Meniscus transplant is a complex procedure that requires precise diagnosis, obtaining the right donor tissue, a difficult surgery, and specialized rehabilitation. Dr. Amit Meena is among the few specialists in the Middle East who perform this procedure.
In the past, when a meniscus was too severely damaged to repair, it was often completely removed without any replacement. However, we now have a better understanding. Using donor tissue to replace a damaged meniscus can help reduce or delay the need for a knee replacement and may even help prevent the onset of osteoarthritis. Research over the long term shows that a meniscus transplant can relieve pain, enhance joint function, and assist individuals in returning to sports activities, even if they already have arthritis.
What is the meniscus & its importance?
The knee has two wedge-shaped cartilage pieces, with one located on each side. Each of these is referred to as a "meniscus." These cartilage structures are flexible and serve as shock absorbers between the thighbone, called the femur, and the shinbone, known as the tibia. In addition, there is another type of cartilage that covers the ends of both the tibia and femur, enabling the bones to glide over each other smoothly. The menisci also play a role in protecting the ends of the femur and tibia as they move against each other.
Sometimes, a twisting injury can lead to significant damage to the meniscus. In cases where the injury is severe, the surgeon may need to remove part or all of the meniscus. The meniscus acts as a cushion that helps reduce the impact between the bones in the knee. If the meniscus is damaged or removed, the ends of the tibia and femur may come into abnormal contact with each other. Over time, this can result in ongoing knee pain. As the protective cartilage covering the bones deteriorates, the bones underneath start to rub against each other.
Meniscal transplant surgery provides another treatment option for you. The surgeon starts the procedure by making a small incision in your knee. They use special tools along with a camera to reach the area between your thigh bone and shin bone. Once there, the surgeon carefully places the donated meniscus into the joint space and secures it with surgical stitches.
Who gets a meniscus replacement?
Meniscus replacement isn’t suitable for everyone. To see if this procedure is right for you, your doctor will look at several factors, including:
- Age, activity level and overall health: Surgeons typically perform this procedure on individuals who are physically active and are under the age of 40 or 50, provided they do not have knee arthritis. Teenagers may be considered for the surgery, but medical professionals often advise waiting until their bones have fully developed. The procedure tends to be more effective in people who remain physically active and maintain a healthy weight.
- Anatomy of the knee: To qualify for a meniscus transplant, you need to have missing part of the meniscus or a serious tear in it. However, the rest of your knee should not be damaged. Your healthcare provider will assess your knee to ensure the ligaments, which are the soft tissues connecting bones, are properly aligned and stable.
- Arthritis: If you have arthritis, you might not be eligible for a meniscus transplant. If the cartilage in your knee has deteriorated significantly, the procedure could fail to work properly.
Knee injuries are frequently seen in teenagers, particularly during sports activities. A common type of injury involves the meniscus, which can tear when the knee is twisted abruptly. In cases where the injury is significant, medical professionals might suggest removing the damaged portion of the meniscus and using a healthy part from the same or another area to replace it.
What are the advantages of meniscus replacement?
Because a meniscus transplant is a minimally invasive procedure, it generally needs less time to recover than traditional open surgery. This procedure can help younger and more active people return to their regular activities without pain. It also helps prevent the onset of osteoarthritis that might develop as a result of a damaged meniscus.
What does a meniscus replacement treat?
Your healthcare provider might suggest this procedure if your meniscus is significantly damaged or if you previously had a meniscus removed through a procedure called meniscectomy following an earlier injury. In some cases, a meniscus may be removed if the damage is too extensive to fix. Not having a meniscus can lead to a higher chance of developing osteoarthritis and long-term knee pain.
A torn or damaged meniscus may also contribute to the development of osteoarthritis. This condition occurs when the other cartilage in the knee starts to break down, leading to pain and difficulty moving the joint. A meniscal transplant may help prevent or slow the progression of osteoarthritis. However, this surgery is not effective for individuals who already experience knee pain due to arthritis.
What are the risks of meniscal transplant surgery?
Most people have meniscal transplant surgery without any problems. Rarely, complications happen, like:
- Stiffness of the joint after surgery (more common)
- Incomplete healing. This might need another surgery.
- Excess bleeding
- Infection
- Damage to nearby nerves
- Complications from anesthesia
- Getting an infection from the donated tissue (extremely rare)
Your own risks may vary according to your age, your other medical conditions, and the specific anatomy of your knee. Talk with your surgeon about your concerns. Make sure you include the risks that most apply to you.
How do I get ready for a meniscal transplant surgery?
alk with your healthcare provider about how to prepare for your meniscal transplant surgery. Ask whether you should stop taking any medicines ahead of time, like blood thinners. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines like aspirin. You’ll need to avoid food and drink after the midnight before your procedure.
Before your procedure, you may need additional imaging tests, like X-rays and magnetic resonance imaging (MRI).
You may need to rearrange your living arrangements as you recover because you’ll need to use crutches for several weeks.
You may be able to go home on the day of your surgery. It’s also possible you’ll need to stay in the hospital for a day or two. Talk with your healthcare provider ahead of time so that you can make the necessary arrangements for your recovery period.
Before your surgery, a healthcare provider will carefully screen the donated meniscus for any signs of infection.
What happens during meniscal transplant surgery?
Your healthcare provider will explain the details of your particular surgery. An orthopedic surgeon will perform the surgery. The whole operation may take a couple of hours. In general, you can expect the following:
- A healthcare provider (anesthesiologist) will give you medicine so that you’ll sleep through the operation and won’t feel any pain or discomfort during the surgery. (You may receive spinal anesthesia and a medicine to help you relax.)
- Your vital signs, like your heart rate and blood pressure, will be monitored during the operation. You may have a breathing tube inserted down your throat during the operation to help you breathe.
- After cleaning the affected area, your surgeon will make a small incision through the skin and muscle of your knee.
- Your healthcare provider will insert a very small camera through this incision, using this camera to guide the surgery.
- Using very small instruments inserted through the incision, your surgeon will remove any remaining meniscus.
- Next, he or she will surgically sew the donated meniscus into the joint space. The healthcare provider might use screws or other devices to hold the meniscus in place.
- Your surgeon will make other repairs, if necessary.
- The surgeon will close the layers of skin and muscle around your knee.
When can I go back to my usual activities after a meniscus replacement?
Most people need to rest and stay off their feet as much as possible for about two weeks after meniscus transplant surgery. To give your new meniscus time to heal properly, you may need to take a break from sports or strenuous activities for six to 12 months.
