The evolution of meniscal surgery: from 1980 to today

As members of Equilae, it is always a pleasure to have Dr. Monllau share his experience with us. This time, he’s discussing the evolution of meniscal surgery from the early 1980s to today. We hope you find it as interesting as we do.

For many years, complete meniscectomy was the treatment of choice for a meniscal tear. This technique provided good clinical results in the short term, but these results deteriorated over time.

In the 1940s, Dr. Fairbank described the appearance of radiographic arthritic changes after a complete meniscectomy. Over the years, a relationship has been shown to exist between the quantity of meniscal tissue resected, chondral damage and subsequent degenerative changes appearing in the meniscectomized compartment.

Meniscectomies have grown increasingly conservative, mainly since the advent of arthroscopy in the early 1960s.

Towards the end of the 1980s, the concept of suture-based meniscal repair arose.  Despite this, and for various reasons (the vascularization of the meniscus, progression time, the type of injury, etc.), not all meniscal tears should or can be sutured. It some cases it is still necessary to perform a partial meniscectomy.

During the 1990s, in an effort to prevent the deterioration of the joint after a meniscectomy, meniscal transplant appeared on the scene, through implants in cases with partial meniscal defects, or allografts or “donor meniscus” for complete meniscal defects.

Dr. Monllau and his team have made numerous relevant scientific contributions to the field of meniscal replacement over the last 10 years. To date, more than 150 collagen and polyurethane implants and around 200 meniscal transplants have been performed at Equilae.

Over the years, the technique used by the team for meniscal transplants has evolved (initially, the transplant focused only on sutures, later with bone plugs and most recently using capsulodesis) in order to obtain better results in terms of pain reduction, increased quality of life, the prevention of wear of the joint and the optimization of extrusion of the transplanted tissue.

When can a meniscal transplant be performed?

The most common surgical indication for a meniscal transplant is the emergence of post-meniscectomy syndrome. That is, the appearance of pain, discomfort and/or effusion in a patient who has had a meniscectomy and is at an early age for the use of a prosthesis.  Also, the joint must show limited articular degeneration, integrity of the ligaments and correct alignment of the extremity.

What postoperative care should follow?

Postoperative care will be adapted to each patient based on the surgical procedures that have been carried out.

In general, the patient will remain at rest and with the knee extended for the first two weeks. Then, they will progressively increase weight-bearing using crutches until the sixth week.  The joint’s range of motion will increase, allowing for flexion greater than 90° after the sixth week.

The concept of joint preservation

After 16 years of experience and more than 200 patients operated on at Equilae, it can be concluded that after meniscal transplant surgery, patients attain a decrease in pain and improved quality of life, changing the natural history of a degenerative knee and delaying possible prosthetic surgery.