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Q:
I would like to know how the Collagen Meniscus Implant trials in the FDA clinical trials are going. I have had about half of my meniscus removed and have been in pain ever since. I see the CMI as a hopeful way of restoring my lost meniscal function.
Answered by
Jack Farr M.D.
on November 12, 2001
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A:
The Collagen Meniscal Implant study is proprietary. The first question you need to address is the extent of your "partial meniscectomy." That is, if the half that is missing represents the entire posterior horn, then from a biomechanical standpoint the entire meniscus is absent. On the other extreme, if the one half is missing represents the central one half of the entire rim, there is both better biomechanical function and this is an "avascular" area which would poorly heal – natural meniscus, CMI or meniscal transplant. The next major question is: are you symptomatic and, if so are there other problems such as chondrosis, malalignment and ligament instability? These are an excellent starting point for discussions with your doctor.
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Q:
I am a 33 year-old male about to undergo my eighth knee surgery. I have had five arthroscopies and 2 ACL reconstructions (first one in 1989 using synthetic material, second in 1997 using patellar tendon graft) on my right knee. The present status of my right knee is as follows: No medial meniscus, no ACL (1997 graft failed), patellar tendonitis, arthritis (mild) and possible tear of lateral meniscus. My orthopaedic surgeon has recommended a meniscal allograft along with an ACL reconstruction. What is the success rate of this combined procedure? Are donor grafts as strong as a person's own body tissue? What is the best type of donor graft: fresh, fresh-frozen or cryogenically frozen? Any drawbacks from any of these grafts?
Answered by
Jack Farr M.D.
on November 12, 2001
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A:
Meniscal transplants have a good intermediate track record for pain relief if used in the proper setting. The knee must be stable, so a concomitant ACL revision is necessary unless performed earlier. It is easier on the patient to have the surgeries combined. Of great concern is the amount of "arthritis." The meniscal transplant needs to have an optimal environment and thus the articular cartilage should typically have no more than mild chondrosis (grades one and two per the ICRS standards: www.cartilage.org) or, if more involvement is noted, then there is the option of concomitant articular cartilage restoration. The success also depends on normalizing alignment and optimizing body weight and lower extremity strength. Donor tissue is not normal and most studies have a certain re-tear rate. The most commonly used graft is a fresh frozen or cyropreserved that is NOT irradiated.
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Q:
I have been playing basketball for a number of years now. I have had two tears to my left knees Lateral Meniscus in which my Dr. has gone in and either shaved the piece off or smoothed up what he calls some of the hard Teflon coating of my knee. Recently, I played a pickup game (and) my knee gave me the worst pain on the outside. I have heard that there may be a new procedure to extend the life of a knee by replacing the meniscus with one from a cadaver.
Answered by
Jack Farr M.D.
on November 12, 2001
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A:
After meniscectomy the lateral side has more problems with degeneration than the medial, if all other things are equal (for example, alignment). It appears your doctor documented involvement of the articular cartilage, verifying this degeneration. Meniscal transplantation has good intermediate term outcomes for pain relief, while the effect on the articular surface in the long term remains under study. Certainly, your knee deserves evaluation. Understand that all aspects of the knee must be addressed for an optimal outcome. That is, you must have a stable well aligned knee with restorable articular cartilage and should have excellent musculature and normal body mass index.
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Q:
I've been told that I need a menisectomy to repair a tear in my knee. Does this surgery lead to arthritis? Is there some way I can prevent arthritis in the knee after this surgery?
Answered by
Louis Meeks M.D.
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A:
Surgery does not lead to arthritis; it is the mechanical derangement within the knee for which surgery is necessary or recommended. If not cared for, it will cause post-traumatic arthritis of the knee.
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Q:
I am having a meniscal transplant. Can you describe this type of surgery and what it may entail for my rehabilitation?
Answered by
Louis Meeks M.D.
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You should discuss the upcoming procedure and rehabilitation with your orthopedic surgeon.
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Q:
What is the treatment of meniscal cysts and how often do they reoccur?
Answered by
Louis Meeks M.D.
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A:
Treatment for recurring meniscal cysts is usually an arthroscopic approach to the meniscal tear and attempt at removal of the cyst. It is not uncommon for cysts to recur in the lateral compartment. Often it is necessary to have an open excision of the meniscus rim and the cyst.
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Q:
I have medial and lateral meniscal tears in my right knee. My knee is slightly unstable, but the pain is decreasing and I can walk normally (with some pain) as long as I use a neoprene brace. There is no cartilage damage. Can I avoid surgery? Will physical therapy help?
Answered by
David Golden M.D.
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A:
Meniscal damage is a type of cartilage damage. The cartilage damage, to which you are referring, when you state no cartilage was damaged, is the articular cartilage. That is the cartilage that, if injured, leads to arthritis. Meniscal tears vary tremendously. Different areas of the meniscus have different blood supplies. The greater the blood supply, the greater the chance of healing the meniscus. Sometimes, a meniscal injury can be surgically repaired, depending on the size and, more importantly, the location of the injury. The meniscus is also capable of healing on its own. If your meniscal injury is in a location that is amenable to healing, surgery may be avoided. Bracing and therapy may help condition the knee if recovery is possible without surgery. Your doctor will recommend the appropriate treatment based on the location and type of meniscal tear that you have sustained. The type and aggressiveness of the therapy is individualized to your injury.
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Q:
My doctor diagnosed me with a meniscal tear. After about three months, a surgeon operated and found that my articular cartilage was deteriorating as well. Could the meniscal tear and the amount of time before the operation cause this deterioration? Will this injury ever heal itself?
Answered by
David Golden M.D.
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A:
It is possible that the articular cartilage is affected by injury to the meniscus. After only three months, it is unlikely that the meniscal injury was the only cause of the articular cartilage damage. The amount of damage depends on your age and the mechanism by which you sustained injury to the cartilage. The meniscus provides stability to the knee, and without it, damage to the articular surface may occur. Sometimes, they can both be injured. Surgery may help to heal the meniscus, but the articular surface cannot be changed. Arthroscopic surgery can remove painful areas of the articular surface but new articular cartilage will not grow back to replace it.
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Q:
I am a 38-year-old male who had the lateral meniscus removed from my right knee at age 17. Consequently, my knee is severely arthritic. I have been told that I should eventually have the knee replaced, but that I'm too young now. I used to be very active, but am now restricted in what I can do. Are there any treatments available that may help me?
Answered by
David Golden M.D.
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A:
There are various treatments, but it depends on the condition of your knee and the disability it causes. A change in activity level can greatly decrease pain. With severe arthritis, intense or impact activities should be decreased or stopped. Talk to your doctor about different options. Depending on the appearance of your x-ray, your doctor may consider a realignment surgery to take the pressure off the area of the knee that is arthritic. There are also various types of joint replacement, including partial knee replacements, which may spare as much of your native knee as possible. Arthroscopic surgery may also be considered to determine the damage within the area of arthritis and whether it is amenable to a type of cartilage treatment. The reason you are “too young” for a knee replacement is because the synthetic components of the replacement wear out over time, and you would need additional surgeries because of continued wear and tear. Be sure to investigate all options with your surgeon.
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Q:
I am having a meniscal transplant. Can you describe this type of surgery and what my rehabilitation may entail?
Answered by
David Golden M.D.
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A:
A meniscal transplant replaces your native meniscus. The function of the meniscus is to provide cushioning, support and stability for the knee. After a transplant, your surgeon will limit the activity of the knee. Weight bearing will be modified for a few weeks to a few months and you will likely work with a physical therapist to regain range of motion. During the procedure, a surgeon will suture a meniscus to the periphery of the inside joint capsule. It is tailored to fit your knee during the operation. The location of the incision can vary but will be on the front of the knee. Be sure to ask your surgeon about the postoperative protocol for rehabilitation.
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