CINCINNATI -- You’re exercising or playing sports. As you dart down the field or make a sudden turn or twisting motion on the gym floor, your knee gives out. You might even feel a popping sensation as it happens.
Chances are, you’ve just torn a meniscus, one of the most common injuries in sports medicine.
“There are over 700,000 meniscus injuries a year,” said Dr. Frank Noyes, medical director of Mercy Health–Cincinnati SportsMedicine and Orthopaedic Center in Montgomery. “It (a torn meniscus) occurs all the way from junior high school to high school to college or in any active person.”
The meniscus is a wedge of cartilage that cushions the knee joints. Humans have two menisci in each knee.
“Without the meniscus, it’s like driving your car without shock absorbers,” said Noyes. “And it produces arthritis in 10 to 15 years.”
Now, Noyes has released new research that provides insight for patients who are considering a meniscus transplant because their meniscus is damaged beyond repair.
“Meniscus transplants are not an experimental procedure anymore. We do have a track record,” said Noyes. “I can tell the patient that 70 percent of the time I can get rid of most of your knee pain … for seven to eight years.”
Before considering a transplant, Noyes said doctors will try everything possible to save the natural meniscus and postpone the need for a knee replacement. “We’re trying to extend the life of the knee,” he explained.
Using meniscus transplants to extend the life of the knee
Doctors can repair large tears in the meniscus with sutures.
“We can save four out of five menisci,” said Noyes. “There are very good repair techniques that we can now perform, many arthroscopically, to save the meniscus.”
Doctors can treat smaller tears without surgery. However, in some young patients, the meniscus is torn so badly that surgical treatments don’t work anymore. They suffer pain with every step. For these patients, Noyes suggests a meniscus transplant, because they’re too young for a knee replacement.
“The meniscus transplant is designed for those younger individuals, less than 50 years of age, when they've had to have the meniscus completely removed,” explained Noyes.
In a meniscus transplant, the surgeon implants a meniscus from a donor cadaver into the patient’s knee joint through two small incisions.
“It has to be meticulously placed into the joint. It’s sutured into place, commonly as an outpatient. You start immediate motion.”
Noyes has performed meniscus transplants for more than two decades. For his study, published in the Journal of Bone and Joint Surgery, he tracked 38 patients for an average of 11 years.
“We’ve found that it will help 70 percent of the patients and extend their knee joint for up to 10 years,” Noyes said.
The downside is that the meniscus implant will not work in 30 percent of patients. Even successful implants will eventually fail, and a second transplant may be needed to extend the life of the knee.
“Many times we’ll have to come back after seven to 10 years,” said Noyes. “I always say it’s like a brake pad in your car. I have to put another pad into the knee joint, but again, that’s better than having a partial replacement.”
The idea with meniscus transplants is to extend the life of the knee, allowing patients to walk without pain for as long as possible, until a partial or full knee replacement is needed.
“The results of this study are beneficial for patients because they know what to expect,” said Noyes. “It’s beneficial for surgeons as to whether they recommend the procedure.”
Different risk for older patients
Noyes noted that older patients, usually over age 50, often experience another type of meniscus injury, degenerative tears, which occur as the cartilage weakens over time. Not all older patients require surgery, but, if arthritis and pain become major issues and other treatments fail, doctors might consider a partial or full knee replacement.
- Contact Mercy Health–Cincinnati SportsMedicine and Orthopaedic Center: 513-347-9999 or www.cincinnatisportsmed.com. There are five locations around the Tri-State.
- Read Dr. Noyes’ article on meniscus transplants in the Journal of Bone and Joint Surgery (account required for access to full text): jbjs.org/content/97/15/1209.