Risks and Rehab Post Meniscus Transplant Surgery

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Meniscus transplant surgery is a treatment option for people who have sustained very large meniscal tears that have required surgical removal. The goal of meniscus surgery is to leave behind as much normal meniscus tissue as possible, but in some situations, most or all of the meniscus is removed at the time of surgery. Removal of the meniscus can decrease the stability of the knee joint and also make people more prone to developing arthritis of the knee.

For this reason, some doctors may recommend a meniscus transplant surgery to replace the removed meniscus with a donor meniscus.

Performing Transplant Surgery

Meniscus transplant surgery is performed by obtaining a meniscus from a cadaver donor. The meniscus tissue has been sterilized and preserved. There are different methods of preservation and sterilization of grafts, with advantages and disadvantages of each. Most meniscus transplant grafts are frozen to a temperature that kills all living cells in the graft but does not significantly alter the mechanical properties of the tissue.

Once the graft is obtained and matched to the size and shape of the recipient patient's knee, the new meniscus is surgically implanted. Most surgeons transplant some bone along with the meniscus tissue to help create a stronger attachment. In addition, the main portion of the meniscus is sutured to the surrounding capsule inside the knee joint.

The healing of the bone and the meniscal tissue are both critical to ​the success of the transplant surgery.

Rehab After Surgery

Post-surgical rehabilitation protocols vary depending on the exact procedure and your surgeon's preference. Most surgeons have patients protect the knee with crutches and limit ​mobility of the knee joint with a brace until healing of the meniscus has occurred.

Healing of a transplanted meniscus has been shown to occur after 8-12 weeks. Patients will not be able to squat, run, or perform athletic activities for at least several months. Most patients who have a successful outcome return to their usual activities about 8-12 months after surgery.

Risks of Meniscus Transplant

The risks of every surgery must be carefully considered, but there are some unique risks to meniscal transplant that patients should be aware of.

  • Long-term results are lacking
    Long-term results simply are not available because meniscus transplantation is a relatively new procedure. There are some mid-term (3-6 year) studies which show encouraging results, but no one knows for sure how well the knee will be working in 10 or 20 years.
  • More surgery may be coming
    Studies have shown a significant number of these patients do require further surgery, about 30 percent. If you are looking for one-stop shopping, a procedure that you can confidently call your last, a meniscus transplant is not for you.
  • The transplant can fail
    Not all transplants have healed into position, and some need to be removed because they end up causing more problems than they solved. Even if you undergo proper rehabilitation and therapy, there is a chance that your new meniscus will not heal into your knee.
  • Disease transmission
    There is a very small, but a real risk of disease transmission when using another person's tissue in your body. These tissues are preserved and cleaned to destroy bacteria and viruses, but there are no guarantees. There is a theoretical risk of HIV, hepatitis, bacterial, or other infectious disease transmission with these grafts. Again, the risk is very small, but not zero.

Meniscus transplant surgery is seldom performed for a number of reasons. Only a few people meet the limited criteria for having this surgical procedure, and many of these individuals choose not to have surgery because of the lengthy rehabilitation and the risks of having surgery. That said, it can be a helpful surgical option for people who have their meniscus removed and are concerned about risks of developing arthritis of the knee joint.

Sources:

Sekiya JK, Ellingson CI. "Meniscal allograft transplantation"J Am Acad Orthop Surg. 2006 Mar;14(3):164-74.

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