Meniscal transplant is a specialized knee-preserving surgery used in selected patients who have already lost much or all of their meniscus and continue to suffer from pain, swelling, or mechanical symptoms. In my practice, I often explain to Bangladeshi patients and families that this is not the same as a standard meniscus repair. It is also not a routine operation for every meniscus injury. Meniscal transplant is usually considered when the knee has become meniscus-deficient after previous surgery or severe meniscal damage, and the patient remains symptomatic despite appropriate non-surgical care [1][2].

The meniscus acts like a shock absorber and load distributor inside the knee. When too much meniscal tissue is lost, the joint surfaces are exposed to higher stress. Over time, this can increase pain, swelling, and the risk of cartilage wear. The aim of meniscal transplant is to restore some of that protective function by implanting donor meniscal tissue into the knee [1][3].

For patients in Dhaka and across Bangladesh, the key question is not simply, “Can my meniscus be replaced?” The more important question is whether the knee is a good candidate for this operation and whether the expected benefit matches the patient’s age, activity level, cartilage condition, alignment, and long-term goals.

What is a meniscal transplant?

Meniscal transplant, also called meniscal allograft transplantation, is a procedure in which damaged or missing meniscal tissue is replaced with donor meniscus tissue from a human graft source [1][2]. The goal is to reduce pain, improve function, and help protect the knee joint in carefully selected patients.

It is different from meniscus repair

I usually explain to my patients that a meniscus repair is done when the patient’s own torn meniscus can still be preserved and stitched. A meniscal transplant is considered later, usually when the original meniscus has already been largely removed, is not repairable, or has become non-functional [1][4].

It is a joint-preserving procedure

One important point I want Bangladeshi patients to understand is that meniscal transplant is generally a joint-preserving surgery, not a replacement of the whole knee. The purpose is to improve the environment inside the knee and possibly delay further damage, not to create a brand-new knee.

Who may need a meniscal transplant?

This surgery is usually considered for younger or middle-aged active patients who have ongoing symptoms in a meniscus-deficient knee [1][2][3].

Common situations where I may consider this option

Meniscal transplant may be discussed when:

• a large part of the meniscus was removed in a previous surgery
• the patient has ongoing knee pain after meniscectomy
• swelling keeps recurring with activity
• there is pain on the side of the missing meniscus
• the patient is too young or not appropriate for joint replacement
• imaging shows meniscal deficiency with relatively preserved joint surfaces

Not every painful knee is a transplant knee

If a patient already has advanced arthritis, severe stiffness, major untreated malalignment, uncontrolled ligament instability, infection, or certain inflammatory joint conditions, a meniscal transplant may not be the right solution [1][2][3]. In some cases, associated problems such as malalignment or instability may need to be corrected along with the transplant for the surgery to have a better chance of success.

Why meniscus loss causes ongoing problems

When the meniscus is missing, the knee loses part of its natural cushioning system. This leads to higher contact stress between the femur and tibia. Patients may notice:

• pain with walking, stairs, squatting, or sports
• recurrent swelling after activity
• reduced tolerance for standing or running
• sense of weakness or lack of confidence in the knee

I often see patients who felt better temporarily after prior meniscus surgery, but later developed pain again because too much meniscal tissue had been lost.

Symptoms that may lead to evaluation

Meniscal transplant is not based on MRI alone. It is a decision based on symptoms, examination, prior surgical history, and imaging together.

Common symptoms include:

• pain on one side of the knee
• recurrent swelling
• difficulty with walking long distances
• pain with stairs or squatting
• inability to return to desired sports or work demands
• mechanical discomfort or reduced knee trust

When should you seek orthopedic evaluation sooner?

Please seek timely assessment if:

• knee pain persists after previous meniscus surgery
• swelling repeatedly returns after daily activity
• the knee is painful enough to limit work, sports, or walking
• there is associated locking, instability, or recurrent giving way
• symptoms are gradually worsening over time

If there is sudden major swelling, inability to bear weight, obvious deformity, fever, redness, or a new traumatic injury, that needs more urgent evaluation because other serious problems may also be present.

How I assess a patient for meniscal transplant

When I evaluate patients with this problem, I try to answer one central question: is the knee still salvageable with a joint-preserving approach?

Clinical history

I ask about:

• prior meniscus surgeries
• current pain location
• activity-related swelling
• sports or occupational demands
• whether the knee also feels unstable
• any previous ACL or ligament injury
• whether the patient has had alignment problems or bow-leg/knock-knee pattern

Physical examination

I examine:

• joint line tenderness
• swelling
• range of movement
• ligament stability
• alignment
• walking pattern
• signs of cartilage overload in the involved compartment

Imaging and planning

Evaluation often includes:

• standing X-rays
• long-leg alignment films in selected patients
• MRI to assess meniscal deficiency, cartilage status, and associated pathology

Sizing of the donor meniscus is important. Proper matching matters because a graft that is too small or too large may not function as intended [1][2].