Injury to the meniscus is one of the most common knee-related ailments and is often accompanied by pain, swelling, and difficulty with knee function. Many patients with this problem will be able to regain normal function through a variety of well-known treatments. For those who aren’t that fortunate, Brigham and Women’s Hospital orthopedic surgeon, Dr. Andreas Gomoll, is working to offer an alternate solution.
Dr. Gomoll recently became the first physician in New England to perform a new type of knee surgery that replaces a patient’s damaged meniscus with an artificial implant made from synthetic polymers (plastics). The procedure is being offered to certain patients as part of a clinical trial studying the experimental device’s effectiveness at relieving pain and restoring function in the knee.
The artificial meniscus is inserted into a patient’s knee through a small incision (two to three inches). Because of its special design, featuring a thick rim and a thinner center, the device stays in place – even when squatting – without being attached to bones or any other surrounding tissue. Over time, the implant molds itself to the patient, creating a secure, comfortable shock absorber for the knee. This design is a significant advance from a similar approach that uses a metal device, which, due to its hardness, doesn’t provide shock absorption or mold itself to the patient’s anatomy.
Patients wear a knee brace for approximately one week after the procedure, but they can put their entire weight on the knee during this time. After removing the brace, the pain and swelling continue to diminish, and within four to six weeks, the knee is functional for daily activities. Recovering the full range of motion, however, may take up to three months.
Who is a candidate for an artificial meniscus implant?
For the majority of patients with meniscus damage, arthroscopic surgery to clean out the torn tissue leads to satisfactory outcomes. However, in some patients with significant meniscus damage, arthroscopy doesn’t provide a sufficient remedy. Without a healthy meniscus to act as a shock absorber and protect cartilage, these patients continue to experience pain and are at risk of developing arthritis more quickly.
There are a few treatment options for these patients. These include meniscus implantation from an organ donor or an osteotomy, which involves cutting the shin (tibia) bone. However, these procedures are more complex and require a longer recovery.
“We’ve been looking for something that’s a bridge for those patients,” says Dr. Gomoll. “They don’t have a meniscus, they don’t like the current treatment options, and they’re not candidates yet for joint replacement. For them, this artificial meniscus implant would be a great option.”
Meniscus implant outcomes
Although this latest meniscus implant is relatively new in the United States, several generations of the device have been tested in Europe and Israel. This has led to significant improvements in design and material composition.