When Is a Meniscus Transplant an Option?

Whether or not meniscus replacement is a good option for you

knee meniscus anatomy
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If you have a specific type of knee pain and meet the right criteria, a meniscus transplant may be an option for you. Meniscus transplantation involves placing cartilage from a cadaver donor into a patient.

Why Meniscus Removal Is a Last Resort

The meniscus is a complex structure that provides both cushioning and stability to the knee. Without the meniscus present, you're much more likely to develop accelerated degenerative changes to the knee joint.

As this happens, the remaining cartilage that covers the ends of the bone, called the articular cartilage, is worn away, and bone is exposed. 

For this reason, orthopedic surgeons attempt to preserve the meniscus when surgically treating a torn meniscus. During surgery, only the damaged portion of the meniscus is removed, or your surgeon will perform a meniscal repair if possible. Unfortunately, despite advances in arthroscopy, not all meniscus tears are able to be repaired. In some cases, in order to best treat the damaged meniscus, the entire meniscus must be removed.

Potential Problems After Meniscus Removal

When the meniscus is removed, you're left without much of the joint cushion. Initially, this tends not to be a problem. But over time, pain often develops where the meniscus was removed, and you can go on to develop accelerated arthritis in that part of the knee joint.

The goal of a meniscus transplant is to restore the normal joint support and cushioning of the meniscus so that the pain will be alleviated.

However, although it does help alleviate pain, studies show that meniscus transplants don't slow down or prevent osteoarthritis in the knee and more surgeries and/or a knee prosthesis will likely eventually be needed.

When Transplant Is An Option

The ideal candidate for a meniscus transplant is someone who already had his or her meniscus removed but subsequently begins to develop knee pain; is too young and too active to be considered for a joint replacement, yet all the other usual treatments such as anti-inflammatory medicationsphysical therapy, Synvisc, cortisone, and joint supplements, just aren't doing the trick to handle the pain.

You're a good candidate for a meniscus transplant if the following apply to you:

  • You're under the age of 55
  • You have undergone a prior meniscectomy (removal of meniscus) and have no or less than half of your meniscus left
  • You have normal or limited damage to the articular cartilage (bone lining) of the joint
  • You have pain or instability in your knee
  • Your symptoms are consistent with the absence of a meniscus
  • You're prepared for a hard recovery

When Transplant Is Not an Option

Many patients have undergone a prior meniscectomy (meniscus removal surgery) and many of these patients have persistent problems related to the removal of the meniscus. Most people who become symptomatic because of the absence of a meniscus have already developed damage to the cartilage that remains in the knee. Patients who have this accelerated degenerative change in their knee joint are not good candidates for meniscus transplant surgery. Other reasons why a meniscus transplant won't work for you include:

  • You still have a significant portion of the meniscus remaining (this procedure is only for patients who had the bulk of the meniscus removed)
  • You have degenerative changes within the joint (early arthritis)
  • You have instability or malalignment of the knee joint
  • You're obese
  • You're unwilling to perform the lengthy rehabilitation from meniscus transplant surgery
  • You have unrealistic expectations

Unrealistic Expectations of a Meniscus Transplant

Further explaining this last point: Some patients are looking for solutions that surgeons cannot necessarily offer. The goal of a meniscus transplant surgery is to reduce pain associated with normal activities. The goal is not to give you a "normal" knee, but rather to make it better. It's possible that you may not be able to resume competitive athletics despite a successful meniscus transplant. If you're expecting more than the reduction of pain, you may want to consider other options as you may be disappointed in the results of a meniscus transplant.

Sources:

Medline Plus. Meniscal Allograft Transplantation. U.S. National Library of Medicine. Updated April 18, 2017.

Meniscal Transplant Surgery. Johns Hopkins Medicine.

Van Der Straeten C, Byttebier P, Eeckhoudt A, Victor J. Meniscal Allograft Transplantation Does Not Prevent or Delay Progression of Knee Osteoarthritis. Zhao C, ed. PLoS ONE. 2016;11(5):e0156183. doi:10.1371/journal.pone.0156183.

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