Our knees are the largest joints in our bodies, and two c-shaped wedges of cartilage called the menisci help cushion and stabilize our knee joints. Each meniscus acts as a shock absorber between your thigh bone (femur) and your shinbone (tibia).

Meniscal tears, due to trauma or age, require surgical intervention in about 85% of cases. In severe cases, a meniscus transplant is necessary to restore proper function to the knee. Read further to learn more about this procedure, its benefits, risks, and what is involved in meniscal transplant recovery.

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• What Is a Meniscal Transplant?

• Understand Why a Meniscal Transplant is Performed

• Preparing for Meniscal Transplant Surgery

• What Happens During a Meniscal Transplant?

• Understand Meniscal Transplant Risks

• Meniscal Transplant Recovery: What to Expect

A meniscal transplant is an outpatient procedure performed under general anesthesia. The physician performing the procedure uses a small camera, called an arthroscope, and miniature instruments to access and replace the meniscus. Arthroscopic joint procedures are preferred because they are minimally invasive and promote faster recovery.

Technically known as meniscal allograft transplantation (MAT), this procedure replaces a severely damaged and ineffective meniscus with the meniscus from a cadaver (deceased donor). There are also synthetic replacements used in less severe partial meniscus transplants.

Replacing a severely damaged meniscus is critical because, beyond the cushion and stability it provides, it protects the articular cartilage in the knee joint. Damage to the articular cartilage can speed up the development of osteoarthritis, causing severe pain and knee instability. For some patients who already have osteoarthritis, a meniscal transplant may not help if the damage to the articular cartilage and bone is too extensive. In these cases, a knee replacement procedure would be more effective.

A meniscus can tear due to a forceful twist in the knee or hyper-flexing of the knee joint. Sometimes a torn meniscus heals on its own or can be stitched back together if the damage isn't too severe. However, the tear could become worse and the meniscus could deteriorate, necessitating a meniscus transplant.

A key goal of a knee meniscus transplant is to replace the vital joint cushion before damage to the articular cartilage and bone occurs. The ideal candidates for this procedure would be those who:

• Are younger than 55

• Are missing more than half of their meniscus

• Have a meniscus tear that isn't healing on its own or can't be stitched back together

• Have severe and constant knee joint pain

• Have an unstable knee joint

• Don't have significant osteoarthritis or have none at all

• Have a normal knee alignment with healthy ligaments

In preparation for a meniscal transplant procedure, a physician will ready a meniscus taken from a deceased donor's knee by analyzing its compatibility and conducting laboratory tests to ensure the replacement is disease and infection-free.

Because patients will be under general anesthesia, before the procedure, they will need to disclose to their physician any medications they are taking, their existing medical conditions, allergies, lifestyle habits, and previous reactions to anesthesia. The physician will most likely order additional imaging tests, like X-rays and MRIs, to properly prepare the replacement meniscus and aid in planning the procedure.

Patients can usually leave the hospital once the procedure is complete and the anesthesia wears off. Even though this is an outpatient procedure, the patient should arrange transportation home ahead of time, as their mobility will be limited and the anesthesia may have some lingering effects.

A meniscal transplant involves several important steps to ensure successful outcomes. The procedure often uses knee arthroscopy, a technique where a tiny camera is inserted through a small incision. With this camera, a physician can see the knee's interior on a screen, guiding them throughout the procedure. Here's an overview of what happens during the procedure:

1. Preparation of the Joint: First, the surgeon removes any damaged meniscal cartilage within the joint using specialized instruments. The surfaces of the joint are shaped to fit the graft (allograft). This step is crucial to prepare the joint surfaces for the new graft.

2. Insertion of the Allograft: The surgeon creates a small incision in the knee to insert the allograft (tissue transplanted from one person to another). This graft, precisely shaped to fit the joint, is then sutured securely into place, ensuring it aligns perfectly with the knee's anatomy.

3. Securing the Transplant: The new meniscal tissue is anchored into the shinbone to stabilize the transplant. Additional stitches or screws may be used to attach the meniscus firmly to the shinbone and the knee joint capsule.

4. Final Steps: Once the meniscal transplant is securely in place, the surgeon removes the instruments, closes the incisions, and applies a bandage.

Meniscal transplant surgery is normally safe and effective. Still, it's important to be aware of potential risks and complications. Understanding these risks will aid in making informed decisions and preparing for a smooth recovery process.

• Joint Stiffness: After the procedure, some patients may experience stiffness in the knee joint. This is one of the more common side effects, but it is remedied with time and physical therapy.

• Incomplete Healing: In some cases, the graft may not heal completely, potentially requiring an additional procedure.

• Excess Bleeding: There's a risk of excessive bleeding during or after the procedure.

• Infection: Although rare, infection at the incision site is possible. In extremely rare instances, infections can also originate from the donated tissue.

• Nerve Damage: The procedure carries a minor risk of damage to nearby nerves during the procedure.

• Anesthesia Complications: Some patients may experience anesthesia-related complications, like allergic reactions or breathing problems.

• Personal Health Factors: Individual risks can vary based on factors like age, existing medical conditions, and the specific anatomy of your knee. It's crucial to discuss these personalized risks with your surgeon.

Patients should consult with their physician to understand the recovery guidelines that are specific to them. Generally, after the procedure, meniscal transplant recovery will involve the patient wearing a knee brace and using crutches for about the first 1-5 weeks.

Physical therapy (PT) will begin early in the healing process, as stiffness can easily set in if the joint is left immobilized for too long. Patients will receive a customized PT program to help restore the range of motion and strength to the knee. Most patients will be able to resume work (depending on the nature of their work) and other normal activities within six months to one year.

At Resurgens Orthopaedics, we take pride in providing the highest quality care and treatments for patients who need meniscal transplants and various other orthopedic procedures. Schedule an appointment to discuss your treatment options with one of our expert physicians.