The meniscus is a pliable substance that sits between two bones in the knee joint, the femur (thigh bone) and tibia (shin bone). Some patients with meniscus tears can be treated with a combination of activity modification and a focused physical therapy program. Some patients who have had previous meniscus surgery may develop pain and instability due to limited functioning meniscal tissue. In such patients, Dr. Welch may recommend a meniscal transplant. A meniscal transplant involves transferring a healthy meniscus from a donor and securing it to the patient’s knee where the meniscus is deficient.
Dr. Welch prefers a “bone-plug” technique for meniscus transplantation. Prior to surgery, Dr. Welch measures the size of the deficient meniscus using x-rays and/or an MRI. A donor with a similar sized meniscus is identified and the tissue is cleaned and prepared appropriately prior to surgery. During surgery, Dr. Welch positions the donor graft in the knee and secures the bone part of the graft to the tibia bone with a medical screw (interference screw). Next, Dr. Welch uses a suture-passing device to attach stitches form the donor meniscus to the capsule (a soft tissue pouch that surrounds the knee). The stitches are then secured with square knots. These stitches help stabilize the meniscus and keep the meniscus in the appropriate position during the healing phase.
Following surgery, patients are placed in a hinged brace that is locked straight. Dr. Welch recommends partial weight bearing for 4-6 weeks in the brace. When the patient is sitting or lying down, Dr. Welch encourages knee range of motion from 0-90 degrees with the brace removed for the first few weeks after surgery. Dr. Welch also recommends intermittent icing and straight leg raise exercises to strengthen the quadriceps muscles. Dr. Welch recommends starting physical therapy two weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee. Most patients can start full weight bearing on the affected leg 4-6 weeks after surgery. Most patients start cutting activities and sporting activity approximately 4-6 months after surgery.