One of the concerns about surgery to trim out part of a meniscus tear is long-term arthritis. If an orthopedic surgeon removes a large portion of the meniscus, the patient loses some of its shock-absorbing ability. In my latest Ask Dr. Geier column, I answer the question of the reader who asks about a surgery to replace the damaged meniscus – a meniscus transplant.
Matthew Braddy writes:
Hello Dr. Geier. I am a 33-year-old male who will be undergoing a second meniscus surgery. The first surgery was a repair 17 years ago. The most recent MRI shows a left lateral bucket handle tear. This is the same as the previous injury. I am considering meniscectomy because I can’t be off of my feet for eight to ten weeks. My doctor has advised me of the potential for arthritis. This is a pivotal moment in my life as I am five months out from finishing nursing school. If I don’t finish now I will be forced to wait another year to enroll and pick up where I left off. I work full-time as a fireman and part-time as an ER tech. The question I would like to pose follows: Is it possible to have a meniscus transplant following meniscectomy? How long is too long to wait for the transplant following meniscectomy? Hope I posed my questions clearly, and thank you in advance.
That’s a great question, Matthew. If you are interested in the decision to perform a partial meniscectomy for a bucket-handle meniscus tear instead of a meniscus repair, you might check these links or read these other Ask Dr. Geier columns. Generally bucket-handle meniscus tears are repairable. If a meniscal repair heals, then the patient has the entire meniscus remaining to protect the knee.
What is a meniscus transplant?
If a patient has had a large amount of meniscus removed from one or more prior meniscus surgeries – to the point there is little meniscus left – he would be at great risk for developing degenerative arthritis earlier in life. It is often possible in these situations for an orthopedic surgeon to implant a meniscal allograft.
Basically the surgeon gets a meniscus and block of bone from the tibia that was harvested from an organ donor after he died. It is transplanted into the patient’s knee in a fairly extensive operation.
Criteria for a meniscus transplant
Most patients who undergo meniscus transplants are young. This fact likely results from an orthopedic surgeon wanting to perform these surgeries before patients develop degenerative arthritis changes.
Minimal damage to the articular cartilage is one of the patient criteria for such a procedure. Any knee instability from deficiency or injury to the ACL, PCL or other major ligaments must be corrected if it exists. Abnormal alignment of the knee, especially one that is in excessive valgus or varus (knocked-kneed or bowlegged, respectively) should be corrected with an osteotomy – a surgery to cut the bone and fix it in better alignment.
As far as the timing of the operation, there is no consensus answer. If a large amount of meniscus is removed, and he meets the other criteria or had them corrected, he might be a candidate for a meniscus transplant even with minimal pain in order to try to decrease the risk of later osteoarthritis.
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