Meniscal Transplant Surgery in Children and Adolescents

Meniscal transplant surgery replaces a severely damaged or missing meniscus with meniscal tissue from a donor. The meniscus is cartilage that sits between the tibia (shinbone) and femur (thighbone) and serves as a shock absorber between these bones.

The goal of meniscal transplant surgery in children is to prevent early arthritis and, in many cases, postpone or eliminate the need for knee replacement surgery. Without the cushioning of a meniscus, the tibia and femur rub against each other, which can lead to arthritis within 10 years.

Most meniscal injuries in children and adolescents aren’t severe enough to make replacing the meniscus necessary. When they are, the damage is typically due to:

• Severe discoid meniscus, a condition in which the meniscus is abnormally shaped, causing pain and limiting mobility. A simple surgery can usually correct painful discoid meniscus, but in rare cases, the surgery is not successful.
• Sports injuries, falls, and accidents that severely damage the meniscus.

Meniscal transplant surgery is a minimally invasive arthroscopic procedure that usually takes about two hours. Your child will be placed under general anesthesia. Orthopedic surgical teams at Boston Children’s Hospital use nerve blocks whenever possible to minimize our patients’ exposure to anesthesia and speed their recovery.

During the operation, your child’s surgeon will:

• Use a type of X-ray called fluoroscopy to ensure your child’s growth plate remains undisturbed throughout the operation
• Insert a small camera into an incision near your child’s knee to look for and repair any signs of tissue damage
• Insert the new meniscus, which will have been sized to your child’s knee
• Stabilize the meniscus in place with stitches. Over time, the new meniscal tissue will naturally adhere to your child’s knee and the stitches will dissolve

Because the procedure is performed through small incisions, children typically recover quickly. Recovery from meniscal transplant surgery usually looks like this:

• Physical therapy (PT) beginning right away
• Crutches and possibly a knee brace for six weeks
• Return to activity four to six months after surgery

After meniscal transplant surgery, your child should avoid high-impact sports that could put strain on the new meniscus. Your child’s doctor will talk with you and your child about which activities they can safely participate in.

Your child will have a follow-up appointment six months after the surgery and then once a year as long as they continue to grow. This allows your child’s doctor to monitor the health and growth of your child’s leg and knee with the transplant.

Meniscal transplant surgery may be an option for children at risk of developing arthritis in their teens or early adulthood. Indications include:

• Knee pain and limited mobility after meniscectomy (a procedure to remove the damaged part of a torn meniscus)
• Extensive meniscal damage associated with ACL injury
• Little or no sign of arthritis in the bones around the knee that could tear the new meniscus

Traditionally, meniscal transplants were only performed on adults. Until recently, they were not considered for growing children due to concerns about:

• Potential for injury to the growth plate, which could cause the leg to stop growing or to grow crooked
• Failure of the donor meniscus to grow with the knee

In 2010, orthopedic surgeons at Boston Children’s Hospital modified the procedure to address these concerns. While growing children rarely have meniscal damage severe enough to need a meniscal transplant, the operation is now an option for them.

Other risks include:

• Stiffness
• Incomplete healing
• Bleeding
• Infection
• Damage to nearby nerves and blood vessels

For a child whose function and mobility are limited by a severely damaged or missing meniscus, the benefits of meniscal transplant include:

• Ability to live an active life
• Freedom from pain
• Reduced risk of early arthritis
• Ability to delay or eliminate the need for knee replacement surgery

Because many knee replacements need to be replaced after 15 to 20 years, maintaining the knee for as long as possible may eliminate the need for a second knee replacement later in life.

Orthopedic surgeons at Boston Children’s Hospital successfully performed the first meniscal transplant on a growing child in 2010 after modifying the procedure to protect the growth plate. Since that first transplant, we have continued to refine the procedure and conduct extensive research on patient outcomes. Today, children and adolescents with significant meniscal damage travel to Boston Children's Orthopedics and Sports Medicine Department from around the country for the operation.