"So far I have undergone surgery six times, but now I can see the end of the road." This is how Alazne summarises how she is experiencing the postoperative period, a few weeks after the meniscus transplant that was performed at the SJD Barcelona Children's Hospital. The 17-year-old patient underwent surgery at another hospital when she was 6 years old for a congenital malformation of the knee (discoid meniscus), a relatively common pathology, which was treated at that time with resection of the meniscus (meniscectomy).
The classic treatment for this anomaly was to remove the morphologically altered meniscal tissue in cases where patients had pain or discomfort, but the medium-term results have not been good. The function of the meniscus is of great importance since it acts by protecting the articular cartilage, distributing the loads of force in the knee and also participates in its nutrition and stabilisation. At present, to avoid joint deterioration (as has happened in the case of Alazne), the preferential treatment whenever possible is tissue preservation using arthroscopic techniques to normalise the morphology of the meniscus (meniscoplasty/saucerization) and its stabilisation, since it usually presents alterations at the level of insertion in the joint.
Between 2010 and 2020, the Pediatric Orthopaedics and Traumatology Department of the SJD Barcelona Children's Hospital has operated on 78 patients using this surgical technique to preserve the meniscal tissue using different approaches depending on the type of Discoid meniscus (meniscoplasty, meniscal suture, meniscal regularisation, etc). The result is satisfactory in more than 95% of the cases.
A very rare surgery for an unusual case
In Alazne's case, however, this was not an option because there was no meniscus to preserve. The patient had become accustomed to living with discomfort and having pain when performing daily activities due to the presence of degenerative arthropathy (osteoarthritis), which she suffered as a result of the initial treatment. To prevent the degeneration increasing, the pediatric orthopaedic surgeon David Moreno, proposed a meniscus transplant, a technique used for adult patients which, in this case, was the best option for the adolescent .
To be able to perform this intervention for the first time in our centre, it was necessary to find a meniscus morphologically compatible with the anatomy of the patient's knee, something that was possible thanks to the close collaboration of the Banc de Sang i Teixits (Blood and Tissue Bank). The organisation obtained a compatible graft at the osteoarticular level. In this case, the graft does not pose a risk of donor-recipient incompatibility since it is subjected to cryopreservation and decontamination techniques. On the other hand, it used a specific surgical instrument for such surgeries as it is a rare intervention with very specific indications.
Alazne underwent surgery on February 25 in a surgery involving numerous professionals from the Paediatric Orthopaedics and Traumatology team (specialists in knee pathology), radiology, nursing and anaesthesiology. The surgery was performed without complications, as planned, and Alazne is now able to walk. Thanks to surgery and rehabilitation, the patient will be able to have a normal life without deterioration of the knee or pain.
SJD Barcelona Children's Hospital, a centre with experience in paediatric knee pathology
The Pediatric Orthopaedics and Traumatology Department of the SJD Barcelona Children's Hospital is one of the largest in Europe; it has 20 specialists in different areas of paediatric orthopaedics and has extensive experience in paediatric knee pathology which, in children and adolescents, can cause pain and discomfort of various kinds. The knee specialists alone, in the last 10 years, have performed more than 600 surgeries, 434 of which were arthroscopic. Among the most frequent pathologies treated by arthroscopic technique are cruciate ligament repairs (203), traumatic meniscal injuries (57), congenital meniscal malformations (78), repair of osteochondral injuries (29) and joint tumours / diseases of the synovial tissue (67).