July 24, 2008

White Right to Be Worried

First of all, can you describe what the meniscal transplant procedure entails?The meniscus is a C-shaped cartilage between the end of the thigh bone and the tibia. When some people remove it, they go on to get early arthritis. If they get arthritis, if you catch it early enough, you can put a meniscus back in from a donor that is size-matched. That will decrease or relieve pain and hopefully prevent the progression of arthritis, but it doesn't guarantee to do that. We just hope to decrease symptoms, and it's generally pretty effective in doing that.Is there any risk the body will reject transplant tissue?With meniscus transplants, cells are very deep within the tissue, so the body doesn't view it as harmful. Therefore there's no immune response. There's negligible to minimal risk of any disease transmission, such as HIV or hepatitis or bacterial infection. Some players recover quickly from a meniscal injury. When is transplant surgery necessary? In general, most people do just fine when they lose their meniscus, and they do get back within a couple weeks. A small subset -- for mechanical or alignment reasons, predisposition, or reasons we just don't understand -- they don't do well. When they don't do well, we recommend the transplant. I'd say it's probably less than 3 percent (who need a transplant). I do about 40 a year, but this is a referral center -- I get patients from all over the world. It's not common.Is this a relatively new procedure?The first one was probably in 1984. It's becoming more common because the results have been published in the literature as being favorable at various centers, including our own. If there are 2,000 or 2,500 done a year, that would be a good estimate.What's the probability that an athlete can regain 100 percent of his or her abilities after this surgery?That's a really tough question because there are so many other variables. Depends on what other cartilage is damaged. In this particular instance, this young guy had two problems. He had a cartilage defect that could develop arthritis in his femur, so I had to repair that with another cartilage graft. Really, the complexity of the case dictates what level their return is. In general, if they have pain with everyday activities, that's eliminated. If they're accustomed to having swelling, that's eliminated or decreased. If they have pain with high-level activity, sometimes that persists. We do have athletes from D-I colleges that have returned to play for a year or two afterward. It's very hard to say the probability because patients are so different across the board.Independents are more bored with the campaign than any other group of people -- 28 percent of them say so -- according to an AP-Yahoo News survey conducted in June.

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