A study that has been published in the Journal of Bone and Joint Surgery is revealing that patients under age 50 who have a torn or damaged meniscus will have lessened pain and improved knee function after a meniscal transplant. The only bad news about doing the surgery on a patient that is under 50-years-old is that many of those patients need another surgery within 10 years.
A lot of people don’t even know what the meniscus is, but it is the wedge-shaped piece of fibrocartilage in the knee that basically is a shock absorber between the thighbone and shinbone. A torn meniscus can be the result of a sports injury or it can just wear out over time as the body gets older and starts to break down. Younger patients who have knee pain are the prime candidates for the meniscus transplant, since this can help maintain the cushion between the two bones, helps stabilize the joint, can allow for mobility, and it can also help prevent persistent pain in the knee. The knee surgery is performed by a orthopaedic surgeon using an arthroscope, which helps accurately place the new transplanted meniscal tissue, and then it is stitched up.
The researchers followed 38 different meniscal transplant patients who were all under age of 50 and none of them suffered from arthritis at the time of the study. The researchers followed these patients for about 11 years after their surgery, and then patient outcomes were evaluated based on subjective, clinical, and radiographic measurements. The researchers found that 63 percent of the meniscal transplants were viable at 10 years after the operaton, with only 11 percent of patients suffering from pain when engaging in daily activities. The study showed that 72 percent of patients were able to participate in low-impact sports, such as swimming and bicycle riding. The patients that required additional surgery ended up only having a viable initial transplant of around 7 or 8 years, meaning that after 8 years following the initial surgery, the meniscal transplant began to breakdown. One of the interesting parts about this was that the viability in these patients depended upon which knee the meniscus transplant was performed on.
The lead researcher and study author was Frank R. Noyes, who is the founder of the Noyes Knee Institute at the Cincinnati Sports Medicine & Orthopaedic Center. Noyes said that this data can help provide surgeons with percentages that help them know when additional major surgeries will need to be performed in the patients with a meniscus transplant. The longer-term functionality of meniscus transplants still remains questionable though, since the surviorship rate of the transplants decreases with age. This means that the success rate of the transplants decreases from 40 percent to 15 percent when you get to around 15 years after the surgery. Some patients think that having a meniscus transplant is a long term final solution to their knee pain and problems, but this is just not the case. Dr. Noyes points out that the patients need to be aware of the fact that more surgeries will likely be needed in the future, especially if the patient was in their 20s or 30s when the initial transplant happened. This study shows that the success rate and viability of the transplant is around 10 years, so if a patient is not aware that after 10 years things start to get dicey, then they will be in for a surprise when 13 years down the road they are faced with yet another major surgery to repair the meniscus. The good news from this study though is that the meniscus transplant does relieve most of the pain surrounding the knee in the patients who are under age 50, and this can significantly help these patients have a normal quality of life with minimal medications or therapy.
For the younger generations, a meniscal transplant might just be the best course of action so that they can continue on with their lives and also still participate in the low-impact sports, although they will likely not be able to participate in the more intense sports, even years after the surgery. If the patient does try to participate in some of the more intense sports, they are risking needing another surgery within a few years, since that increases the odds of the transplant breaking down in the knee, and they can basically injure the knee all over again. The best piece of advise that doctors can give patients regarding the surgery is that while it can help minimize pain and get them back to a normal lifestyle, they will end up more likely needing other surgeries, and the younger the person is the more surgeries that likely will be in their future. It is not known yet though why sometimes it depends on the knee that the transplant was done on, as far as why some people ended up only lasting 7 years before another surgery was needed. More research will be needed to determine how the left and right knee varies in terms of longevity of the transplant or whether or not the dominate side of the body is more prone to early breakdown.