1. Meniscus repairs are not for everyone.
The majority of meniscus tears (>90%) will have to be trimmed out (meniscectomy) because they are not repairable. A meniscus repair is best performed in a young patient (<40-ish), with an acute vertical longitudinal tear, in a stable knee (ligaments intact), in the peripheral 1/2 to 1/3 of the meniscus. Most tears do not fit these criteria.
2. What is the rehab after a meniscus repair?
Afterwards, you will likely need to be on crutches for a few weeks to months, with limitations in terms of bending your knee. Even if the tear is amenable to repair, it may not be the right option if you cannot comply with the post-operative restrictions and rehabilitation. This situation includes athletes who are in-season, want to return to play and cannot wait until the next year. It also includes workers who need to be on their feet and cannot afford to take the time off from their job.
3. Meniscus transplants are not for everyone.
If the majority of the meniscus was not repairable and had to be taken out, then you may be a candidate for a meniscus transplant. These are best performed in a young patient (<40-ish), with a stable knee in correct alignment (not too bow-legged or knock-kneed), with intact articular cartilage, who is having pain with activities. If the cartilage is too worn out or roughened, then it will shred apart the new meniscus. If the knee is malaligned, there may be excessive forces on the new meniscus, causing it to wear out prematurely. You may need an osteotomy to realign your knee in addition to having the transplant. The goal of the surgery is to protect the remaining articular cartilage. It is not meant to allow you to return to high-impact activities, because this will wear out the meniscus.
4. What does the surgery involve?
Your knee will have to be sized with X-rays and a calibration marker so that the tissue bank can find a cadaver meniscus that will fit your knee. The surgery is arthroscopic, but requires a larger incision in the front in order to pass the graft into the joint. The meniscus comes attached with some bone to allow better fixation. Depending on the technique, the bone may be slotted into the knee or it may need to be secured with sutures. There may also be incisions on the sides of your knee to pass sutures to secure the meniscus itself to the joint capsule. The meniscus needs to be secured in the front and back of the knee.
5. What is the rehab after a meniscus transplant?
Physical therapy is very important so that your knee does not become stiff. You are on crutches for about 2-3 months. Generally, you cannot bear weight on that knee for the first month, to allow the bone block and meniscus to heal. After that, you can put some weight on the knee with support. Also, your bending may be restricted for a period of time. Again, if your situation does not allow you to comply with these restrictions, this may not be right for you.
