Meniscal Replacement / Transplant
Other popular names
- Meniscal Transplant
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.
Pain, often localised and the possibility of clicking and locking. Inflammation and swelling are likely in the impacted area.
Detailed diagnosis is only possible with an MRI or CT examination.
As Meniscal damage is not self-healing, there are no non-surgical treatments that will give any lasting benefits.
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 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.
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.
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.
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!
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:
- Desk work: as soon as pain allows and you can travel easily to and from work (2 weeks)
- Light duties: if the job allows partial use of crutches or limited walking (2-5 weeks). If the job involves standing for prolonged walking, bending, lifting, stairs but no squatting (7-8 weeks)
- Heavy duties: full squatting, heavy lifting, digging, in and out of heavy machinery, ladder work etc (3-4 months)
When you can walk without crutches or a limp and be in control of your vehicle (about 4-6 weeks).
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:
- Infection, which can occur with any operation. Special precautions are taken during surgery to diminish this risk, however, the risk still exists but there is <1% chance of developing a serious infection (major wound breakdown, septic arthritis or osteomyelitis).
- Injury to blood vessels or nerves. Major injuries to these structures are extremely rare, although it is not uncommon to develop some reduced sensation around the shin wound, this rarely causes a problem
- Deep vein thrombosis / pulmonary embolus (DVT/PE) (blood clots) can also occur as with all operations (<0.2% of a serious clot). This does pose a definite but miniscule risk to life (<1:10000).
- Stiffness of the knee joint after surgery can result from a number of causes. Fortunately these are rare. Some individuals are predisposed to form excessive and thick scar tissue. This is treated by surgical excision of the scar tissue (0.5%)
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%.