Treatment - How can I help

Meniscal Replacement / Transplant

Other popular names

Who does it affect? 

Young people, with early onset arthritis.

Why does it happen?

Patients who lose mensicus volume at a young age will inevitably develop wear and tear osteoarthritis and if they have persistent symptoms meniscal replacement techniques offer a way of reducing and delaying this risk.

A small percentage of patients who lose all or part of their meniscus will be suitable for a meniscal replacement technique. 

Patients who lose only part of their meniscus might be suitable for implantation of an artificial device or collagen meniscal implant.

Patients who lose all of a meniscus are not suitable for this device might be suitable for a mensical transplant.

Both these procedures are safe and well established with evidence they improve symptoms in suitable patients. 

However these operations involve lengthy rehabilitation period and whilst there is good evidence that they improve symptoms, they might not abolish them completely and are unlikely to enable patients to return to high impact sports.

Symptoms

Pain, often localised and the possibility of clicking and locking.  Inflammation and swelling are likely in the impacted area.

Diagnosis

Detailed diagnosis is only possible with an MRI or CT examination.

Non-surgical treatment

As Meniscal damage is not self-healing, there are no non-surgical treatments that will give any lasting benefits.

Surgical treatment

Meniscal Implant

This procedure involves implantation of a collagen mensical implant to replace the portion of meniscus that he been lost. 

The implant is inserted arthroscopically, usually a day case procedure

Meniscal Transplant

Meniscal Transplantation is an operation that involves implanting a donor graft (allograft) supplied from a tissue bank. The new meniscus is implanted by arthroscopic surgery (although often several more incisions are required) and sutured to the site of the original meniscus.

The implanted mensicus has to be of the correct size and often there can be difficulty and therefore some delay in finding a donor meniscus of the correct size.  The grafts are donated like other organ transplants and are then prepared and frozen until required for a suitable patient.

The grafts are carefully selected and prepared under a closely regulated system by the tissue banks to ensure that the tissue is as free of disease risk as is possible.  With this the risk of any disease transmission is extremely low but difficult to quantify.

Post-surgery rehabilitation

Implant

Rehabilitation after surgery is more prolonged than for a standard meniscal repair as there is a need to protect the implant until tissue grows and replaces the implant.   As the body has to grow this is a slow process. Patients tend to need to use crutches for a minimum of 6 weeks and need to use a brace in the first 6 weeks following surgery.  A specific rehabilitation programme is tailored to each patient depending on their individual circumstances.

Transplant

The rehabilitation period is relatively long with patients having to use crutches and a brace for a minimum of 6 weeks and it is often a year until a patient gains maximal function.  As expected, whilst it is a very safe operation the level of risk is higher than that of a straightforward meniscal repair or implantation procedure.

Therefore Meniscal transplant is only used when patients have a significant level of pain from loss of the entire meniscus and there is a need for it to be performed before advanced degenerative changes develop. 

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. 

The post-operative rehabilitation is slower than after a standard knee arthroscopic meniscal repair as the meniscal implant or transplant needs to be protected from excessive forces whilst it is healing. 

My patients are guided, with the help of a physiotherapist, through a rehabilitation program that I tailor to you and depend on the size and nature of your tear.

Most patients will need to use crutches for a period of 6 weeks.  You will also need to use a knee brace for the first few weeks and restrict the range of movement for up to 6 weeks following surgery.

Patients should not squat for 3 months and generally it is 3 months before they can return to sports.

Dressings

The large bandage around the knee is normally removed 24-48 hours after surgery and a tubigrip to supply gentle compression to reduce post-operative swelling.

The non-stick sterile dressings on the wounds are replaced with clean waterproof dressings .

Return to normal routine

Bathing and showering

The wounds should be kept clean and dry until the wound has sealed. Showering is fine and the waterproof dressings can be changed afterwards. Bathing is best avoided until the wounds are sealed, typically 10 days after surgery.
In summary, whilst the wounds are wet - keep them dry and when the wounds are dry, you can get them wet!

Rehabilitation

Surgery is followed by a prolonged course of physiotherapy. This requires a commitment to undertake this rehabilitation in order to achieve the best possible result (at least half an hour per day for 6 months).  It is vitally important to stay within the post-operative activity restrictions an physiotherapy guidelines to avoid damaging stretching your reconstructed ligament.

Return to work

The timing of your return to work depends on the type of work and your access, however, the following is a general guide:

Driving

When you can walk without crutches or a limp and be in control of your vehicle (about 4-6 weeks).

Risks

Due to the nature of the procedure, the rehabilitation and the risks involved it should not be performed simply because the meniscus has to be removed as the majority of patients who lose a meniscus will have many year of symptoms free activity.  It is difficult to get evidence to show that it might slow the development of degenerative changes and it is an operation that is aimed at reducing symptoms with hopefully the added benefit that it might slow the rate of development of degenerative changes.

Whilst there is good evidence that transplantation reduces symptoms it is unlikely to result in a normal knee capable of returning to high levels of impact sports and whilst the procedure is safe, as with any surgery, there are always a number of risks that need to be considered.

These risks include:

All these risks are uncommon and in total, the chance of you or your knee being worse off in the long term is about or less than 1%.

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