menuResults and Frequently Asked Questions
Meniscal Allograft Transplant
Over 140 procedures have now been undertaken and University Hospital Coventry and Warwickshire NHS Trust remains the leading referral centre for the UK. Mr Spalding and Mr Thompson now have over 10 years’ experience of the technique and through continued analysis and lecturing internationally the team is one of the leading centres in the world.
9 out of 10 procedures have been successful with patients experiencing less pain feeling more active. Only 1.5% have failed when the joint is not significantly worn but some patients have had minor problems of swelling or pain from the stitches holding the meniscus in place resulting in the need for further minor surgery
When Meniscal Transplantation is performed as part of a biological treatment program for patients with advanced wear in the knee then the risk of re-tearing the graft is higher. Each patient is carefully considered and a treatment program is individualised in this situation.
Frequently Asked Questions
How long will I have to wait for a donor meniscus to be found?
Waiting time depends on the availability of a graft. This time can be between six to twelve months. Once a graft has been identified then we tend to plan two - three months ahead giving you as much notice as possible. The graft is frozen in a tissue bank and there is then no urgency to use it. It lasts for a few years.
How will you know the result of the operation?
We are very keen to know exactly how you get on. We ask all our patients to complete a short series of questions before the operation and then at set times after. We contact you by email and so far we have only lost contact with two patients out of over 150 - we hope you agree to be part of this evaluation as its the only way to better inform other patients
What are your results?
We have now undertaken over 160 meniscal transplants, the most in UK, and the results really depend on how worn the knee is to start with. Broadly speaking 8 out of 10 are very happy with the result. When the knee surfaces are still good then currently the failure rate by the graft re tearing is only 3%, but it is higher if the surfaces are worn down to bare bone. This risk clearly needs to be discussed before surgery.
Do you do any other surgery at the same time?
Yes - it is very important to correct any problem with the knees not being straight (bow legged or knock kneed) if this is putting more load on the damaged side. The leg needs to be straightened by carefully reshaping the bone around the knee.
If the knee is unstable do to damage to the anterior cruciate ligament (ACL) then this can be rebuilt at the same operation.
How long will I be off work after surgery?
This clearly depends on your work and whether you have a sedentary of an active job. Following surgery you are on crutches taking no weight on the operated leg for six weeks then building up to full weight bearing by about 8 weeks. You could return to desk based work from two to three weeks, prolonged standing work by 3 months, manual work with load carrying or ladder work by 4-6 months but for more active work such as police, security or military type work, we recommend nine months rehabilitation prior to a return to full duties.
How long will I be in hospital for?
You are usually in hospital one to two nights after surgery. Post op rehabilitation will be back in your home area following our detailed plan given to you.
What contact is required with you and your team after the operation?
We see you back in clinic at six weeks, three months, six months and a year. One of the research team will also follow up with you at regular intervals to ascertain your progress and collect information on your current activity levels.
What is microfracture? [NOT ROUTINE IN MENISCAL TRANSPLANT SURGERY ALTHOUGH OFTEN COMBINED WHEN AN AREA OF SURFACE DAMAGE IS PRESENT]
We sometimes treat the joint surface damage using the technique of microfracture to try and stimulate new growth. This makes small holes in the surface of the bone allowing bone marrow stem cells to repair the surface. This is one way to try and encourage repair of the bare bone area.
You say I have a badly damaged knee with worn surfaces. Will this surgery fail?
Anything we are doing is an attempt to try and salvage the situation with your knee, by putting in a new cushion and resurfacing the knee with a microfracture procedure. Hopefully this will give you a good functional result but you will still obviously need to look after the knee as it is not ‘normal’. If we can get 10–15 good years out of the knee after surgery then that would be excellent. There is always the chance that you will not get a good functional result. As I am sure you are aware the end result of a worn knee is a metal and plastic new surface but hopefully with our biological techniques we can postpone the need for that.
Can I return to sport after my surgery?
The main goal of meniscal transplantation surgery is to preserve the joint surfaces. Returning to high sporting activity is not the ideal end stage outcome. Non-impact sports such as swimming and cycling are preferable, although you may feel that higher activity levels are possible. At this stage you must consider the higher risks of re-injury to the transplanted meniscus and joint surfaces upon return to sport. Its a bit like trying to conserve your tyres by not driving fast corners all the time.
