The meniscus is a somewhat semicircular structure that is attached to the top of the tibia (shin bone) and serves as a cushion between the femur (thigh bone) and tibia (shin bone). Most patients present with fairly localized pain to either the medial (inside) or lateral (outside) of the knee joint itself. In many circumstances the history and physical examination of a patient are so specific for meniscal tear that an orthopaedic surgeon may need little other information in order to be able to make a diagnosis of the meniscus tear. There are times when damage to a meniscus is to such an extent that it cannot be repaired or repair has failed and a patient is left with minimal to no meniscal cushion present in the knee.
Meniscus transplantation is where an appropriately sized meniscus from a cadaver donor, much like with a heart or kidney, is selected and implanted in the patient’s knee. The patient usually has x-rays to size the anticipated meniscus and a company that deals with obtaining meniscal tissue is contacted. Meniscus transplantations are a reasonably significant operation and so there are several potential problems.
Please use newer version of your browser or visit Internet Explorer 6 countdown page for more information. The meniscus provides many functions within the knee, but most all of those functions relate to protecting the articular cartilage (cartilage on the end of the bone). Typically x-rays are performed in order to evaluate for arthritis, loose pieces in the knee, overall alignment of the leg, and other specific possible diagnoses. This is placing a small microscope into the knee and using small specialized instruments to deal with the meniscus tear. This does not produce any kind of significant rejection phenomenon and patients do not need to take any kind of special drugs or medicines when this is done. When an appropriate size is available this would then be shipped to the patient’s hospital.
First of all, the meniscus has to be sized accurately and a meniscus that is too small or too large may fail.
Patients are typically kept on crutches for a period of 6-8 weeks allowing the meniscus to heal so that it can withstand the stress of weightbearing. When the articular cartilage is significantly damaged one has the condition that would commonly be called degenerative arthritis.
Other times it can be a more simple injury such as just being in a squatted position and twisting the knee or moving to stand up.


In settings where radiographs, history, and physical do not clearly point to a meniscus tear, the orthopaedic surgeon may consider getting an MRI for confirmation. There is the tiny risk of the potential for disease transmission with meniscal tissues, and these implications should be discussed with the surgeon.
The patient then comes in and has a combined arthroscopic and open procedure to implant the meniscus with its attached bone. Because the patient has functioned without this meniscus for a long time sometimes regaining absolutely full motion can be a problem since the knee gets a little “tighter”. It probably takes 3 to 6 months to get back to normal activity on the meniscus and return to recreational activities. So when possible, particularly in young patients, keeping the menisci are very important for ultimate knee function.
In other patients no specific injury can be pinpointed and the patient just notes progressive onset of pain with perhaps some swelling over time.
Frayed and torn meniscal fragments are removed, but as much of the normal rim of the meniscus is kept in place to maintain as much function as possible. The patient’s knee needs to be stable so that if there are significant ligament issues these need to be addressed prior to, or in addition to, meniscus transplantation. Obviously, as with other surgeries complications such as infection, blood clots in the leg, etc. It needs to be clear, however, that meniscal tears are not always the cause of a patient’s symptoms. There are circumstances, most commonly seen with associated ligament injuries, when the meniscus can be repaired.
Many patients, after surgery, can do their own rehabilitation by getting on an exercise bike, for example, but some patients are slower or have more swelling and pain, and formal physical therapy may be considered. Leg alignment is important in that some people have significant bow legs or knock knees, and this can play a role in successful meniscus transplantation and needs to be evaluated.
The patient, depending on certain circumstances, could potentially be done as an outpatient, but at other times will spend a night in the hospital. It is not that uncommon that a patient has significant arthritis and perhaps other associated factors such as abnormal limb (leg) alignment or being overweight.
In this setting the meniscus itself appears fairly normal, but it has been separated from the surrounding attachment to the knee.


Age of the patient is a factor in that as patients get older other options may become more reasonable and predictable to solve pain problems. True locking in this sense is an inability for the patient to straighten the knee, NOT an inability to bend the knee. Although an MRI might show a meniscal tear a large aspect of the patient’s symptoms may well relate more clearly to these other issues. In this setting, the meniscus can be sutured back to the periphery in order to get the meniscus to heal. Because the healing process can be slow with a repair, patients would not return to twisting, cutting, or jumping type of sports typically for a minimum of 4 months. Symptoms can come and go and at times be confusing for a patient since one day they can function very normally and another day they may feel very limited.
Therefore, meniscal surgery may not result in good symptom relief in some of these patients.
The purpose of this is to maintain meniscal function for the future and minimize chances for arthritis.
Meniscus transplantation really shouldn’t be viewed as a replacement for a meniscus that was removed and then return to full high end competitive athletics or stressful activity. It should be noted that the majority of tears are not amenable to this type of repair treatment. Most are fragmented and split in a way that the meniscus will not heal and so the offending pieces need to be removed. A patient has to be aware of the limitations of what meniscus transplantation can do to return them to a normal situation. Someone who might be a reasonable candidate for meniscus transplantation but is significantly overweight would perhaps be better served by losing that weight to see if that helped with symptoms prior to consideration of meniscus transplantation. There are many other factors in this decision making process and they should be discussed with the surgeon.



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