Meniscus transplantation replaces a damaged or non-functioning meniscus with a donor meniscus, called an allograft. The meniscus is an important structure that helps distribute forces evenly across the knee joint.
Loss of a functioning meniscus increases loading on the cartilage and can lead to early development of knee arthritis. The goal of meniscus transplant surgery is to reduce pain by replacing the damaged meniscus with a new functioning meniscus.
What Is Meniscus Transplantation?
Meniscus transplant surgery replaces a damaged or missing meniscus with an allograft meniscus from a deceased donor.
Because there is not a good artificial replacement for meniscal tissue, the donor meniscus must be similar in size and shape to the patient’s native meniscus. Finding an appropriate match can take time and may make scheduling the surgery more difficult.
Removing the remaining non-functioning meniscus and replacing it with a functioning meniscus can help prevent progression of arthritis and deterioration of the knee joint.
In some patients, an osteotomy, which realigns the bones of the knee to improve weight distribution across the joint, may also be recommended.
Who Is a Candidate?
Meniscus transplantation may be indicated for patients who have lost meniscus tissue because of previous injuries or meniscectomies and have severe pain and symptoms related to the loss of the meniscus.
Contraindications include:
- Infection of the knee
- Minimal loss of meniscus
- Elderly patients
- Pain or symptoms not related to the meniscus
- Diffuse and advanced knee arthritis
- Inability to be flexible with the timing of surgery
- Inability or unwillingness to complete the appropriate postoperative rehabilitation program
How the Procedure Is Performed
Dr. Chudik performs meniscus transplant surgery with the assistance of an arthroscope, a small camera inserted through small incisions that allows him to view the inside of the knee. A few larger incisions are also used to place the new meniscus.
Small shavers and cutting instruments are used to remove the remaining portion of the meniscus that is no longer functioning.
The allograft meniscus is then prepared and implanted in the knee where the previous meniscus was located. Sutures are used to secure the transplanted meniscus in place.
The surgery is performed as an outpatient procedure under general anesthesia with a femoral nerve block.
Recovery and Rehabilitation
Following meniscus transplant surgery:
- The wound should be kept clean and dry for 14 days
- Showering is allowed after 14 days, but the wounds should not be submerged in water for three weeks
- A hinged knee brace is worn for six weeks
- Crutches are used for six weeks, with gradual progression to full weight bearing after four weeks
- Physical therapy should begin two to three days after surgery and continue for approximately six months
The success of meniscal surgery depends on postoperative rehabilitation, making it important to follow and maintain the prescribed therapy program.
Return to running may occur at approximately four months. Full return to sports may occur at approximately six months when there is no pain and full knee range of motion, muscle strength, and endurance have been restored.
Risks and Outcomes
Potential surgical risks and complications include:
- Surgical infection
- Transmission of disease from the allograft
- Incomplete healing or failure of the transplanted meniscus
- Re-tearing of the new meniscus
- Knee stiffness or loss of knee motion
- Continued pain and progressive arthritis
- Weakness of the quadriceps muscles if proper rehabilitation is not completed
- Unexpected areas of significant arthritis that may be responsible for symptoms and be less treatable
The goal of meniscus transplantation is to reduce pain by replacing the damaged, non-functioning meniscus with a functioning allograft and to help prevent progression of arthritis and deterioration of the knee joint.
Why Dr. Chudik for Meniscus Transplantation
Dr. Chudik performs meniscus transplant surgery arthroscopically with additional limited incisions to remove the remaining non-functioning meniscus and implant a properly sized donor meniscus.
He also evaluates whether additional treatment, such as an osteotomy to improve weight distribution across the knee joint, may be appropriate for certain patients.
Because the donor meniscus must closely match the size and shape of the patient’s native meniscus, Dr. Chudik’s surgical planning includes identifying an appropriate allograft before the transplant is performed.