My knee story – meniscal transplant

Mountains

I was always quite physically active. Since I have a sitting and indoor type of job, I rather like outdoor activities. I would spent my free time by walking in countryside, doing several hundred miles per year.

I really love hiking and climbing in the mountains. There is nothing as beautiful as breath taking views from the top of peaks to area below your feet. During winter I like to go skiing, both downhill and cross-country.

Each year I would spend a substantial part of my holiday somewhere in the mountains over the world. I consider outdoor activities to be inseparable part of my life helping me to regain energy for my quite demanding research type of job and to be more efficient in it.

Marta mountaineering

Knee Problems

2-3 years ago I started to have a problem with my right knee. I used to get a sharp knee pain, which however always settled down in few minutes and was not restricting my activities. That was the case until the beginning of May 2016 when I went for my annual 40-mile Ridgeway walk (already 14th one).

Right at the beginning of that walk, I experienced my usual sharp knee pain. When the pain eased I was able to finish the walk, even in a quite good time. The next morning I was not able to put the slightest weight on my knee. Although after few days of icing it and taking painkillers the pain was reduced, I was limping a lot and really struggling with different movements, such as climbing stairs or turning. Thus I decided to see a specialist, prof. Wilson, suggested by my colleague. I was hoping that my knee problem could be treated fast and that I will be able to go to my planned trip to the mountains towards the end of August. Unfortunately, that appeared not to be the case.

Bucket handle tear of meniscus

I was diagnosed with a bucket handle tear of my medial meniscus causing locking of my right knee and severe osteitis in my tibia. Because of that, I needed to have an urgent arthroscopy just in 5 days, at the end of May. I was also ordered to start using crutches immediately with just touch weight bearing for the next 6 weeks. To help my recovery because of weight bearing restrictions after the surgery, prof. Wilson suggested using offloading brace allowing me to put more weight on my leg. Finally, towards the end of July I was allowed to stop using the brace and crutches. I was looking forward to rebuild my strength and to return to my activities.

Sadly, my knee started to be painful just the following day. For several weeks my physiotherapist, Simon Orr, was trying to find a way for gradual weaning off brace without triggering a pain. However, my knee was not only getting gradually more painful, but I also started to experience sharp catching pains. When whatever we tried did not work, I had to go back to prof. Wilson. His effort to ease my pain by anti-inflammatory medicine, painkillers and also by injection did not help either. I felt better in the brace and thus I ended up to use it for most of the day to cope somehow. However, that was not something what I was ready to accept as a long-term solution. Being in a lot of discomfort with the slightest increase of activeness, it looked that I can forget about my active life and that was really frustrating for me.

Meniscus transplant

To deal with my persisting knee problem, prof. Wilson recommended a meniscal transplant surgery which I underwent on 16 November 2016. When the worst swelling after the surgery was eased, the first sign that this time things might be different was that I was not exposed anymore to those catching pains which I was suffering so often before.

When three months after surgery I started to walk unsupported, I was so happy not to experience any pain in my knee.

To rebuild my muscle strength after many months of limited movement, I go for a regular physiotherapy and I work hard with my home exercises. All that hard work pays off. My range of motion is now 0-136°.

Walking after meniscal transplant

16 weeks after surgery (just 3 weeks after starting to wean off crutches and brace) I was able to walk without limping, something what I could not do for the past 10 months. Another 3 weeks later I already walked one mile in 17 minutes (sure reaching 13-14 minutes per mile as before my surgeries is just matter of time). The week after I also managed my first countryside walk of 5 miles (still with a support of the brace and walking polls recommended by my physiotherapist). All those activities did not trigger any knee pain.

I am now hoping to go on hiking in the mountains (with peaks above 2000 m) in August. My physiotherapist thinks that at that time I should be strong enough to do it, providing I continue to work hard. Of course, I will also need to get a doctor's clearance. I do hope as well not to miss the next skiing season. On top of that, I am also looking forward that the next year I might be able to go on the famous GR-20 hiking in Corsica something what is on top of my list of many dreamed hiking adventures.

To conclude, I am so grateful to be offered to undergo meniscal transplant surgery which seems to be providing an amazing result. It is turning me from a person full of pain and limping back to mobile and active one which I would like to be as long as possible.

Since surgery...

Achievements after meniscal transplant
Hiking after meniscal transplant
I hope that in one month - in August 2017 - I will be able to send you some pictures
from my hiking in real (i.e. high) mountains.
adrian wilson

This patient had a very surprising finding - a true chronic bucket handle tear, stuck in the joint and not repairable...it was the entire meniscus sadly.

The knee was physically locked and she couldn't straighten her knee and this had been the case since the onset of her symptoms which had been for a good few weeks - the only option was to resect the meniscus.

It's a bit unpredictable but patients can do well without the medial meniscus - it's not that uncommon for teenagers to have a traumatic bucket handle tear and have it resected and they don't have problems for many years...perhaps 20-30.

It was different here as Marta was in her 50s and therefore there was an underlying degree of wear and tear - but on MRI and during arthroscopy her joint surfaces looked really very good.

As she had such good articular surfaces and didn't have severe bone-on-bone arthritis I considered biological options. I looked at her alignment and considered an osteotomy, but she was well aligned and therefore that wouldn't have been appropriate. So I then went for meniscal transplantation instead.

She has a good long term prognosis as the meniscus has taken well and she was pretty much an ideal candidate for the surgery - active, well aligned, good joint surfaces and with a low BMI (body mass index).

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