A medial meniscus transplant is a surgical procedure used to replace a damaged or missing medial meniscus in the knee with a donor meniscus. The meniscus is a C-shaped cartilage structure that acts as a cushion and stabiliser within the knee joint. Each knee has two menisci, one on the inner side (medial) and one on the outer side (lateral).
When the medial meniscus is damaged or removed due to injury or surgery, it can lead to knee pain, instability, and an increased risk of developing osteoarthritis in the affected joint. Medial meniscus transplant surgery is typically considered for patients who have persistent knee symptoms after the removal of the medial meniscus or have experienced a significant meniscal tear that cannot be repaired.
Here is an overview of the medial meniscus transplant procedure:
Patient Evaluation
Before considering a medial meniscus transplant, the patient undergoes a thorough evaluation by an orthopaedic surgeon. This evaluation includes assessing the extent of meniscal damage, the overall condition of the knee joint, and the patient’s overall health.
Donor Meniscus
The donor meniscus is typically obtained from a tissue bank or a cadaver. The donor meniscus is carefully screened for compatibility and safety to minimise the risk of disease transmission.
Surgery
The transplant surgery is typically performed as an arthroscopic procedure. Small incisions are made around the knee, and a small camera (arthroscope) is inserted to visualise the joint. The damaged or missing medial meniscus is removed or prepared to receive the donor meniscus.
Transplant
The donor meniscus is sized and shaped to fit the recipient’s knee and is secured in place using sutures or fixation devices. The goal is to recreate the natural anatomy of the knee as closely as possible.
Recovery
After surgery, the patient undergoes a rehabilitation program to promote healing, regain strength, and improve knee function. Physical therapy is an essential part of the recovery process.
It is important to note that medial meniscus transplantation is not suitable for all patients, and candidacy depends on various factors, including the extent of meniscal damage, age, overall health, and the presence of other knee conditions. This procedure is generally considered when other conservative treatments have failed, and the goal is to restore knee function and reduce pain.
As with any surgical procedure, there are risks involved, including infection, graft rejection, and ongoing knee issues. Patients should discuss the potential benefits and risks of medial meniscus transplantation with their orthopaedic surgeon to make an informed decision about the best course of action for their specific condition. Additionally, outcomes can vary from patient to patient, and success depends on various factors, including surgical technique, postoperative rehabilitation, and individual healing responses.
Medial Meniscus Transplant Using a Double Bone Plug Technique
A 28 year old man ruptured his right knee anterior cruciate ligament ACL. The medial meniscus was also torn in a bucket handle manner.
During surgery to reconstruct the ACL, the displaced and torn medial meniscus bucket handle tear had become macerated, deformed and was not repairable.
It had to be removed.
The loss of a large portion of his medial meniscus created 2 problems.
- The 1st problem is that the patient is young and without a large portion of his medial meniscus, he is at high risk of post-menisectomy syndrome with early onset osteoarthritis of his right knee medial compartment.
- The 2nd problem is the right knee reconstructed ACL graft is at risk of re-rupture as the posterior horn and root of the medial meniscus acts as an important secondary stabiliser to the knee.
A medial meniscus transplantation will help to mitigate these problems.
The patient was counselled on the option of a medial meniscus allograft transplantation procedure. The pros and cons were explained. He was keen to proceed.
A request for size matching of his medial meniscus allograft was sent to the various tissue banks in the USA. A match was eventually found after a few months.
The allograft medial meniscus is supplied in a bone block.
I have to fashion it into a graft with 2 bone plugs.
The surgical technique involves arthroscopic drilling of a tunnel for the posterior root and an anterior tunnel for the anterior root.
The allograft medial meniscus is introduced into the joint and the bone plugs seated inside the tunnels and secured to the anterior cortex of the shin bone using buttons.
