Frequently Asked Questions
Compiled by patients that have undergone meniscal transplant surgery, it is hoped these Frequently Asked Questions will answer some of your concerns prior to surgery.
Waiting time depends on the availability of a graft. This time can be between six to twelve months. The graft is frozen in a tissue bank and there is then no urgency to use it. It lasts for a few years.
Yes – it is very important to correct any problem with the knees not being straight (bow legged or knock kneed) if this is putting more load on the damaged side. The leg needs to be straightened by carefully reshaping the bone around the knee.
If the knee is unstable due to damage to the anterior cruciate ligament (ACL) then this can be rebuilt at the same operation.
This clearly depends on the type of work and whether you have a sedentary or an active job. Following surgery patients are on crutches taking no weight on the operated leg for six weeks then building up to full weight bearing by about 8 weeks. Patients could return to desk based work from two to three weeks, prolonged standing work by 3 months, manual work with load carrying or ladder work by 4-6 months but for more active work such as police, security or military type work, we recommend nine months rehabilitation prior to a return to full duties.
Patients are usually in hospital one to two nights after surgery.
Anything we are doing is an attempt to try and salvage the situation with your knee, by putting in a new cushion and resurfacing the knee with a microfracture procedure. Hopefully this will give you a good functional result but you will still obviously need to look after the knee as it is not ‘normal’. If we can get 10–15 good years out of the knee after surgery then that would be excellent. There is always the chance that you will not get a good functional result. As I am sure you are aware the end result of a worn knee is a metal and plastic new surface but hopefully with our biological techniques we can postpone the need for that.
The main goal of meniscal transplantation surgery is to preserve the joint surfaces. Returning to high sporting activity is not the ideal end stage outcome. Non-impact sports such as swimming and cycling are preferable, although you may feel that higher activity levels are possible. At this stage you must consider the higher risks of re-injury to the transplanted meniscus and joint surfaces upon return to sport. It’s a bit like trying to conserve your tyres by not driving fast corners all the time.
In the United Kingdom there are between 70-100 a year.
The menisci are sourced from various tissue banks in the United Kingdom and the United States of America. You will be able to know where your graft is from once a match is found.
The graft can be either male or female, the requirements are based on size rather than any other factors. All donors are under the age of 35 years.
During harvest of the graft, a blood sample is collected from the donor and tested for infectious diseases by a certified laboratory. The donor must test negative or non-reactive for the following:
- Antibody to Human Immunodeficiency Virus 1 & 2 (anti-HIV 1 & 2)
- Human Immunodeficiency Virus Type 1
- Hepatitis B Surface Antigen (HBsAg)
- Hepatitis B Core IgG/IgM Antibody
- Antibody to Hepatitis C
- Hepatitis C Virus Nucleic Acid Testing
- Rapid Plasma Reagin or Serologic Test for Syphilis
Your surgeon will have explored other options prior to recommending this option of treatment.
Due to the nature of the tissue anti-rejection drugs are not required.
The meniscal transplant surgery takes approximately two hours, if any other procedure is required e.g. ACL reconstruction or straightening of the leg then the time will be longer.
No, the surgeries are very different and suitable for very different patient groups. Meniscal transplant is best suited for a person under the age of 45 who has had previous knee surgeries on their meniscus leaving them with no or very little remaining.
Knee replacement is for patients generally over the age of 55 who have osteoarthritis/ a degenerative knee.
This is a pioneering technique that certain surgeons have chosen to specialise in. There are a number of surgeons throughout the country that now do this surgery.
Physiotherapy is vital to recovery after surgery. You surgeon will advise you of a rehabilitation programme that they advise you to follow to return to your activity goals.
Due to the biology of the graft and the fixation methods used it is advised that a return to full sport is not anticipated until at least a year post surgery. However, activity levels can begin to increase from 6 months with an aim to consider a full return to all activity at around 12 months.
Driving is at the Consultants’ discretion – usually at around six weeks.
There are a number of factors that will affect the longevity of the graft including the state of the joint surfaces in the knee, any other procedures being done at the same time as the transplant and the level of activity to which the patient returns.