Meniscal Transplantation

A specialist procedure to restore the meniscus, reduce pain, and improve function in the meniscus-deficient knee.

Meniscal Transplantation – Key Points

• Meniscal transplantation is used for patients who have ongoing pain after previous removal of part or all of the meniscus
• The meniscus is a cushion in the knee that helps transmit load evenly through the joint
• This procedure aims to improve pain and function and restore more normal knee mechanics
• It is most commonly considered in younger, active patients with a symptomatic meniscus-deficient knee
• In selected patients, it can allow return to higher levels of activity
• Recovery is gradual, with return to sport at 12 months, once clinically cleared

What is a meniscal transplant?

Knee compartment without meniscus

Knee compartment following meniscal transplant

A meniscal transplant involves replacing a missing or severely damaged meniscus with a donor (allograft) meniscus.

The meniscus is an important structure within the knee. It acts as a cushion and helps transmit load evenly across the joint. When the meniscus has been removed, the knee can become painful and less able to tolerate activity, and the joint may be at greater risk of further wear over time.

Meniscal transplantation is designed to restore meniscal function and improve symptoms in carefully selected patients.

Who is this procedure for?

Meniscal transplantation is typically considered in patients who:

• Have previously had part or all of their meniscus removed
• Continue to experience pain in the affected side of the knee
• Are relatively young and active
• Do not yet have advanced arthritis throughout the knee

It is particularly useful in patients who remain limited by a painful meniscus-deficient knee despite appropriate rehabilitation and activity modification.

What are the benefits?

Potential benefits of meniscal transplantation include:

• Improvement in pain
• Improved function and ability to remain active
• Restoration of more normal load transmission within the knee
• Protection of the joint compared with leaving the knee meniscus-deficient

For many patients, the aim is to improve quality of life and preserve the knee for as long as possible.

How does it compare to other treatments?

For patients with a meniscus-deficient knee, treatment options are often limited.

• Physiotherapy can help symptoms, but it does not replace the missing meniscus
• Further trimming surgery is usually not beneficial once the meniscus is already deficient
• Knee replacement is generally not appropriate in younger patients

Meniscal transplantation offers a reconstructive option in patients where other treatments may not adequately address the underlying problem.

Meniscal transplantation and cartilage damage

Meniscal transplantation is most predictable when the surrounding joint surfaces are well preserved. However, some patients have already developed cartilage damage by the time they are assessed.

Our research has shown that even in patients with substantial cartilage damage, meniscal transplantation can still lead to a sustained improvement in patient-reported outcomes, although graft survival is lower than in knees without major cartilage damage. This can be helpful when counselling patients with more complex knees.

Return to sport

Historically, there has been concern that returning to high-level sport after meniscal transplantation might increase the risk of failure.

Our published work has shown that patients who returned to competitive sport after meniscal transplantation had excellent medium-term graft survival and superior patient-reported outcomes, with no evidence of increased graft failure compared with those who did not return to competitive sport.

This information is important for active patients considering surgery and helps guide realistic expectations after recovery.

Surgical approach

Meniscal transplantation is performed using keyhole (arthroscopic) surgery, often with small additional incisions.

The operation involves:

• Preparing the knee and assessing the joint surfaces
• Inserting a carefully size-matched donor meniscus
• Securing the transplant to the bone and surrounding soft tissues

In some patients, additional procedures may be needed at the same time, such as:

• Ligament reconstruction
• Osteotomy (realignment surgery)
• Cartilage treatment

This is determined on an individual basis depending on the condition of the knee.

Recovery and rehabilitation

Recovery following meniscal transplantation is gradual and carefully structured to protect the transplant while restoring strength and function.

• Crutches are typically required for approximately 4–6 weeks
• Weight-bearing is progressed gradually under guidance
• A structured physiotherapy programme is essential throughout recovery

Most patients can expect:

• Return to low-impact activities by around 3–4 months
• Return to sport at 12 months, once clinically cleared

Recovery timelines vary depending on individual factors, including any additional procedures performed and progress with rehabilitation.

Expected outcomes

Most patients can expect meaningful improvement in pain and function following meniscal transplantation.

Outcomes depend on a number of factors, including:

• The condition of the cartilage
• Alignment of the knee
• Ligament stability
• Previous surgery
• Adherence to rehabilitation

Meniscal transplantation is a specialist procedure, and careful patient selection is important in achieving the best possible outcome.

A specialist, evidence-based approach

Mr Smith has one of the largest meniscal transplant practices in Europe and has published widely on the outcomes of meniscal transplantation. His work includes prospective outcome studies and randomised trial research in this area. The aim is always to combine specialist surgical expertise with evidence-based decision-making to deliver the best possible care for each patient.

Is meniscal transplantation right for you?

Meniscal transplantation is a highly specialised procedure and is not suitable for everyone.

A detailed assessment, including imaging and clinical examination, is essential to determine:

• Whether your symptoms are due to meniscus deficiency
• Whether a transplant is appropriate
• Whether any additional procedures are needed
• What outcome you can reasonably expect