Knee Problems-Meniscus
Transplant
Anterior
Cruciate Ligament
Posterior Cruciate Ligament
ACL
/ PCL Revision Operations
Meniscus Repair
Meniscus Transplant
Total Knee Replacement
Osteotomy
Cartilage Regeneration and Arthritis
Orthopaedic Updates
Mensicus Transplants
Meniscus transplantation
is designed for young, otherwise healthy patients who face the
prospect of severe arthritis and significant disability due to the
loss of a meniscus. In 1987, Dr. Noyes became one of the first
surgeons in the U.S. to offer this operation. He published the
results in orthopedics’ most prestigious journal, The Journal of
Bone and Joint Surgery, and in the American Academy of Orthopaedic
Surgeon’s Instructional Course Lectures. Technical details of the
operation were described for orthopaedic surgeons in a special
edition issue of The Journal of Bone and Joint Surgery, and in the
Video Journal of Orthopaedics, in 2005. In addition, Dr. Noyes has
given many lectures on this operation to orthopaedic surgeons
throughout the United States and abroad.
Meniscus transplants have a satisfactory short-term (5 to 10 years)
outcome in carefully selected knees. Patient candidates are usually
under 40 years of age, have had a prior meniscectomy, have knee pain
with activities or have evidence of early joint arthritis, and are
in good overall health. The knee must be stable and in correct
alignment, or the patient must be willing to undergo a ligament
reconstruction or corrective osteotomy which is usually done before
the transplant.
A meniscus from a human donor (also called an allograft) is used for
this operation and only healthy tissues from young donors are used
in our Center. The transplant comes from tissue banks that are
certified by the American Association of Tissue Banks and have
passed FDA inspection. The meniscus tissue is tested extensively to
ensure it is safe from transmittable disease. Patients who receive a
meniscus transplant do not have to be on medication to prevent
rejection. The surgery is accomplished through small incisions with
the aid of an arthroscope. It is done on an outpatient basis or with
an overnight hospital stay.
The purpose of the transplant is to prevent arthritis or to slow its
advance; however, the transplant cannot reverse any degenerative
arthritic changes that have already occurred to the knee. The
long-term success rates of meniscus transplants are not known at
present. For this reason, we offer this surgery only to patients who
face the likelihood of severe and debilitating arthritis and who are
not candidates for total joint replacement. We do not perform this
operation in patients who have lost a meniscus and do not have any
symptoms or arthritis in their knee.
"Meniscus transplantation has moved out of the experimental realm
and offers pain relief to young, otherwise healthy patients who
suffer symptoms due to a previously removed meniscus. While our
Center has one of the largest and longest-running clinical trials
for this operation, we are very careful with patient selection
criteria. If you believe you may be a candidate, please realize that
only a select group of patients are eligible for this procedure. We
believe this procedure is well worth considering, as many
transplants have survived 10 years or greater."
Sue Barber-Westin, B.S.
Director of Clinical and Applied Research
Cincinnati Sportsmedicine Research and Education Foundation
"Our extensive experience with meniscus transplants has lead to
significant developments in not only the operation itself and the
subsequent rehabilitation program, but in the understanding of the
best patient candidates for the procedure. We have also made
advances in the treatment of joint lining (articular cartilage)
damage, which often accompanies loss of the meniscus. Therefore,
many patients can now have one operation in which they receive both
a new meniscus and a procedure to restore the joint lining. We
believe these advances are important as they may prove a benefit to
patients who require this operation where in the past very little
could be done."
Frank R. Noyes, M.D.
President
and Medical Director
Cincinnati SportsMedicine Research and Education Foundation
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Patients
Krista Cannon
Krista Cannon
It's not a typical procedure for someone young or old, but a meniscus
allograft was the only choice for 11-year -old Krista Cannon, a choice that
would help her lead a normal, active lifestyle.
While in the fourth grade, Krista injured her knee several times just by
repetitive falls. Unfortunately, they weren't minor injuries as it turns out
and her knee gave out. It was then that Krista's parents took her to see Dr.
Frank Noyes, who diagnosed her with having a torn meniscus, a rather
uncommon injury for such a young patient.
Since the meniscus is the knee's "shock" absorber, it plays an essential
role in protecting the bones from rubbing together. Without a meniscus,
complications may arise later in life, such as early arthritis. Initially,
Dr. Noyes repaired or sewed the torn meniscus, hoping to salvage the tissue.
This surgery was done at Deaconess Hospital.
Two years later, Krista was having problems again. Dr. Noyes found that her
meniscus was torn so badly this time that he could not repair it a second time.
Dr. Noyes elected to remove the torn portion of the meniscus and replace it
with a meniscus allograft. This requires taking a meniscus from a donor and
transplanting it into the knee with the hope that the body will accept it.
This procedure is only performed on younger patients to delay the onset of
arthritis, the breakdown of the joint's lining.
"The loss of the meniscus can be devastating to a young person, such as
Krista," said Dr. Noyes. "Without a meniscus the joint might deteriorate and
develop arthritis.
"Up until five or six years ago, there were minimal treatments for this
injury. Patients, like Krista, had to be monitored for early signs of
arthritis," Dr. Noyes added. "Knee centers in the U.S. and Europe continue
to work to develop a replacement. The only real option at this time is to
take a meniscus from a donor's healthy knee."
Dr. Noyes was one of the first surgeons to arthroscopically transplant the
meniscus, reducing the chances for surgical complications,requiring a smaller
incision, less post-operative pain, and need for protection.
Following the transplant, Krista followed an extensive rehabilitation
program. "We worked with her on exercises to increase her motion," said
physical therapist Tim Heckmann. "Besides watching the graft very closely,
we also retrained her way of walking in order to control any unnecessary
forces that could adversely affect the graft," he added.
"With someone so young, we found it especially important for all of us to
give Krista support and encouragement through this rigorous surgical and
rehabilitative procedure," shared her mother, Beth.
Now four years after the transplant, Krista is back at it again. A sophomore
at McAuley High School, Krista plays recreational volleyball and softball
and is able to live her normal, active life with the help of her new meniscus.
Still, it is important to be cautious. Dr. Noyes believes it important to let
patients know that the meniscus transplant may not hold up over the long term,
therefore, caution and common sense are important.
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Questions and Answers
What exactly is meniscus transplant surgery?
A meniscus from a human donor (also called an allograft) is used to replace your damaged or lost meniscus. Only healthy tissues from young healthy donors are used. The allograft tissues come from tissue banks that are certified by the American Association of Tissue Banks and have passed FDA inspection. The surgery is accomplished through small incisions with the aid of an arthroscope. It is done on an outpatient basis or with an overnight hospital stay.
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Why is the transplant considered an important surgical development?
The transplant is a significant surgical development because the meniscus itself is so important. The menisci, two c-shaped wafers made of cartilage, act as shock absorbers within the knee and add to joint stability. With activity, forces as great as 3 to 6 times your body weight cross the knee joint. In other words, if you weigh 150 pounds, your knee joint feels 450 to 900 pounds of force when you run or stoop. The menisci diffuse these forces over a wide area. But if the meniscus is torn, or badly damaged, the forces are concentrated onto a small area of the joint. Eventually, they cause the joint lining to crack and fragment, and pain and swelling result. After a meniscus is damaged or lost, the joint begins to deteriorate. This process is called "arthritis".
Individuals in their 50's, 60's, and 70's can undergo partial or total joint replacement to counteract the ravaging effects of arthritis. But joint replacement is not an option for younger people, simply because the artificial joint will commonly loosen and fail in these patients and only last for about 15 years
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Am I a good candidate for meniscus transplant surgery?
Meniscus transplant surgery is an option for younger patients under the age of 45, especially active individuals whose knees already show early signs of degenerative arthritic changes. For these patients, advancing arthritis and significant disability are almost certain. If you have either had your meniscus previously removed, or have incurred a recent tear which cannot be repaired, this operation may allow you to return to a more active lifestyle with reduced pain
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What can the transplant do for me?
The purpose of the transplant is to prevent arthritis or to slow its advance. Its value lies in the fact that it can help prevent or slow further damage and disability. The transplant cannot reverse any degenerative arthritic changes that have already occurred to the knee. That means that if you are already experiencing significant knee pain due to arthritic changes, they might continue after surgery and the transplant may not allow you to become more active than you are right now. |
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How successful is the procedure?
The long-term success rates of meniscus transplants are not known. For this reason, we offer this surgery only to patients who face the likelihood of severe and debilitating arthritis and who are not candidates for total joint replacement. The ideal candidates are patients under 40 years of age, athletically active, who have lost a meniscus and have begun to experience early knee pain and swelling. At present, we estimate that the short-term success rate in these patients is 50% to 75%. We do not perform this operation in patients who have lost a meniscus and do not have any symptoms or problems with their knee.
The biggest reason the surgery may not be successful is that the body gradually replaces and remodels the meniscus transplant with your own tissue and blood supply. If this remodeling process does not fully occur, then the transplant will not function.
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How is the surgery performed?
Several small sutures are placed into the transplant, which is then inserted into the knee joint through a small incision. Additional small incisions may be used in order to properly fit the transplant. The meniscus is anchored into the tibia bone for adequate fixation, which allows it to function. |
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How long will it take me to recover from surgery?
Because the procedure is arthroscopically-assisted, the recovery period is rather fast. You'll need to remain on crutches for 6 weeks in order to protect the transplant and give it time to become firmly implanted within the joint. Crutches will prevent any turning or twisting activities that might dislodge the transplant. Additionally, you will need to avoid deep squatting and other activities in high knee flexion angles for 6 months because these activities produce large forces that can also dislodge the meniscus. If the meniscus becomes dislodged, a repeat transplantation will be necessary.
Click here to see
our detailed rehabilitation protocol
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What are the potential complications of meniscus transplant surgery?
With any surgery, there is a small risk of infection, typically less than 1%. Tissue rejection is another remote possibility. The rejection rate is very low, less than 1%, because the transplant does not contain live cells. (That's why the transplant does not have to be "matched" to the patient like an organ transplant). There is also a small chance that the transplant could tear once it is implanted within the joint. If this occurs, the tissue would be removed arthroscopically and a new transplant inserted.
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Can I contract a disease from the transplant itself?
The tissue bank screens all transplant donors through an exhaustive process in order to exclude any potential donors with hepatitis, AIDS, or any other transmittable diseases. All transplants are obtained using sterile techniques following FDA safety guidelines. Tissue and blood specimens from the donors are evaluated for tissue health, microbiological contamination, and viruses.
Although there is relatively little blood in the meniscus transplant once removed from the donor, the tissue is washed thoroughly to remove blood and blood byproducts. To date, there have been no reports of disease transmission through meniscus transplants.We advise patients that the risk is not zero, but it would be extremely rare, one in a million or more.
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| If I need other knee surgery, can the transplant be performed at the same time? |
If you need to have a knee ligament reconstruction or high tibial osteotomy, the transplant will probably be performed after the other operation. This is because the results of meniscus transplants depend on having a stable knee and a lower leg in correct alignment. We prefer to stage the procedures, and achieve proper stability and alignment before implanting a meniscus into your knee. Staging the procedures also lessens the risk of a complication from what would be a much larger and longer operation.
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What happens after the transplant?
If you decide to undergo the meniscus transplant, you will automatically become part of a special study to determine the procedure's long-term effects. You are obligated to return annually to Cincinnati Sportsmedicine for an examination. This examination consists of an x-ray and, possibly, an MRI. The MRI is a magnetic resonance imaging device that takes a picture of the knee without using an x-ray. The picture is evaluated by a computer to determine the condition of the transplant.
You might also be required to undergo a future arthroscopic examination. This procedure will be done only if your physician feels that it is necessary in order to evaluate the condition of the transplant properly.
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How can I schedule a meniscus transplant? |
| If you are deemed a transplant candidate, our medical secretary will work with your insurance company to obtain pre-certification for the procedure. At present, the majority of insurance companies cover a portion or all of the costs of the transplant operation. As with all surgeries, the patient is ultimately responsible for the cost of the procedure. When insurance pre-certification has been obtained, your name will be placed on a waiting list. X-rays will be taken of both of your knees to determine the proper size of the transplant. Because it can be difficult to obtain high-quality transplants, there is usually a waiting period until we are able to secure the necessary tissue. |
After surgery, you are obligated to follow all of our postoperative instructions exactly. These include using crutches as directed and performing specific exercises to rehabilitate your knee. If you do not follow the instructions carefully, the transplant may fail. |
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If you'd like more information
regarding meniscus transplantation,
please contact our Director of Clinical Studies, Sue Barber-Westin, at sbwestin@csmref.org.
