(336) 716-8091
Book Appointment
Knee

Meniscus Transplantation

The meniscus is a C-shaped cartilage that cushions between the thigh bone (femur) and the shin bone (tibia), preventing the bones from rubbing together. Its primary function is to absorb shock and distribute load in the knee joint, thus protecting it from wear and tear.

Due to the limited blood supply to the inner two-thirds of the meniscus (“white zone”), the meniscus is unable to heal.

Meniscus injuries are common. When meniscus repair fails or is not an option, surgical removal of the meniscus is associated with advancing cartilage wear and early-onset osteoarthritis. Both partial meniscectomy (removal of the damaged part of the meniscus) and complete meniscectomy (removal of the entire meniscus) have been shown to significantly raise the risk of osteoarthritis and joint degeneration, leading to joint damage and worse function. Today, a meniscal transplant is the preferred method for preserving the knee joint. It is an effective solution for young, active, and symptomatic patients with a deficient meniscus.

Meniscus allograft transplantation (MAT) is a surgical procedure aimed at replacing a damaged or missing meniscus in the knee with a donor meniscus from a cadaver. It is designed to preserve the knee joint and restore the shock absorber function of the meniscus. Meniscus allograft transplantation has proven to be an effective rescue procedure for restoring a meniscus and knee biomechanics for patients with a painful, damaged, and irreparable meniscus.

Meniscus allograft transplantation is an outpatient procedure performed arthroscopically (minimally invasive). Post-operative rehabilitation is crucial for successful recovery. This includes physical therapy to restore knee function, strength, and range of motion.

Meniscus allograft transplantation is indicated in patients who have undergone a total or near-total meniscectomy (surgical removal of the meniscus) and are experiencing symptoms related to the loss of meniscal function. Symptoms include moderate to severe pain, stiffness and swelling, catching or locking of the knee, knee buckling, and reduced activity levels because of compromised knee function. The procedure is particularly considered for patients with early cartilage wear due to meniscus loss but whose knee joint remains relatively healthy.

  • Meniscus deficiency occurs when the meniscus has been removed or severely damaged due to injury or previous surgical interventions.
  • Chronic knee pain: Persistent pain due to meniscal damage that does not respond to conservative treatments such as physical therapy or medications.
  • Degenerative joint disease: Early stages of osteoarthritis where meniscus loss contributes significantly to joint degeneration and prevents the progression of arthritis.
  • Instability and mechanical symptoms, Such as catching or locking of the knee, affect daily activities.

Dr. Waterman will determine who is a good candidate, and here is what he will consider:

  • Good candidates are typically younger (under age 50) and lead an active lifestyle. Meniscus allograft transplantation is not recommended for older people due to the likelihood of more advanced joint degeneration and arthritis.
  • Good candidates have a normal or near-normal knee alignment. However, significant malalignment (valgus or varus deformity) can be corrected before or during the MAT procedure.
  • Good candidates have stable knee ligaments, especially the anterior cruciate ligament. It must be treated before or during the Meniscus Allograft Transplantation procedure if instability exists.
  • Minimal to no knee arthritis on imaging studies. Isolated areas of cartilage damage can also be treated during surgery with cartilage restoration, such as fresh osteochondral allograft (OCA), matrix-assisted chondrocyte implantation (MACI), or other techniques.

Good candidates are generally in good health and do not use tobacco products, as they impair the ability to heal.

  • The donor meniscus is selected to match the size and shape of the patient’s knee.
  • The procedure may be performed as an outpatient minimally invasive arthroscopic procedure or open surgery.
  • Post-operative rehabilitation is crucial to a successful recovery.

The answer depends on several factors, such as the patient’s job and adherence to post-operative rehabilitation. To return to desk work takes about 3-6 weeks, and light physical work can resume at 4-6 months. Heavy physical labor requires recovery of 6-9 months. Recent studies suggest that returning to modest sports activities in the short term is a reasonable goal at about 9 months postoperatively, and two-thirds of athletes were able to return to pre-injury levels.

Meniscus allograft transplantation offers pain relief and improved knee function while delaying the progression of knee osteoarthritis. However, the success of the procedure depends on multiple factors, including patient selection, surgical technique, and adherence to post-operative rehabilitation protocols.

When you or a loved one suffers a knee injury, contact Dr. Brian Waterman at Wake Forest Baptist/Atrium Health in Winston-Salem, NC, for expert care for athletes and nonathletes.

Dr. Waterman is a board-certified orthopedic surgeon specializing in adult and pediatric sports medicine, cartilage restoration, joint preservation, complex knee surgery, and shoulder and elbow care. He is the Chief and Fellowship Director for sports medicine, and his patients find him professional, kind, caring, and trustworthy.

References

  • Wang D, Gonzalez-Leon E, et al. Clinical Replacement Strategies for Meniscus Tissue Deficiency. Cartilage. 2021 Dec;13(1_suppl):262S-270S. doi: 10.1177/19476035211060512. Epub 2021 Nov 20. PMID: 34802295; PMCID: PMC8808868.
  • Vasta S, Zampogna B, et al. Uribe-Echevarria B, Amendola A. Outcomes, Complications, and Reoperations After Meniscal Allograft Transplantation. Orthop J Sports Med. 2022 Mar 10;10(3):23259671221075310. doi: 10.1177/23259671221075310. PMID: 35295549; PMCID: PMC8918750.
  • Grassi A, Bailey JR, et al. Return to sports activity after meniscal allograft transplantation: at what level and cost? A systematic review and meta-analysis. Sports Health. 2019;11(2):123-33
  • Waterman BR, Rensing N, Cameron KL, Owens BD, Pallis M. Survivorship of Meniscal Allograft Transplantation in an Athletic Patient Population. Am J Sports Med. 2016 May;44(5):1237-42. doi: 10.1177/0363546515626184. Epub 2016 Feb 17. PMID: 26888878.
  • Van der List JP, Trasolini NA, Waterman BR. Editorial Commentary: Meniscal Allograft Transplantation Is Effective for Adolescents With Meniscal Insufficiency, Although Outcomes May Decline Over Time. Arthroscopy. 2024 Apr;40(4):1195-1196. doi: 10.1016/j.arthro.2023.09.005. Epub 2024 Jan 16. PMID: 38231142.
At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more
Call • (336) 716-8091
Request an Appointment

End of content dots
Schedule Consult