Introduction

The meniscus is a C-shaped piece of cartilage that cushions and stabilizes the knee joint. When severely damaged or removed (meniscectomy), patients may develop pain, swelling, and an increased risk of early arthritis. For younger, active patients with persistent knee symptoms after meniscus loss, a meniscus transplant (meniscal allograft transplantation) may be recommended.

This blog explores why a meniscus transplant may be necessary, the techniques used, and what current evidence says about outcomes.

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Why Consider a Meniscus Transplant?

Meniscus transplants are not performed for every meniscus tear. Instead, they are reserved for specific cases:

• Previous meniscus removal (meniscectomy): Patients with ongoing pain, swelling, or functional limitation.
• Younger, active individuals (<50 years): Particularly those who want to preserve their joint and remain active.
• Joint preservation: Helps delay or prevent the onset of osteoarthritis by restoring knee biomechanics.
• Failed prior treatments: Persistent knee pain despite physical therapy, injections, or bracing.

Contraindications: Advanced arthritis, severe malalignment (unless corrected), or knee instability without ligament reconstruction.

Meniscus Transplant Techniques

Modern meniscus transplantation involves donor (allograft) tissue that is size-matched to the patient’s knee. Techniques include:

1. Open Technique
   • Traditional approach with a larger incision.
   • Provides full visualization of the joint but is less common today.
2. Arthroscopic-Assisted Technique
   • Minimally invasive with small incisions and camera guidance.
   • Reduces recovery time and surgical trauma.
   • Now the standard method.
3. Fixation Methods
   • Bone plug / bone bridge techniques: Secure graft with bone-to-bone healing.
   • Suture-only fixation: Graft is attached with sutures to the joint capsule.
   • Hybrid approaches: Combination of bone fixation and sutures.

Often, meniscus transplantation is performed in combination with other joint preservation procedures, such as cartilage repair, ligament reconstruction, or osteotomy (realigning knee bones).

Evidence-Based Outcomes

Short- and Mid-Term Results

• Meniscus transplant has been shown to reduce pain and improve function in appropriately selected patients.
• Many athletes return to low- to moderate-impact sports, though high-level professional play may be limited.

Long-Term Evidence

• Studies show survivorship rates of 70–80% at 10 years post-surgery.
• Meniscus transplantation appears to delay the progression of osteoarthritis, though it does not completely eliminate the risk.
• Best outcomes occur in patients without advanced arthritis at the time of surgery.

Key Evidence Highlights

• A meta-analysis in The American Journal of Sports Medicine found significant improvements in pain scores, activity levels, and quality of life after meniscus allograft transplantation.
• Patients with combined procedures (like cartilage restoration or ACL reconstruction) can also achieve good outcomes, though recovery may take longer.

Recovery and Rehabilitation

• Initial recovery: Protected weight-bearing with crutches and a brace for 4–6 weeks.
• Physical therapy: Focus on range of motion, muscle strengthening, and gradual return to activity.
• Return to sport: Often possible within 9–12 months, depending on sport intensity and associated procedures.

Conclusion

Meniscus transplantation is a joint-preserving surgical option for younger, active patients with persistent knee pain after meniscus loss. While not appropriate for everyone, advances in surgical techniques and rehabilitation have improved outcomes significantly. Evidence supports its role in pain relief, function restoration, and delaying arthritis progression.

If you have ongoing knee pain after meniscus surgery, ask your orthopedic sports medicine specialist if a meniscus transplant may be right for you.

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