Meniscal transplantation vs physiotherapy

https://pubmed.ncbi.nlm.nih.gov/29305451/

Evidence base

Smith NA, Parsons N, Wright D, Hutchinson C, Metcalfe A, Thompson P, Costa ML, Spalding T. A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. Bone Joint J. 2018 Jan;100-B(1):56-63. doi: 10.1302/0301-620X.100B1.BJJ-2017-0918.R1. PMID: 29305451.

Key points

  • Meniscal transplantation improves pain and function more than physiotherapy at one year
  • The average improvement is around 10 to 20 points greater on validated knee scores
  • Physiotherapy still provides benefit and remains an important treatment option
  • Surgery carries higher risk and should be carefully considered
  • Ongoing research will further define which patients benefit most

What does the evidence show?

We conducted one of the first studies directly comparing meniscal transplant surgery with specialist physiotherapy for patients who have ongoing pain after losing part or all of their meniscus.

Why is this important?

The meniscus is a key structure that helps distribute load across the knee. When it is lost, contact pressures increase, which can lead to pain, reduced function, and a higher risk of developing arthritis.

Meniscal transplantation aims to restore this function and improve symptoms. Until recently, there had been no direct comparison between surgery and high-quality non-surgical treatment.

What did the study involve?

We studied 36 patients with a symptomatic meniscus-deficient knee.

Patients either:

  • were randomly allocated to meniscal transplant surgery or a structured physiotherapy programme, or
  • chose their preferred treatment and were followed in the same way

Outcomes were assessed over 12 months using validated knee scores that measure pain, function, and quality of life.

What were the results?

At 12 months, patients who had meniscal transplantation improved more than those treated with physiotherapy.

  • Overall knee score (KOOS4) improved by around 12 points more in the surgery group
  • Pain improved by around 15 points more with surgery
  • Function in daily activities improved by around 18 points more with surgery

These differences are considered clinically meaningful and suggest a real benefit from surgery in appropriately selected patients.

Other areas such as sport and quality of life also improved more after surgery, although these differences were smaller.

Patients treated with physiotherapy also improved, confirming that this remains a valuable treatment option.

Risks and considerations

Meniscal transplantation is a surgical procedure and carries some risks.

In this study:

  • There were 5 complications in the surgery group
  • There was 1 complication in the physiotherapy group

Most surgical complications were manageable, but this highlights the importance of careful patient selection.

Physiotherapy avoids surgical risk but may not provide the same level of improvement for all patients.

What does this mean for you?

Meniscal transplantation can provide meaningful improvements in pain and function, particularly in younger, active patients with ongoing symptoms after meniscus loss.

Physiotherapy remains an important first step and may be sufficient for some patients.

The right treatment depends on:

  • your symptoms
  • your activity goals
  • the condition of your knee

Ongoing research

This study was designed as an early step to better understand the role of meniscal transplantation.

We are now leading a large national study, the METEOR 2 trial, which aims to provide more definitive answers by comparing meniscal transplantation with non-surgical treatment across multiple centres.