Meniscus Allograft Replacement Surgery: A minimally invasive method to restore previously removed torn knee cartilage with cadaver tissue
Edited By: John R. Green III, M.D.
Last updated Thursday, January 05, 2006
Considering surgeryTypes of surgery recommended Arthroscopic surgery is recommended for meniscus tears. The basic
principle of meniscus surgery is preservation of healthy meniscus.
Since meniscus repair is only feasible in the peripheral area of
meniscus that has adequate blood supply, most meniscus tears are
treated with arthroscopic meniscectomy. Some patients experience
activity related pain in the region where a significant portion of
meniscus has been removed. In many patients, there is a window of time
after the development of this pain, and before the onset of arthritis,
when meniscus replacement surgery can be effective.Who should consider allograft meniscus replacement surgery? Meniscus replacement is considered when:
- the patient is healthy and wishes to remain active,
- the patient understands the rehabilitation, and accepts the risks of surgery,
-
the patient experiences pain located in the same area, from which a
significant portion of meniscus has previously been removed no less
than six months prior,
- the patient is not overweight,
- the patient is skeletally mature and less than 50 years old,
- the knee alignment is normal with stable ligaments
- the knee does not have significant injury to the articular (gliding surface) cartilage or evidence of arthritis on x-rays, and
- the surgeon is experienced in meniscus replacement
What happens without surgery? Unfortunately, most patients who have significant portions of their
meniscus removed develop arthritis over the ensuing decades. A few of
these patients develop activity related pain in the region of meniscus
removal prior to the development of arthritis. These patients have an
opportunity for allograft meniscus replacement surgery. The window of
opportunity will close when arthritis develops, and the opportunity for
allograft meniscus replacement will be lost. The time for arthritis to
develop is highly variable and unpredictable.Surgical options Meniscus tears can be treated by meniscus removal (meniscectomy),
meniscus repair, or in unusual circumstances, meniscus replacement.
Since the goal of surgery is to preserve healthy meniscus, meniscus
repair is attempted when the tear is repairable.
The simplest
operation is meniscectomy, removing the damaged meniscus tissue. This
has good short term results but leads to the development of arthritis
ten to twenty years later. Meniscus repair also has good results, but
has a longer recovery time than meniscectomy and is limited to tears,
which are amenable to repair. Meniscus replacement is considered for
young, active patients who have previously had most of their meniscus
removed, and develop pain in the area without having advanced
degenerative changes to the articular (gliding surface) cartilage.
Please see meniscectomy and meniscus repair for additional information.Effectiveness In the hands of an experienced surgeon, meniscus allograft replacement
is an effective operation to restore comfort and function to the knee
of a well-motivated patient. Using the technique described below,
meniscus healing is about 90%. Short term outcomes are good, but the
long term benefits are still unknown, since the procedure is still
relatively new.Urgency Surgery for pain following significant meniscus removal is not an
emergency. It is reserved for at least six months following
meniscectomy. Arthroscopic meniscus replacement is an elective
procedure that can be scheduled to minimize disruption of patients’
lives. The window of opportunity will close when arthritis develops,
and the opportunity for allograft meniscus replacement will be lost.
The time for arthritis to develop is highly variable and unpredictable.Risks All surgery has risks. There is likely nothing you could imagine could
go wrong that has not gone wrong at some time. That being said, meniscus
replacement is a safe procedure with a complication rate of 1.3%. The
most common complications are injuries to skin nerves, the vast
majority of which resolve without additional procedures by three months
post surgery. Injury to larger nerves or blood vessels is rare, as are
blood clots. Knee stiffness, infections, and other problems are
uncommon, but can occur. An experienced surgical team uses special
techniques to minimize these risks, but unfortunately they cannot be
completely eliminated.Managing risk The most effective treatment of complications is prevention. For
example, the risk of infection is decreased by giving antibiotics prior
to surgery, and the risk of blood clots is decreased by using
anti-embolism stockings. If infection does occur, repeat arthroscopy to
remove infected tissue and debris, in conjunction with antibiotics for
six weeks is generally effective. If blood clots occur, blood thinners
are used for three months to decrease the chance of clots growing or
breaking off and traveling to the lungs. Knee stiffness can often be
managed with physical therapy and braces, but may require arthroscopic
releases to restore motion. Since most complications can be effectively
managed when identified promptly, if patients have questions or
concerns about the post-operative course, the surgeon should be
informed as soon as possible.Surgery for Meniscus Tear at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 to make an appointment.
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