By Joseph C. Tauro, MD. Follow on Twitter @OCSM_
One of our greatest priorities is joint preservation, meaning prevention of joint deterioration and arthritis, rather than trying to treat it once it occurs. This can include both non-surgical and surgical treatments.
Proper nutrition and weight control are extremely important for healthy joints and we offer guidance for our patients in these areas. Some nutritional supplements such as glucosamine and chondroitin can also help. Training and proper conditioning for daily and sports activities are also important. Our team of athletic trainers can help you prevent or treat injuries.
However, in cases where damage to a join is severe and surgery is needed, we may perform realignment procedures (such as a tibial osteotomy) and/or transplants of healthy joint surface (articulate cartilage) or the cushion in the knee (the meniscus).
Recently we performed a lateral meniscal allograft on an 18-year-old baseball player who had two previous attempts at repairing his meniscus which failed, resulting in almost complete loss of his meniscus.
Meniscal allograft transplantation is a type of surgery in which a meniscus – the cushioning ring between the femoral and tibial surfaces of the joint – is implanted into the knee:
The meniscus plays an important role because it helps distribute the load inside of the knee. Tears of the meniscus are a common problem because it has a poor blood supply and when tears occur, they often don’t heal. Small tears are trimmed out but larger tears are repaired.
Unfortunately, because of poor blood supply, some of these repairs fail, resulting in a loss of much of the meniscus. The larger the loss and younger the patient, the greater the need to replace the meniscus with a donor meniscus from a tissue bank. Grafts taken from donors are called allografts.
The meniscal allograft comes attached to a piece of donor joint surface and is matched in size to the patient’s knee joint using an MRI scan:
For a lateral meniscus, we cut the donor piece of bone to match a trough we cut in the patient’s bone and then slide the bone block and meniscus into the joint with sutures passed from the inside to the outside of the joint:
We then place multiple sutures to secure the graft to the wall of the knee joint:
This is a complex surgery that can take 2-3 hours and is done partly arthroscopically and partly open. Recovery takes 4-6 months but the results are typically very good for active young patients who do not have arthritis.
Our latest patient is doing very well and we are hoping for a return to baseball next season!
Links to References On Meniscal Allograft Transplantation:
Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation