Page 75 - IDF Journal 2023

Meniscal transplantation is a complex, ‘fiddly’ and technically-demanding operation, and it is only performed in significant numbers by a small number
of specialist knee surgeons in the UK. The operation takes about 21⁄2 hours and requires a 1-night stay in hospital post- op. The patient is kept in a knee brace and on crutches for the first 6 weeks post-op, before then commencing several months of physio rehab treatments. It can take 6 to 9 months for a patient to fully plateau in their recovery from the surgery.
In terms of outcomes, the success rate for meniscal transplantation is about 80 to 85% at 5-year follow-up. Importantly, it should be emphasised to patients that meniscal transplantation is very much a salvage procedure, and it is
not ‘restorative’. A meniscal allograft is better than no meniscus, but it’s never as good as one’s own original meniscus, and it doesn’t reverse whatever articular cartilage damage might already be present in the knee. The aim is simply to reduce a patient’s knee symptoms, help them maintain their function and their fitness levels (and hence their general health), and to try and delay (but not necessarily avoid) the need for knee replacement surgery at some later stage in the future.
I always emphasise to my patients that you wouldn’t go back to smoking after
a lung transplant, you wouldn’t go back to drinking after a liver transplant so, likewise, it’s silly to go back to impact- type exercise or sport after meniscal transplantation surgery. Instead, patients should restrict themselves to light, non-
impact, non-pivoting cardio fitness type exercises only if they want their meniscal allograft to be a success and to last.
Articular cartilage grafting
Although you cannot, under most circumstances, justify meniscal transplantation surgery for purely prophylactic reasons in a patient with an asymptomatic knee, at the same time, the longer you leave a knee without a meniscus, the more likely the patient is
to develop articular cartilage damage, and then the less likely it is that their knee will actually be suitable for any kind of biological reconstruction.
If there is an area of full-thickness articular cartilage damage or loss in the compartment of the knee where a meniscus is missing, then this can potentially be replaced by articular cartilage grafting.
There are several different techniques
for trying to replace missing articular cartilage. However, my preferred
method is Autologous Membrane- Induced Chondrogenesis (AMIC) using
a Chondrotissue graft. This is a single- stage procedure using a bioabsorbable synthetic scaffold that relies on bone marrow cells from nano-drilling of the joint surface to grow new cartilage tissue. Again, the surgery is ‘fiddly’, and I secure my grafts in place using Vivostat PRF / ArthroZheal platelet-rich fibrin (PRF, not PRP) biological glue.
Success rates for articular cartilage grafting are about 80% at 5-year follow-up.
Biological Knee Replacement
When meniscal allograft transplantation
is combined with articular cartilage grafting at the same time, then this is what is referred to as a ‘Biological Knee Replacement’. I believe the term was first coined by Dr Kevin Stone, the well-known knee surgeon in San Francisco.
Biological Knee Replacement really is
the ultimate in technically demanding, complex soft-tissue knee surgery. This
is not an alternative treatment for a knee with full-blown arthritis, and it is reserved as salvage surgery for really bad knees
in younger patients where alternative options are very limited. Very few patients are actually appropriate for this specific surgery, and appropriate patient selection and assessment by a specialist knee surgeon experienced in these techniques is key.
To find out more visit: www.meniscaltransplantation.com
Mr Ian McDermott
MB BS MS FRCS (Tr&Orth) FFSEM (UK)
Consultant Knee Surgeon London Sports Orthopaedics W: www.kneesurgeon.london
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