Meniscus Repair or Transplantation

Often times, when people talk about torn cartilage in the knee, they are usually referring to torn meniscus.   The meniscus is a C-shaped cushion of cartilage in the knee joint. At this time there is no known medicine or therapy that will heal or fix a torn meniscus.

This usually means either partial excision (removal) or repair of the tear is necessary. Excision versus repair is often decided at the time of arthroscopic surgery.

The type of procedure decided by the surgeon will depend upon several factors:

• the patient’s age
• the age of the tear
• the size and location
• as well as the patient’s activity level

All these factors play a role in deciding whether a tear can be repaired or must be excised. In general, due to the essential role of the meniscus in protecting the knee from early arthritis, repair when possible, is always preferable to removal. Only tears in the outermost regions of the knee can be repaired.

Many meniscal tears do not occur at the periphery, where there is a blood supply for healing and cannot be repaired. The torn portion must be surgically removed. Losing a large portion of the meniscus cushion in your healthy knee can lead to persistent knee pain and arthritis could develop. For many older patients with this condition, a knee joint replacement might be the right option.

A meniscal transplant replaces the damaged meniscus with donor cartilage.

Meniscal transplants are not right for everyone and are uncommonly done. If you already have arthritis in your knee, a meniscal transplant may not help you. But for a select group of young, active patients, meniscal transplants can offer significant pain relief.

Procedure

Knee arthroscopy is one of the most commonly performed surgical procedures. During the procedure a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. Your Wisconsin Bone & Joint orthopedic surgeon then inserts miniature surgical instruments through other small incisions to trim or repair the tear.

Meniscectomy

In this procedure, the damaged meniscal tissue is trimmed away.

Meniscus Repair

Some meniscal tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.

Allograft/Transplant Procedure

If your meniscus is severely damaged or a large portion has been removed, it is possible that the articular cartilage protecting your knee will begin to wear. As this cartilage wears away, it becomes frayed and rough. Moving the bones along this exposed surface is painful. This condition is called osteoarthritis.

The goal of meniscal transplant surgery is to replace the meniscus cushion before the articular cartilage is damaged. The donor cartilage supports and stabilizes the knee joint. This is a complicated procedure. The hope is that the transplant will also delay the development of arthritis, but long-term results are not yet available.

If your own torn meniscus can not be repaired, your surgeon may elect to insert a new (transplanted) meniscus to maintain the healthy space in your knee joint.  Transplant materials is healthy cartilage tissue taken from a cadaver (human donor) and treated with a medical solution to preserve the graft in a frozen state before implanting in the new knee area. This tissue is called an allograft. It is sized, tested, and stored. Correct sizing is one of the most important factors in the success of the transplant.