Meniscus Transplantation

Meniscus transplantation is typically considered when an individual experiences persistent knee pain and functional limitations due to meniscal deficiency. The following are common indications for this procedure:

• Previous Meniscectomy: Individuals who have previously undergone partial or total meniscectomy (removal of a portion or the entire meniscus) are at an increased risk of developing knee osteoarthritis. Following meniscectomy, if patients develop symptoms along the joint line and/or swelling, meniscus transplantation can help restore the missing cushioning, improve symptoms and reduce the progression of joint degeneration.
• Active Patients without osteoarthritis: Meniscus transplantation is often considered for physically active patients who wish to maintain their active lifestyles and do not have evidence of joint osteoarthritis. Preserving knee joint health is crucial for these individuals, and meniscus transplantation can be a viable option.
• Pain and Dysfunction: Patients experiencing persistent knee pain, swelling, and functional limitations despite conservative treatments like physical therapy and anti-inflammatory medications may be candidates for meniscus transplantation. Often, patients with a deficient meniscus can have co-existing cartilage, ligament or alignment issues that also need to be addressed at the same time.
• Revision ACL Reconstruction: When a patient is undergoing revision ACL reconstruction and there is a deficient meniscus, concomitant meniscus transplantation can be considered in some cases.

Meniscus transplantation is not an option to improve pain and eliminate functional limitations in older patients and for patients with osteoarthritis of the knee joint. These patients would benefit from a total or partial knee joint replacement.  Currently, meniscus transplantation is also not performed as a prophylactic procedure.  That is, it is generally recommended when a patient has had a prior meniscectomy and has developed symptoms down the road.

It is a surgical procedure to replace a patient’s irreparably damaged or missing meniscus with a meniscus from a human cadaver donor. The tissue is called an allograft. Healthy cartilage tissue is obtained from a donor and frozen. It is sized, tested for disease, and stored. The size of the donor meniscus is a critical consideration. An accurately sized donor meniscus helps in achieving a proper fit within the recipient’s knee joint.

The procedure can be performed as open surgery or arthroscopic surgery.

• Patient evaluation: Before surgery, a thorough evaluation of the patient’s knee is conducted, including imaging studies such as MRI to assess the extent of meniscus damage and the overall condition of the joint.
• Donor Meniscus Selection: A suitable donor meniscus is carefully chosen based on size and compatibility with the recipient’s knee.
• Recipient Preparation: The recipient’s knee is prepared for the transplant, which may involve removing any remaining damaged meniscus tissue and preparing the bones.
• Transplantation: The donor meniscus is secured in place within the recipient’s knee using sutures or fixation devices. The goal is to recreate the natural anatomy of the meniscus.
• Rehabilitation: Following surgery, you will wear a knee brace and use crutches for the first 6 weeks to give the transplant time to heal to the capsule. When pain and swelling reside, physical therapy will begin and is focused on reducing pain, reactivating muscles, and range of motion.

Following meniscus transplantation, return to daily activities can occur within 3-4 months. Time is the most important determining factor in returning athletes to sports and it varies between 3-6 months for low-impact sports and 6-12months for high-impact sports with a mean time of 9 months. Transplants can last up to 15 years.

Meniscal transplantation helps to restore the native biomechanics of the knee, which can provide protection against knee osteoarthritis and restore knee stability. It also offers improvements in pain, function, and activity level. It may also prevent or delay the need for more invasive knee replacement surgery in young and active patients.