Our Summary

This research paper discusses the challenges and potential solutions for young, active patients suffering from pain after a partial or total meniscectomy, a surgical procedure to remove part or all of a damaged meniscus in the knee. This post-surgery pain, known as “post-meniscectomy syndrome,” affects 4-25% of patients and is caused by increased stress and overload on the knee’s cartilage.

One treatment option mentioned in the paper is Meniscal Allograft Transplantation (MAT), which involves transplanting a meniscus from a donor. This procedure can be beneficial for some patients, especially those under 50 years old with no degenerative changes or correctable instability. However, it has downsides, including cost, difficulty in obtaining donor tissue, and its technical complexity.

The paper also discusses the use of meniscal scaffolds, which have been commercially available since the early 2000s. These are artificial structures inserted into the knee to support tissue growth. While they have generally led to clinical improvement, over time, they often show signs of radiological failure. Despite this, recent research indicates that a specific type of scaffold made from polyurethane can last for a long time in carefully selected patients.

Although these scaffolds have not been proven to protect cartilage, they could serve as a temporary solution before a patient undergoes MAT or a joint replacement operation.

FAQs

  1. What is “post-meniscectomy syndrome” and how often does it occur?
  2. What is Meniscal allograft transplantation (MAT) and who is it typically suitable for?
  3. What is a meniscal scaffold and what are the potential issues with its use?

Doctor’s Tip

A helpful tip a doctor might tell a patient about meniscectomy is to follow their post-operative rehabilitation plan carefully. This may include physical therapy exercises to strengthen the muscles around the knee and improve range of motion. It is important to follow these instructions to support healing and prevent further complications.

Suitable For

Patients who are typically recommended meniscectomy are those who have a torn meniscus that is causing significant pain, swelling, and limited range of motion in the knee. Meniscectomy may be recommended for patients who have not responded to conservative treatments such as rest, physical therapy, and anti-inflammatory medications.

Patients who have a meniscal tear that is causing locking or catching of the knee joint may also be recommended for meniscectomy. This is because a torn meniscus can interfere with the normal motion of the knee joint, leading to these symptoms.

Additionally, patients who have a large tear in the meniscus that is not amenable to repair may be recommended for meniscectomy. In some cases, a meniscal tear may be too large or in an area of poor blood supply, making it difficult to repair surgically. In these cases, meniscectomy may be the best option to relieve symptoms and improve knee function.

Overall, the decision to recommend meniscectomy is based on the individual patient’s symptoms, the size and location of the meniscal tear, and the patient’s overall health and activity level. It is important for patients to discuss their treatment options with their healthcare provider to determine the best course of action for their specific situation.

Timeline

  • Patient experiences knee pain and functional limitations after subtotal or total meniscectomy
  • Diagnosis of “post-meniscectomy syndrome” is made, indicating increased contact stresses and overload of the articular cartilage in the knee compartment
  • Meniscal allograft transplantation (MAT) is considered for patients under the age of 50 with no degenerative change, instability, or malalignment
  • Meniscal scaffolds are used as an alternative treatment option, showing clinical improvement but potential radiologic failure over time
  • Some patients may experience long-term survivorship with a polyurethane scaffold, serving as a bridge to MAT or arthroplasty.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with meniscectomy surgery?
  2. What is the expected recovery time and rehabilitation process after meniscectomy?
  3. Will I need physical therapy after the surgery, and if so, for how long?
  4. How soon can I return to my normal activities and exercise routine after the surgery?
  5. Are there any alternative treatments to meniscectomy that I should consider?
  6. What are the chances of developing post-meniscectomy syndrome after the surgery?
  7. Would I be a candidate for meniscal allograft transplantation or a meniscal scaffold in the future if needed?
  8. How long do the results of meniscal allograft transplantation or a meniscal scaffold typically last?
  9. What are the costs associated with meniscectomy surgery and any potential follow-up procedures?
  10. Are there any specific lifestyle changes or precautions I should take after the surgery to prevent further knee problems?

Reference

Authors: Shubert SB. Journal: Arthroscopy. 2024 Apr;40(4):1262-1263. doi: 10.1016/j.arthro.2023.10.034. Epub 2024 Jan 11. PMID: 38219122