Meniscal transplantation is a fairly major complex procedure. The surgery is not ‘big’ in terms of the size of the incisions, but the surgery is quite long (about 2 hours for an isolated meniscal transplant, longer if other concomitant procedures are undertaken at the same time) and it is a highly technically demanding.

There is only a small handful of surgeons in the UK who have undertaken any significant number of meniscal transplants and who have proper experience in this procedure.

There are a variety of different surgical techniques that are used for meniscal transplantation, ranging from wide open surgery to keyhole, and from the use of large bone blocks to soft tissue fixation only. The technique that is favoured by most expert meniscal transplant surgeons involves minimally invasive keyhole surgery with fixation of the allograft to the bone of the tibia by transosseous sutures, as follows:

  • First, an arthroscopy is performed and whatever remaining meniscal tissue might be present is trimmed back to the peripheral meniscal rim (preserving a thin rim of tissue if possible) and freshened up. The rim is then ‘trephined’ (lanced repeatedly with a needle) to create multiple bleeding ‘vascular channels’, to promote healing of the graft to the rim.
  • Super strong ‘stay sutures’ are then tied separately through the anterior and posterior insertional ligaments.
  • Bone tunnels are drilled from the front of the tibia up into the knee into the site of attachment of each of the insertional ligaments to the surface of the tibia in the knee.
  • The meniscal allograft is passed into the knee through a 1.5 to 2cm incision.
  • The insertional ligament stay sutures are passed down each of the tibial tunnels and tensioned. The sutures are then tied under tension through tiny metal suture buttons on the surface of the bone of the front of the tibia.
  • The meniscus is then stitched around its periphery to the meniscal rim remnant and/or the capsule (the lining) of the knee joint.
  • Mr McDermott then uses Vivostat PRF biological glue to seal the gap between the peripheral edge of the meniscal allograft and the rim/capsule of the patient’s knee and to cover over the insertional ligament sutures and tunnels, in order to promote healing.
  • The incisions at the front of the knee are then closed with skin stitches. (This surgery can normally be performed through just 3 small incisions at the front of the knee.)
  • Patients are kept in hospital overnight after this surgery, and most people are then able to leave hospital the following morning.