happens during meniscal transplant surgery?

Your healthcare provider will explain the details of your particular surgery. An orthopedic surgeon will perform the surgery. The whole operation may take a couple of hours. In general, you can expect the following:

• A healthcare provider (anesthesiologist) will give you medicine so that you’ll sleep through the operation and won’t feel any pain or discomfort during the surgery. (You may receive spinal anesthesia and a medicine to help you relax.)
• Your vital signs, like your heart rate and blood pressure, will be monitored during the operation. You may have a breathing tube inserted down your throat during the operation to help you breathe.
• After cleaning the affected area, your surgeon will make a small incision through the skin and muscle of your knee.
• Your healthcare provider will insert a very small camera through this incision, using this camera to guide the surgery.
• Using very small instruments inserted through the incision, your surgeon will remove any remaining meniscus.
• Next, he or she will surgically sew the donated meniscus into the joint space. The healthcare provider might use screws or other devices to hold the meniscus in place.
• Your surgeon will make other repairs, if necessary.
• The surgeon will close the layers of skin and muscle around your knee.

When can I go back to my usual activities after a meniscus replacement?

Most people need to rest and stay off their feet as much as possible for about two weeks after meniscus transplant surgery. To give your new meniscus time to heal properly, you may need to take a break from sports or strenuous activities for six to 12 months.

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