The meniscus are two "C" shaped flexible structures that lie between the articular surfaces of the tibia and the femur. In young people practicing sports, damage to the menisci usually results from an acute knee injury. In the elderly, meniscal rupture is more often the result of progressive degenerative changes.
Treatment of a damaged meniscus can be conservative (rehabilitation) or operative. Not all meniscal injuries qualified for surgery can be repaired by suturing (read more about arthroscopic meniscal suturing). Sometimes it is necessary to remove all or part of the meniscus (meniscectomy), which negatively affects the mechanics of the joint and leads to faster wear of the articular cartilage. To prevent the negative effects of meniscectomy, some patients may undergo a meniscus or fragment transplant. The transplant replaces the function of the natural meniscus, which prevents the rapid progression of degenerative changes. Depending on the degree of damage to the meniscus, the procedure can be performed:
- implantation of the entire meniscus from a tissue bank (allograft),
- implantation of a fragment of a synthetic meniscus (made of polyurethane or collagen).
Make an appointment now - with a specialist in knee meniscus transplant surgery at our hospital
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Who can have a meniscus transplant?
Eligibility for meniscal transplant surgery remains an individual matter. Meniscal transplants are performed mainly in young people with traumatic injuries of the meniscus. The aim of the procedure is to replace the damaged meniscus with a graft before the articular cartilage is destroyed and the knee degenerates.
Meniscal transplants are performed in people:
before the age of 50,
with a defect of more than half of the meniscus or when meniscal damage cannot be sutured,
with knee pain during daily activity or sports (after meniscectomy),
with good condition of the articular cartilage (or repairable trauma to the cartilage),
with the correct body weight.
Meniscal transplant procedures do not make sense in the elderly with a significant degree of degenerative changes and extensive damage to the knee articular cartilage. In this case, a knee joint endoprosthesis procedure is performed.
Benefits of performing a meniscus transplant
The meniscus transplant procedure enables:
complementing the adjustment of the articular surface of the tibia and femur, which protects the knee cartilage against excessive local overload and rapid progression of secondary degenerative changes,
maintaining the stability of the joint,
maintenance of the load-absorbing function,
reducing knee pain.
Types of meniscus transplants
Allograft
A meniscus allograft is a meniscus from a deceased donor. The collected meniscus is always carefully measured and tested for the presence of pathogens, then frozen and stored in a tissue bank. Before the procedure, it is necessary to select the appropriate size of the meniscus graft. For this purpose, X-rays of the knee joint are taken with a special marker that enables the calculation of the dimensions of bone structures. Magnetic resonance imaging of the knee is also performed to precisely assess the structures inside the joint.
Fragment of a synthetic meniscus
Synthetic meniscal implants can be used as long as the peripheral part of the meniscus and its roots are preserved. Meniscus implants, e.g. (Menaflex, Actifit) are made of biodegradable materials that act as a scaffold for incoming cells. The implant is gradually overgrown with natural fibrous tissue with properties similar to the structure of the meniscus. As a result, the damaged part of the meniscus is rebuilt.
What does the meniscus transplant procedure look like?
Meniscal transplantation is performed as part of an arthroscopic procedure. It is a minimally invasive procedure involving the insertion of a camera and surgical tools into the knee without the need to open the joint. The intra-articular structures are observed by the surgeon on the monitor screen. The operator makes several small incisions on the surface of the knee through which he inserts the tools and the previously prepared meniscus graft or synthetic implant. Before implantation of the implant, the damaged meniscus or its part is removed.
The prerequisite for the success of the operation is the precise anatomical positioning of the meniscus allograft and its stable attachment to the tibia. The roots of the transplanted meniscus are attached to the tibia with special screws or anchors, and its peripheral part is sutured to the surrounding tissues. Some techniques may involve implanting a bone block with a meniscus graft attached to it in a previously prepared bone trough.
In the case of implantation of a synthetic meniscus, a suitable fragment of the implant is prepared that matches the defect, and then inserted into the knee and sewn on.
Meniscal transplantation surgery may be combined with other repair or reconstructive procedures within the ligaments and / or articular cartilage.
Rehabilitation after a meniscus transplant
For the first 4-6 weeks after the procedure, it is recommended to wear an orthosis limiting the movement of the knee within the range prescribed by the doctor. Moreover, the patient moves on crutches with partial relief of the operated leg. This time is needed for the transplanted meniscus to naturally fuse with the tibia (or for the synthetic implant to integrate into the adjacent part of the meniscus).
Physiotherapy is started the day after the surgery. In order to reduce swelling and pain, the Game Ready device is used, which at the same time cools and optimally compresses the operated limb. Physiotherapy is a transplant safe, gradual restoration of the range of motion in the joint and the strengthening of the muscles surrounding the knee joint. Along with the progress of rehabilitation, further exercises performed in patterns used in everyday life and elements of sports training are included.
The time to return to normal activity depends on the type and location of the transplant, the surgical technique used and the patient's involvement in the rehabilitation process. Most patients return to professional activity in the third month after the procedure. Returning to sport requires longer preparation - it is about 6-10 months after meniscus transplantation.
Important information
| Duration of the procedure (depending on the method) | 2 - 4 hours |
| Tests required for surgery | basic - preparation for surgery tab |
| Anesthesia | subarachnoid or general |
| Hospital stay | day |
| A period of significant dysfunction | 3 weeks |
| A period of limited dysfunction | 4 - 12 weeks |
| Removal of stitches - first visit | 21 - 16 days |
| Change of dressings | every 3 - 4 days |
| Contraindications to the procedure | zwyrodnienie kolana, niestabilność kolana |
Frequently asked questions about the knee meniscus transplant:
The indication for a transplant is damage to the meniscus, which cannot be repaired by suturing. Then it is necessary to remove the meniscus or part of it (meniscectomy). The absence of a meniscus or its partial loss negatively affects the biomechanics of the knee and significantly accelerates the wear of the articular cartilage. The aim of a meniscus transplant is to eliminate knee pain and protect the joint against premature degenerative changes (gonarthrosis) / link /. Meniscal transplants are usually performed in people aged up to 50-55 with good condition of the articular cartilage.
If it is necessary to remove the entire damaged meniscus, the graft is a meniscus obtained from a deceased donor from a tissue bank (the so-called allograft). When only part of the meniscus is damaged, in some cases it is possible to implant a synthetic implant. The implant is biodegradable and gradually overgrows with natural fibrous tissue, replacing the missing part of the meniscus. The procedure of implanting an allograft or a synthetic fragment of the meniscus is performed as part of a minimally invasive arthroscopy / link / procedure without the need to open the joint.
The duration of rehabilitation depends on the type of transplant used, the surgical technique and the level of activity to which the patient would like to return. Most patients are able to return to their daily work in the third month after the procedure. The return to sports training is usually possible 6-10 months after the surgery - depending on the specificity of the sports discipline practiced and the patient's involvement in the rehabilitation process.
