Meniscus Transplant
What Is a Meniscus Transplant?
The menisci are C-shaped cartilage cushions on the inner and outer sides of the knee; they spread load, absorb impact and add stability to the knee. Tearing away or previously removing a large part of the meniscus increases the load on the joint cartilage and, over time, sets the stage for knee arthritis.
A meniscus transplant (meniscal allograft transplantation) is surgery in which a suitably sized donor meniscus obtained from a tissue bank is placed in the position of a meniscus that has lost its function or been largely removed. The aim is to rebalance the load in the knee, reduce pain and protect the joint. For meniscus injuries and non-surgical or repair options you can review the meniscus tear page.
Who Is a Candidate, and Who Is Not?
A meniscus transplant is not suitable for every patient; it is considered in selected, young and active people. Candidacy is established by a detailed examination and imaging.
- Patients in whom a large part of the meniscus has been removed or torn beyond repair and pain has developed in that compartment.
- Absence of advanced cartilage wear (arthritis) in the knee; a transplant is not a treatment for an arthritic knee.
- Patients whose leg alignment and ligament stability are suitable, or in whom these can be corrected in the same session or in stages.
By contrast, where there is widespread cartilage loss, marked malalignment or uncorrected ligament instability, a transplant alone is not enough; these are addressed first or together. Widespread wear is assessed separately under knee osteoarthritis treatment.
Preoperative Assessment
The history and examination assess the location of the pain, the stability of the knee and the alignment. An X-ray shows the alignment and joint space, and MRI shows the state of the meniscus, cartilage and ligaments. This assessment determines whether the transplant is done alone or together with alignment, ligament or cartilage procedures.
A suitably sized donor meniscus is chosen on the basis of imaging according to the patient's knee measurements. Choosing the correct size and the correct side (inner or outer meniscus) matters for the function of the graft. Allografts are supplied from regulated tissue banks according to quality and safety standards.
How Is the Surgery Performed?
The transplant is most often done arthroscopically or through a small assisting incision. The remaining meniscal tissue is prepared and the donor meniscus is placed into its bed in a way that suits the anatomy of the knee. Different techniques can be used to fix the graft; the choice depends on how the graft is prepared and the surgeon's plan.
The front and back attachment points (roots) of the graft are fixed securely to the bone, and the body of the meniscus is sutured to the surrounding tissue. If there are accompanying cartilage, ligament or alignment (osteotomy) problems, they can be addressed in the same session or in a planned order; this matters for the durability of the result.
Anaesthesia and the First Period
The operation is performed under general or regional anaesthesia; nerve blocks may be added for pain control. In the early period the knee is protected in a brace and weight-bearing is increased gradually to protect the healing of the graft.
In the early period, movements that stress the graft such as deep squatting and twisting are avoided. Cold application and the pain medication advised by the doctor are used for pain and swelling; protection against clots related to immobility is also part of the plan.
Rehabilitation and Return to Sport
The aim of rehabilitation is to preserve range of motion while the graft heals and then to regain strength gradually. The programme progresses through the stages of bracing, weight-bearing and range of motion, according to the doctor's plan.
- Early phase: controlling swelling and pain, protected range of motion and activating the thigh muscles.
- Middle phase: gradually opening the brace and weight-bearing and balanced strengthening.
- Advanced phase: a controlled return with running, change of direction and sport-specific work.
Return to sport is guided by criteria rather than a fixed date: healing of the graft, pain-free full movement, muscle strength close to the other leg and controlled movement quality. Return to high-impact sports involving jumping and twisting takes longer and is planned carefully; no fixed timeframe is promised.
Risks and Factors That Affect the Outcome
The procedure is generally safe; nevertheless, as with any surgery, certain risks are kept in mind: infection, joint stiffness, failure of the graft to heal, a re-tear, blood clots and, rarely, nerve or blood-vessel problems.
The outcome is shaped by the state of the cartilage in the knee, leg alignment, ligament stability, the correct size and placement of the graft and, above all, adherence to rehabilitation. A transplant does not reverse existing cartilage damage; its aim is to preserve the function of the knee and reduce symptoms. Accompanying cartilage problems may be assessed separately under knee cartilage restoration.
When Should You See a Doctor?
In a young knee whose meniscus has been largely removed, early assessment widens the options while the joint is still preserved.
- You have persistent pain and swelling in the relevant compartment of the knee after meniscus surgery.
- You have pain that increases with weight-bearing, restricted activity or recurrent swelling.
- After surgery there is increasing pain, fever, wound drainage or one-sided calf swelling; do not delay.
For the assessment and treatment of meniscus problems you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within knee surgery.