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Author Topic: Repeat Meniscus Transplants?  (Read 1791 times)

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Offline JamieB

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Repeat Meniscus Transplants?
« on: June 22, 2014, 10:39:14 AM »
I'm new to the forum but would appreciate any advice out there.

HISTORY - medial meniscus tear, 3 repairs (unsuccessful) before the entire medial meniscus was removed. Tibial Osteotomy followed by medial meniscus allograft. All of these surgeries were done in the UK.
 
5 years done the line, living in the UAE, and I have an MRI showing that I have a complex tear of my medial meniscus (the new one!) and have torn the root leaving the meniscus protruding out of the medial and anterior part of the joint. I have also torn my medial collateral ligament.  :(

An OS here is suggesting that I may be a candidate for a repeat meniscus transplant (dependent on the state of the articular surfaces and general health of my knee).

QUESTIONS - Does anyone out there have the same/similar history? Is it possible to have multiple meniscus allografts? If another transplant is not appropriate is a partial knee replacement what I'm probably looking at? At 36 this would be a worrying prospect. :-\

Any advice would be greatly appreciated.

Offline MDAL

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Re: Repeat Meniscus Transplants?
« Reply #1 on: June 22, 2014, 11:40:58 AM »
Jamie:

We don't know how bad your situation is in terms of pain and general symptoms...

If it is possible to attempt to repair the meniscus for you to hold on a even few more years would be the ideal. The more you post pone a knee replacement the better.

Offline JamieB

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Re: Repeat Meniscus Transplants?
« Reply #2 on: August 13, 2014, 08:02:39 AM »
Hi MDAL,

Current situation:

-   I am experiencing pain all of the time, made worse by activity (walking or weight bearing);
-   I have not engaged in any sporting activity and have had complete rest for the last 3 months and prior to this the only sport that I have participated in has been golf once a month – no high impact sports;
-   I am finding myself walking with a significant limp every day;
-   The pain is primarily on the medial side and slightly to the front of my knee;
-   I would rate the pain as being anywhere between 4/10 to 8/10 and is generally dependent on the amount of activity I undertake – although there are some occasions when the pain is 8/10 regardless of activity.
-   The knee is noticeably swollen with particular swelling on the medial/anterior part of the knee as well as at the back of the knee (like an inflated cushion);
-   The ‘driving position’ in my car promotes pronounced pain in the aforementioned areas;
-    When walking I experience a large amount of ‘clunking’ or ‘popping’ sounds;
-   I have not experienced any ‘locking’ of the knee but the knee itself feels unstable and I am very nervous that the knee will give way especially when coming down stairs (the knee has not yet given way but I believe that this is as much to do with my protection against the situation rather than the stability of my knee);
-   After my initial OS consultation I began a course of physiotherapy but was forced to stop all knee related exercises as they were seeming to make the pain worse

The OS I am now talking to (based in the UK) was suggested that as the articular surfaces of the knee joint are in relatively good condition then I may be a candidate for a repeat meniscus transplant.

Further to the above it has been noted that the new medial meniscus that I received has significantly shrunk in size and that due to the root tear it is now significantly protruding out of the front and medial side of the knee.

If there is anyone that has had a similar situation (requiring a repeat meniscus transplant or alternative) I would be very interested to hear about it.

Offline MDAL

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Re: Repeat Meniscus Transplants?
« Reply #3 on: August 13, 2014, 08:13:09 AM »
Anything that can post pone a knee replacement at the age of 36 is always a good idea. Meniscus transplants don't last forever (it's not your DNA) and the vascularization and blood supply of the new one will never be the same as the original, and it's a complex surgery, with long recovery time, but the other options are not easy either.

I guess that if your surgeon believes you are a candidate, it's a good option, not an easy or pleasant road, but pushing the PKR / TKR to later should be your goal for now.

Offline GarethNeath

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Re: Repeat Meniscus Transplants?
« Reply #4 on: August 14, 2014, 06:37:36 PM »
Hi, sorry to hear about your knee pain.

Which surgeon in the UK did your medial meniscus allograft?

How did you come to tear the transplanted meniscus plus your medial collateral ligament? Did you have a sporting or other sudden injury or was it just wear and tear?

My mendially un-qualified view is that you cannot go on like you are and your 2 options are:
(a) partial knee replacement
(b) removal of the existing meniscus transplant and it's replacement with a new one. I've not looked into the feasibility of this but it would seem logical that you can have another transplant, assuming they can remove the existing allograft and bone plug they you had put in 5 years ago.

I'm looking at maybe having a lateral mensical allograft myself but I'm reading a lot of unhappy people who have had meniscus transplantation surgery, when it goes wrong it seems to really go wrong.
1996 - Meniscectomy - right knee
1999 - ACL reconstruction left knee
2002 - Meniscectomy - right knee
2004 - Meniscectomy - right knee
2011 - Debridement - right knee

Offline JamieB

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Re: Repeat Meniscus Transplants?
« Reply #5 on: August 17, 2014, 07:39:37 AM »
Hi Gareth,

The surgeon that did my original medial meniscus allograft was Mr Glyn Evans at the London Knee Clinic - he performed this procedure with Mr Angus Strover also of the London Knee Clinic. I understand that Mr Strover has now retired and Mr Evans no longer performs this type of operation so unfortunately I will not be seeing Mr Evans for my next operation but instead have been referred by Mr Evans to Mr Tim Spalding in Coventry who is a meniscus specialist. (Please note that I cannot speak highly enough about Mr Glyn Evans at the LKC - excellent surgeon). I now have a plan of action with Mr Spalding which will involve an exploratory/repair arthroscopy which will serve as a pre-cursor to a repeat medial meniscus allograft later in the year.

My initial allograft with Mr Evans was a complete success and gave me a totally new lease of life - it left me with a knee that felt better than it did when I was 15 years old - my experience was such that I was very grateful to have had the procedure and had 5 years trouble free post op. It is a difficult operation to have due to the arduous recovery regime but in my experience well worth it.

Post recovery, with my shiny new (well, ..... second hand) medial meniscus, my downfall was thinking that I was 18 again and not a 31 year old that had undergone several bouts of major surgery! Field Hockey, Golf, football, road running.......(I can feel readers of this post shaking their heads at this already!)....all the things that I shouldn't be doing.......which has lead me to be in the situation that I am currently in. I have nobody to blame for this other than myself and I believe that if I had been more sensible that I would not be facing my current issues. 

I have also read the stories from unhappy people posting on this site about failed allografts but all I would say is that a) selecting a good surgeon is paramount for a successful procedure, b) for me, the operation left me feeling 100%, and finally c) don't forget that people are more likely to post when they have big issues/problems and less likely to do so when things are a total success and have moved on in their lives.

I hope some of the above helps. I am scheduled for surgery in Coventry at the end of the month so will re-post after the operation.

Offline GarethNeath

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Re: Repeat Meniscus Transplants?
« Reply #6 on: August 17, 2014, 06:30:10 PM »
Hi Jamie,

Thanks for the most useful further info.

Sounds like your wore out your meniscus transplant through exercise. I made the same mistake as you with my original meniscus, I did too much of the wrong types of exercise for years on an acl deficient knee.

I hope to fix up an appointment with Tim Spalding myself in the next month or 2 and will take it from there.

Your comments about the benefits that your previous meniscal allograft brought you are encouraging. How long did it last before you tore it again?

My problem is that I apparently already have arthritis to lateral compartment of knee which doesn't make me an ideal candidate for meniscal transplant but I don't want to give up on my knee.

Good luck for your own op with Tim Spalding, guess you'll be exercising more conservatively after your next operations are done. I've had to give up a lot of things, I just want a knee that isn't going to ache when I go hiking, I don't want to do any contact sports or running, too old for all that now!

Good luck with
1996 - Meniscectomy - right knee
1999 - ACL reconstruction left knee
2002 - Meniscectomy - right knee
2004 - Meniscectomy - right knee
2011 - Debridement - right knee















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