Meniscus transplantation replaces a missing meniscus with a cadaveric (allograft) meniscus, restoring the load-distribution function of the joint. The procedure is reserved for younger patients with significant meniscus deficiency who have not yet developed advanced arthritis. Meniscus transplantation is one of the most demanding cartilage-preservation procedures in the knee and requires careful patient selection for predictable outcomes.
What Is Meniscus Transplantation?
When most or all of a meniscus has been previously removed (typically from prior partial or total meniscectomy years earlier), the loss of load distribution accelerates cartilage wear in the affected compartment. Patients who underwent meniscectomy in their 20s or 30s often present 10 to 20 years later with painful early arthritis localized to the meniscectomy compartment.
Meniscus transplantation uses a size-matched cadaveric meniscus to replace the missing tissue. The graft is anchored to the tibial plateau using bone bridges or bone plugs at the meniscal roots, preserving the meniscus’s ability to translate hoop stresses into compression rather than shear forces on the cartilage.
The procedure does not reverse existing cartilage damage; it slows the progression and relieves symptoms in the meniscectomized compartment.
Who Is a Candidate?
Candidates for meniscus transplantation typically have:
- Prior meniscectomy with persistent compartment-specific pain
- Younger patients (typically under 50) with at least minor cartilage damage but not yet advanced arthritis
- Failure of non-surgical treatment
- Adequate alignment (or willingness to undergo concomitant osteotomy if alignment is malaligned)
- Stable knee with intact ligaments (or planned simultaneous ligament reconstruction)
Patients with advanced bone-on-bone arthritis are typically not candidates because the cartilage damage is too significant for meniscus replacement to provide meaningful benefit.
How the Procedure Is Performed
The procedure is performed arthroscopically with limited open exposure. The remaining meniscus tissue is carefully prepared, leaving the peripheral rim where stable. A size-matched cadaveric meniscus with attached bone is implanted using either bone bridge or bone plug fixation at the meniscal roots.
The periphery of the graft is sutured to the surrounding capsule and remaining native rim using meniscus repair sutures. The graft is brought into anatomic position and tensioned to restore the hoop architecture of the original meniscus.
Associated procedures (cartilage repair, alignment-correcting osteotomy, ligament reconstruction) are commonly performed at the same operation when indicated.
Recovery and Rehabilitation
Recovery is one of the longest in arthroscopic knee surgery:
- Brace and protected weight-bearing for six to eight weeks
- Limited range of motion during the healing phase
- Progressive weight-bearing and strengthening over three months
- Return to low-impact activity at six months
- Return to sport at nine to 12 months
Risks and Outcomes
Risks include graft failure, persistent pain, infection, and progression of cartilage damage despite transplantation. Outcomes in appropriately selected younger patients are good, with meaningful symptomatic improvement and slowed cartilage wear in the affected compartment.
Meniscus transplantation does not restore a normal knee; it provides a functional improvement that delays the eventual need for joint replacement in younger patients.
Why Dr. Chudik for Meniscus Transplantation
Dr. Chudik treats the full spectrum of meniscus pathology, from primary repair to transplantation in patients with prior meniscectomy. His high case volume in complex knee surgery and joint preservation includes the combined cartilage and meniscus procedures often needed in this patient population. Patient selection and concomitant procedure planning drive long-term outcomes.