Many young men suffer from knee pain in India after an injury in sports or a two wheeler accident. This might have resulted in damage to the ligaments and internal structures like the cartilage and menisci. The pain continues despite taking pain killers and physiotherapy. As they are young or middle aged, they have to grin and bear the pain as up to now, their orthopaedic surgeon did not have any surgical or medical solution except advising the above. It will be heartening for these patients to hear that a solution to their problems will be available in Chennai shortly. This procedure is called, "Meniscal transplant”. It is suitable for young men to alleviate their pain for a short tem at least.

What are the menisci?

The knee joint is made by the lower end of the thigh bone (femur) and upper end of the leg bone (tibia). Two "C” shaped pieces of cartilage interposed between these two bones serve as cushions within the joint. They are situated, one on either site. They have several important functions in the knee joint and damage to them triggers damage to the articular or joint cartilage resulting in osteo arthritis, which is the cause of knee pain.

These important functions are 1) Acting as shock absorbers...

2) Increasing the congruity between the ends of the two bones within the joint.

3) Conferring stability to the joint by preventing the leg bone from sliding forwards while rapidly climbing downstairs or running around a curve.

4) Promoting and increasing the area of contact between the two bones, thus preventing overloading of the joint.

How are they damaged?

When your leg gets twisted in an accident in games or a two wheeler, ligaments and menisci are torn. This results in an immediate swelling of your knee indicating damage within. You will no longer be able to continue the game and your knee may feel unsteady. You might have consulted your doctor and he would have aspirated the blood within. An operation might have done to remove torn cartilage and repair the ligaments of the knee. However till date no one has attempted to replace the torn cartilage within the knee-joint in India. Some might have had the cartilage stitched back. Football, hockey, cricket, roller or ice skating are the games in which the knee is likely to be damaged. Many young men and women also get their knee done in in a two wheeler accident.

What are the initial symptoms?

Intermittent giving away of the knee and pain can result if there is persisting damage to the ligaments and menisci. This may lead to a deformity or curvature of the leg bone. Later arthritis develops due to increased friction between the soft articular cartilages.

What is done to treat this injury by orthopedic surgeons?

He might have done an arthroscopy and diagnosed the condition. Later he might have advised you to undergo surgery to reconstruct the torn ligament and might have removed torn cartilage. This corrects part of the problem. The damaged menisci still remain and no solution has been available so far. What is a meniscal transplant? How is the operation done?

In case you have had a meniscus removed, then it is now possible to replace it with a meniscus from a recently brain dead person surgically. Transplantation of organs from cadavers is not a new thing in our country and you might have heard of kidney, cornea and recently liver transplant. To this list' "Meniscal transplant” is likely to be added soon.

The menisci are removed from another person's knee and preserved and stored at minus 85 degrees. When another person with absent menisci needs to have his knee restored back to the original condition, these stored tissue can be transplanted into that person's knee. This is possible using an arthroscope or by minimally invasive open surgery.

The patient will have to stay in hospital for a day or two and need not consume medication for a prolonged period. You might have to remain non weight bearing for a short period and then get back to normal activities. What is the cost?

It is likely to cost less than one lakh and around 70- 80,000 rupees. What are the benefits in the short term?

As the surgery is often required for young and active working people, they need not worry about job losses and productivity. They can remain pain free for about 10 years. This is certainly a big blessing for the young whose knees will be doomed to develop arthritis and need for a knee replacement.