Delivering care through collaboration
August 04, 2022

Orthopaedic surgeons at NHS Golden Jubilee have performed the first meniscal transplant on a patient in Scotland.

Surgeons at the University National Hospital, which carries out over 25% of all Scottish hip and knee replacements, performed the innovative keyhole procedure and implanted donor cartilage into the patient’s knee.

It is hoped the option of transplant will transform patient care for those in need, by offering the procedure at NHS Golden Jubilee.

Each knee has two menisci, a c-shaped cartilage in the knee that acts like a shock absorber between the shinbone and the thighbone.

The meniscus can tear due to trauma or overuse. If the meniscus is so badly damaged that it cannot be repaired, persistent knee pain or osteoarthritis can develop, potentially leading to the need for a total knee replacement.

Suitable for certain younger patients, meniscal transplants have the potential to significantly improve the quality of life for people who suffer from persistent pain in their knee due to damaging or losing their meniscus.

To conduct this transplantation, surgeons sourced a matching deceased donor meniscal graft from the United States. Using a camera as a guide, the new cartilage is implanted through a keyhole procedure under general anaesthetic.

There is increasing evidence that this procedure can play a vital role in preventing arthritis, which can be difficult to treat in younger patients, and reducing the need for a full knee replacement.

NHS Golden Jubilee Orthopaedic Consultants Mr Christopher Gee and Mr Jon Clarke and Queen Elizabeth University Hospital (QEUH) Orthopaedic Consultant Mr Simon Spencer worked together to carry out the procedure.

Mr Christopher Gee said: “We are very excited to be able to offer this surgery, as it is the first time this technique has been carried out in Scotland.

“The procedure tries to restore the cushioning effect of the meniscus, in turn preserving the joints until later in life. There is increasing evidence that it can help with symptoms and reduce the chance of the patient developing arthritis, which can be very difficult to treat in younger patients.

“What we know is that 70 to 80% of people who have a meniscal transplant see an improvement of their symptoms.

“There is a lot of evidence to support good functional outcomes, so we’re really looking to be able to provide this procedure for many more people from across Scotland.”

While for many older patients with this condition, a total or partial joint replacement might be the right option, for a young, active person like Matthew Watkins from Inverness, the idea of waiting through years of pain was daunting.

He said: “After I had an accident in the gym, I was getting a lot of pain which was stopping me from mountain biking and hill walking, my knee would swell up and it was really affecting my quality of life.

“Basically, I had destroyed the whole of the inside of my knee and damaged the actual bones, so the cartilage had worn away and needed to be repaired.

“More of the meniscus needed to be removed to try to alleviate some of the pain.

“In terms of how it felt immediately afterwards, I could feel something was inside my knee when I was putting weight on it compared to how it felt before when I didn’t have any meniscus in there.

“I’m glad I had the surgery, I can really feel a difference.”

Following a careful process in setting up the service and working in collaboration with NHS Greater Glasgow & Clyde, the Clydebank based team ensured the procedure is as safe as possible for patients.

Having discussed the case with Mr Watkins and having gone through a shared decision making process, the team gained approval from the local health board, NHS Highland, to perform the surgery.

Christine Divers, Director of National Elective Services at NHS Golden Jubilee, said:

“NHS Golden Jubilee always looks to innovate and improve the patient experience.

“We are one of Europe’s largest centres for planned arthroplasty, performing around 4,000 joint replacements each year - around 25% of all joint replacements in Scotland.

“Although this is the first time this technique has been used in Scotland and the operation is not yet being widely performed, it is clear this surgery has a real place for people with persistent pain following a meniscal tear.

“The introduction of a new technique like this helps us to deliver person centred care for people who are in extreme pain and gives us the ability to provide the patient with much-needed relief which aids their recovery.

“This landmark meniscal transplant shows that we are always seeking to progress and find new ways to increase the quality of life of our patients while continuing to enhance care for the people of Scotland.”

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