Meniscal transplant - who will benefit?

Meniscus transplant is only twenty years old, and has become an established procedure only in the last five. However, meniscal transplant is NOT a cure-all and is not the answer for every patient suffering the long term consequences of total meniscectomy. For example, in patients where a previous total meniscectomy has left the joint damaged, with established painful arthritis and collapse of the joint space, the results coming in suggest that meniscal transplant is likely to be a waste of time and a waste of valuable donor material.

Patient selection is key to obtaining a good outcome. Results to date suggest that appropriate patients may have an improved quality of life with reduction of pain, improvement of stability, and a return to light sport, but the surgeon needs to be selective in offering this procedure. A consensus is emerging that the ideal candidate -

• has had a total or subtotal meniscectomy
• is more than 20 but less than 50 years of age
• has stable ligaments (eg ACL) or is prepared to undergo ligament reconstruction
• has no abnormality of alignment of the long bones (’axial mal-alignment’) consequent on collapse of the joint where the meniscus is absent
• has no or minimal joint cartilage damage
• is not obese
• does not suffer with an immune or metabolic joint diease, eg rheumatoid arthritis

As long as significant damage or mal-alignment has not occurred, the length of time from total meniscectomy to transplant does not appear to matter much. This logically leads me to caution younger people not to hammer their joint in the years after they have had a total or subtotal meniscectomy. If the cruciates are damaged, too, then the caution to protect the joint is even stronger, and ligament reconstruction to improve stability should be discussed with an experienced surgeon.