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Meniscal Allograft Transplantation

Hello,

I'm looking for advice and insight into whether or not I should progress with a meniscal allograft transplant surgery to my left knee. I'm a 28 year old male and played competitive soccer continuously for 20 years until I tore my ACL.

After the injury, I had an MRI and was told I had fully ruptured my ACL and also damaged the meniscus and had a deep lateral femoral bone bruise. I then had reconstruction surgery 2 years and 4 months ago after which the surgeon said he had to remove a significant amount of the torn meniscus, which I presume was the lateral meniscus, i.e. the outer part of my knee.

I went through rehab and was told I was performing above expectations and afterwards took a year+ hiatus from much of the activities that involved "impact" to my knee as they would cause pain and inflammation. This last summer I grew restless and began with activities I had been accustomed to, e.g. long distance jogging, golfing, wakeboarding, etc. Each of these sporadically brought about substantial, sharp, lingering pain to the outer portion of my knee; of which then led to swelling and reduced range of motion. I then made the decision last fall to play some indoor soccer again and after the first 30 seconds of the game, my knee would be in incredible pain of which would leave me limping for the next 3 days. So besides knocking down, at times, 800mg of ibuprofin 3x a day (with food & water) to manage the swelling, nothing has really helped with the pain.

Yesterday I went to see my surgeon again and discuss my options. He did some knee stability tests and said my ACL is very stable. I had x-rays done about 6 months ago and the knee joint is solid. I have an MRI scheduled for tomorrow to more or less confirm the doctor's claims that the pain and subsequent swelling is derived from lacking of the meniscal cushion and only having articular cartilage on the outer portion of my knee which is resulting in bone bruising. He also recommended a bone scan, but decided we would just start with the MRI.

If anyone has any advice or experience with a similar situation, I would very much appreciate the feedback. Please note that as much as I would enjoy returning to competitive soccer, my main goal is to regain the ability to be active without unbearable pain during the activity and days of recouping afterwards.

Thank you.
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7721494 tn?1431627964
Thank you.

That's good news. Glad you're healing is progressing.
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Avatar universal
Met with my surgeon last night to discuss the MRI. Based on his review of the images he was surprised in how much discomfort and pain I've been realizing. I lost less of the meniscus than he had remembered and the ACL almost looks like the original, with the screws holding properly in their respective positions. So with everything considered, a meniscal transplant isn't even really a realistic option. (Which, despite the current pain, is a HUGE relief to me obviously!) Now it's back to rehab to stretch out all the muscles and push through the discomfort while I get the last couple of degrees on each end of my range of motion. Of course in the back of my mind there is the thought of what if the MRI images missed something, but for now I have enough peace of mind to go crank out a serious low-impact rehab protocol in an effort to strengthen my quad and hammy and hope that the pain lessens. Come summer I'm hoping to be able to tackle more of the typical "impact" activities with less concern and residual effects. I'll try and remember to update this at a later date with my progress. Just wanted wanted to add a closing note to this string in case anyone ever stumbles across it with similar symptoms. Thanks for the comments Phil, I wish you the best!
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1 Comments
HI.  DID YOU GET THE TRANSPLANT?  MY DAUGHTER JUST HAD A MENISCAL TRANSPLANT.
7721494 tn?1431627964
I enthusiastically approve of your efforts to better understand the nature of your injuries.

My son lost a reconstructed autograft ACL because the tendon split around one of those screws, which have a nasty habit of backing out on their own. The same is true with neck and lower back fusion surgery and is one of the risks of the procedure.

I wanted to caution you about using pain as a diagnostic as to location as referred pain may be present, especially in an area of prior injury.

Good luck.
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Avatar universal
Thank you very much for your comments Phil.

As you mention, the rehabilitation protocol following this surgery is not something to take lightly. Also you are correct in that autographs are typically preferred in all surgeries for a multitude of reasons, however I'm afraid in this case my only option would be an allograft from a cadaver or a 3D printed meniscus, but that's only being tested on sheep thus far unfortunately.

I got the MRI today and had them burn me a copy of the CD which I then perused when I got home. With my limited web-based knowledge of interpreting MRI scans and doing my best to act as a radiologist, it looks as though my lateral meniscus is vaguely existent towards the center of my knee and the articular cartilage on my tibial condyle is taking the brunt of the load. There also looks to be swelling around each of the screws that were put in to hold the temporary ACL graft. (If only the technology existed 3 years ago where they are using biodegradable sponges to sew the frayed ends of torn ACL ligaments back together to allow for coagulation and effectively heal the original ACL without the need for drilling screws into bones!)

Nonetheless I spent another hour on the elliptical tonight as well. I paid closer attention to where my pain is and found during exercising that it seems to be more pronounced on the inner side of my knee and still probably on the tibia, whereas the throbbing, lingering pain afterwards and stiffness comes on the outer portion of my knee. Obviously the soccer games last fall confirmed that as well. The pain from the elliptical is manageable but not something I would ever describe as enjoyable. Any activity that requires full straightening of the knee, which is a quite a wide variety of activities that you don't realize until you no longer can comfortably do so, brings about the latter mentioned sharp pain and various degrees of inflammation most likely due to bone bruising.

I have a follow-up meeting with my surgeon on Monday to review the MRI and discuss options for proceeding. I'm undecided about the surgery due to some discouraging literature I've read online about the success rates for this surgery as well as my surgeon's attitude which I will simply describe as less than encouraging. However, I'm not sure I want to go through the next 50 years of my life dealing with this pain and developing (effectively worse) arthritis sooner than later so I may bite the bullet and hope for the best.

For any others that read this -- please leave your thoughts, experiences and comments. Any input is really truly appreciated.

Thank you.
Helpful - 0
7721494 tn?1431627964
As you know from your ACL reconstruction, knee surgery requires diligent rehabilitation efforts on your part.

My orthopaedist prefers the use of autographs (tissue from your body) whenever possible, however, with the meniscus, you may have no choice.

That cartilage is essential to protecting the condyles of the tibia and femur for normal activity. If I were you, I'd have the surgery done.

Yes, you may have to give up all high impact sports, but believe me, you want to avoid chronic pain if you can.

Best wishes.
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