Meniscal allograft transplantation

Definition

Meniscal allograft transplantation is surgery in which a meniscus ­­ a cartilage ring in the knee ­­ is placed into your knee. The new meniscus is taken from a person who has died (cadaver) and donated his or her tissue.

Description

If your doctor finds that you are a good candidate for a meniscus transplant, x­rays of your knee are usually taken to find a meniscus that will fit your knee. The donated meniscus is tested in the lab for any diseases and infection. Other surgeries, such as ligament or cartilage repairs, may be done at the time of the meniscus transplant or with a separate surgery. You will likely receive general anaesthesia before this surgery. This means you will be asleep and unable to feel pain. Or, you may have regional anaesthesia. Your leg and knee area will be numbed so that you do not feel any pain. If you receive regional anaesthesia, you will also be given medicine to make you very sleepy during the operation.

During the surgery:
  • The meniscus transplant is usually performed using knee arthroscopy. The arthroscope is inserted into your knee through a small incision. The scope is connected to a video monitor in the operating room.
  • The surgeon inspects the cartilage and ligaments of your knee, confirming that a meniscus transplant is appropriate and that you don't have severe arthritis of the knee.
  • The new meniscus is prepared to fit your knee correctly.
  • An incision is made in the front of your knee to insert the new meniscus
  • The new meniscus is sutured (sewn) in place. Another incision may be needed to sew the meniscus in place. Screws or other devices may be used to hold the meniscus in place.

After the surgery is finished, the incisions are closed. A dressing is placed over the wound. During arthroscopy, most surgeons take pictures of the procedure from the video monitor to show you what was found and what was done.

Why the Procedure Is Performed

Two cartilage rings are in the center of each knee. One is on the inside (medial meniscus) and one is on the outside (lateral meniscus). When a meniscus is torn, it is commonly removed by knee arthroscopy. Some people can still have pain after the meniscus is removed. A meniscus transplant places a new meniscus in the knee where the meniscus is missing. This procedure is only done when meniscus tears are so severe that all or nearly all of the meniscus cartilage is torn or has to be removed. The new meniscus can help with knee pain and possibly prevent future arthritis. Meniscus allograft transplantation may be recommended for knee problems such as:
  • Inability to play sports or other activities
  • Knee pain
  • Knee that gives way
  • Unstable knee
  • Persistent knee swelling


Risk

Risks of anesthesia and surgery in general are:
  • Allergic reactions to medicines
  • Breathing problems
  • Bleeding, Blood Clots, Infection

Risks for meniscal transplant surgery are:
  • Nerve damage
  • Stiffness of the knee
  • Failure of the surgery to relieve symptoms
  • Failure of the meniscus to heal
  • Tear of the new meniscus
  • Disease from the transplanted meniscus
  • Pain in the knee
  • Weakness of the knee

Before the Procedure

Always tell your health care provider which drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
  • Prepare your home.
  • Ask your provider which medicines you can still take on the day of your surgery.
  • You may be asked to stop taking medicine that makes it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), blood thinners such as warfarin (Coumadin), and other drugs.
  • You may need to stop taking any medicines that weaken your immune system, including Enbrel and methotrexate.
  • If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see the provider who treats you for these conditions.
  • Tell your provider if you have been drinking a lot of alcohol (more than one or two drinks a day).
  • If you smoke, you need to stop. Ask your health care providers for help. Smoking slows healing and recovery.
  • Let your provider know if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.

On the day of your surgery:
  • You may be told not to drink or eat anything for 6 to 12 hours before the procedure.
  • Take the medicines your provider told you to take with a sip of water.
  • Your provider will tell you when to arrive at the hospital.


After the procedure

Follow any discharge and selfcare instructions you are given. After the surgery, you will probably wear a knee brace for the first 6 weeks. You will need crutches for 6 weeks to prevent putting full weight on your knee. You will likely be able to move the knee right after surgery. Doing so helps prevent stiffness. Pain is usually managed with medicines. Physical therapy can help you regain the motion and strength of your knee. Therapy lasts for between 4 and 6 months. How soon you can return to work depends on your job. It can take from a few weeks to a few months. It can take 6 months to a year to fully return to activities and sports.

Outlook (Prognosis)

Meniscus allograft transplantation is a difficult surgery, and the recovery is hard. But for persons who are missing the meniscus and have pain, it can be very successful. Most people have less knee pain after this procedure.