Meniscal allograft Transplantation
Meniscal allograft surgery is a procedure in which a meniscus, a c-shaped piece of cartilage in your knee, is placed in your knee. The tissue of the deceased person is used to create the new meniscus.
What is Meniscus Transplantation?
A surgeon inserts a new meniscus, taken from a cadaver, into the knee joint of a patient during a meniscus transplantation. Technically, this procedure is called a meniscal allograft transplantation. Allograft simply refers to “the transplantation (or transfer) of tissue from one person (a donor).
A torn meniscus can heal on its own sometimes, but in many cases, surgery is necessary. A partial meniscectomy is an operation that removes the damaged meniscus tissue. This can often be a successful treatment for meniscus injuries. A surgeon may perform a meniscal fix, which involves stitching the meniscus together, in some cases. These procedures preserve as much of the healthy meniscus tissue and its shock-absorbing ability as possible.
However, in some cases the meniscus may need to be completely removed due to severe tearing of the meniscus cartilage. This is called a total meniscectomy. The articular cartilage, which allows the bones of the knee joint to glide easily against each other, becomes thin without this shock-absorbing component. This increases your chances of developing arthritis, which is a painful form or arthritis that can require knee replacement surgery. The meniscal allograft transplantation is a way to preserve knee function and decrease the likelihood of osteoarthritis.
Important to know that meniscus transplants do not cause transplant rejection. This is when the patient’s immune systems reject transplanted tissue. Patients who have meniscus transplantation do not need anti-rejection medication to suppress their immune system.
Who is a good candidate to receive a Meniscus Transplant?
The following criteria are generally the criteria for the best meniscus transplant candidates:
- Age 40 or younger
- You must be fit and motivated to complete a rigorous rehabilitation program lasting between 8-10 months
- Meniscectomy with partial (subtotal), or complete meniscectomy, in which some or all of the meniscus was removed
- Continual knee pain that restricts physical activity
- If there is any articular cartilage loss in the knee joint (if it is present, the articular cartilage can be repaired during the meniscal transfer procedure).
- Normal or corrected (by osteotomy, which is a surgical procedure that straightens your leg) limb alignment
- Body Mass Index (BMI), below 30
Patients who meet these criteria are not candidates for meniscal allograft surgery.
- Age over 40
- BMI 30 and higher
- Osteoarthritis and inflammatory arthritis of the affected knee joint
- Poor alignment of the limbs that can’t be corrected
- Instability of the knee can be caused by an untreated ligament injury.
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What are the steps involved?
If a patient has been deemed a suitable candidate for meniscal allograft, the doctor will order tests such as Xrays and magnetic resonance imaging studies (MRI) to determine the size the patient’s meniscus. It is important that the donor meniscus size matches the patient’s.
The knee arthroscopy is a minimally invasive surgery that allows for quicker physical therapy and minimizes scarring. A surgeon will make small incisions at the knee of the patient during an arthroscopy. The surgeon then inserts a thin tube with a camera and other surgical tools into the incisions. The surgeon can see inside the knee by connecting the camera to the monitor in the operating area. This procedure will also require a larger incision to attach the sutures that are passed through both the joint capsule and donor meniscus.
The first part of the procedure usually involves removing any debris from the joint. The surgeon will then implant the donor meniscus.
The surgeon might need to drill small holes in the patient’s shinbone in order to attach it. Sometimes, the surgeon might need to remove a channel at the top of the shinbone. The “c-shaped” donor meniscus’ front and back tips can be attached to small bone plugs or a small bridge of bone. These bony structures will be inserted into the channels or holes in the patient’s spine by the surgeon. Then, the surgeon will sew the meniscus in place with stitches. Sometimes, the bone bridge or bone plugs can be used to hold the meniscus in place.
The surgeon may also need to treat other parts of the patient’s leg. Sometimes, the surgeon may perform an ACL revision or revision (redo), align the limbs, or repair damaged articular cartilage in conjunction with meniscal transplantation.
Meniscus transplants are more likely to be successful and last longer if the patient’s knee joint remains stable and aligned properly. It is crucial that the surgeon corrects the alignment and stability of the knee ligaments during meniscus transplant surgery. This reduces the wear of articular cartilage, and protects the meniscus transplanted from abuse and stress.
What are the Potential Risks?
Meniscal allografts transplantation has been associated with certain complications, including:
- Tears of transplanted meniscus
- Infections (both bacterial, and viral) are possible. Meniscus transplantation has a low risk of disease transmission. Donors are carefully screened and tissue is tested.
- Nerve damage
- Knee effusion is a swelling and stiffness caused by excess fluid buildup in the knee joint.
- Arthrofibrosis is the formation of scar tissue in the knee joints after surgery.
- Synovitis is an inflammation of the membrane covering the knee joint.
- Reduced range of motion at the knee joint
A third of men who have undergone a meniscal allograft transfer will need additional surgery to repair any tears or other problems with the transplanted meniscus.
Meniscal Transplant Recovery and Rehabilitation:
Immobilization. For the first four to six weeks following surgery, you will need to use crutches and wear a knee brace. This allows the transplanted tissue to heal and become attached to the bone. Usually, range of motion can be initiated as soon after the procedure as possible.
Physical Therapy. After the swelling and pain subside, physical therapy can be started. The initial focus of physical therapy is on pain management and muscle activation. You can improve your range of motion with gentle stretches. Your program will continue to improve as you heal. You’ll gradually add strengthening exercises to it.
Return to everyday activities. Most patients cannot return to work for more than 2 weeks following surgery. Patients who work in labor-intensive or active jobs might need to undergo rehabilitation for 3-4 months before returning to work. Talk to your doctor about when you can return to work. Usually, full release from surgery for sport activities is granted 6-12 months after the procedure.
The End Result
A meniscal transplant’s success depends on many factors. These factors include:
- The knee condition at the time of surgery
- Correct size of the transplant
- How to place the tissue
- Patient’s dedication to rehabilitation
- The patient’s health
- Normal alignment of your knee
Surgical Complications
Meniscal transplant surgery has a very low risk of complications. The most common complications are stiffness, reoperation and incomplete healing.
Other potential risks include infection, bleeding, and damage to nerves or blood vessels.
Donor tissue has a very low risk of infection.
What are the Benefits of Meniscus Replacement?
A meniscus transplant is minimally invasive and requires less recovery than open surgery. A meniscus transplant can be beneficial for younger people who are physically active and want to return to their normal activities without any pain. It can prevent osteoarthritis, which is often caused by a damaged meniscus, from occurring.
What are the prospects for men and women who have had their Meniscus Replaced?
There are many factors that can affect the outcome of meniscus transplants. A successful meniscus transplant depends on several factors, including:
- The transplanted tissue’s size, shape, and location.
- After surgery, your commitment to a PT course.
Your overall health, alignment of your ligaments, and condition of your knee.
Some people need to have another surgery after a meniscus repair. The second surgery is most often a debridement, which involves the removal of other damaged or torn cartilage.
Meniscal Transplant Success Rate
The meniscal transplant surgery has a high success rate and is one of the most popular surgeries today. The average recovery time for this surgery is six to twelve weeks, depending on the severity of your injury. This surgery allows patients to enjoy a better quality of life and more mobility.