As mentioned above, the meniscus is the specialized cushion between the femur and tibia (thigh and shin) bones within the knee joint. When a meniscus is torn, it can either be repaired or partially excised based on the type and extent of the tear. On rare occasions, certain patients have too much meniscus trimmed or the repair fails. With the loss of nearly the entire meniscus, some patients develop pain on that side of the knee with activity, indicating that the load being placed on that part of the joint is greater than can be accommodated without a meniscus to distribute the force. In older patients this is typically related to arthritic changes, but in younger patients it can indicate early arthritis. In order to relieve pain and delay or prevent the development of arthritis, a new meniscus can be transplanted into the knee. The new meniscus is obtained from a cadaver after custom sizing it to your knee. The surgery is performed arthroscopically and bone tunnels or a bone trough is created in the tibia to allow for insertion of the bony part of the meniscus graft. The bony graft is secured in place by fit or using screws, then the meniscus is sutured to the joint lining (capsule) in a near 360-degree fashion with sutures. Done properly, this procedure nearly recreates the normal mechanics of the knee joint. After surgery, patients are placed in a knee brace and advised to limit or avoid weight bearing on the knee for 6-8 weeks. Therapy is started the day after surgery and full range of motion is allowed after 6 weeks. After the first 6 weeks, intensive therapy and strength training of the leg are recommended to obtain a good result and a return to full activity.