Have you ever heard the following words from your doctor: “You have arthritis...but you need to wait until you’re old enough for a knee replacement.”? Waiting is not easy when you are in pain, even more so when this wait is measured in decades for some young patients until they can undergo a surgical procedure that is essentially deemed a last resort.
We are all humans and our bodies wear out – eventually, everyone is headed towards arthritis. However, for some people, the wear-and-tear starts earlier in life and the decline is more rapid. If you tear your ACL or meniscus in high school or college, you might end up having trouble playing with your own kids when you are in your 30s. And for someone in their 30s or 40s, a knee replacement would only be done in the most extreme circumstances. So, what other options are there besides artificial replacements?
While replacements are performed by most orthopedic surgeons, joint preserving surgery includes a group of highly incredibly specialized procedures that are not performed by a lot of physicians, such as cartilage and meniscus transplants. The best candidate for these procedures is someone in their 20s, 30s or 40s with damaged cartilage or meniscus, who is at an activity level or age where joint replacement is not recommended. A cartilage transplant replaces cartilage (the bearing surface coating of the knee joint) loss in a focal area, while a meniscus transplant replaces lost meniscus tissue (the shock absorber in the knee joint).
Unfortunately, repairing damaged structures biologically, rather than replacing the knee joint, is not possible for every situation. For example, once advanced arthritis has set in and the joint is bone-on-bone, these procedures are no longer an option. But for those with more localized damage, it is best to preserve as much of a person’s natural joint as possible for as long as possible.
I have been performing both types of transplants for over a decade and have seen success in the majority of my patients. I have also done a lot of research on this topic, looking at outcomes and how to identify the best procedure for the individual patient. As a big proponent of personalized medicine, I believe it’s incredibly important to sit down with a patient to go over their history, previous operations, and figure out exactly what that specific patient needs.
There is no “one size fits all” treatment for knee osteoarthritis -- it’s important to work with your physician to review all of your options and expectations to determine the best course of treatment.