Lateral Meniscus Allograft Transplantation: The Bone Plug Technique

Abstract

Lateral meniscus tears are commonly encountered by orthopaedic surgeons. Despite efforts to repair and preserve the meniscus, meniscectomy is occasionally required to treat irreparable tears. The resulting lateral meniscus deficiency leads to increased tibiofemoral contact pressures and ultimately early osteoarthritic changes in the knee. Lateral meniscal allograft transplant (LMAT) has been proposed as a way to restore the lateral meniscus-deficient knee to its native form. Although several techniques for LMAT have been proposed, osseous fixation has demonstrated increased stability, improved outcomes, and improved long-term survival. This article presents a technique for LMAT using bone plugs and standard arthroscopic portals.

Fig 1

Lateral meniscus allograft transplant graft preparations (A) Size-matched, fresh-frozen graft. (B) Sizing bone blocks to 7 mm (solid arrow). (C) Final graft after placement of fixation sutures.

Fig 2

Arthroscopy being performed on a patient's right knee. Demonstrating anterior and posterior bone tunnel creation. (A) Posterior tunnel drilling: the tibial guide is set to 50° and inserted through the anterolateral portal; the arthroscope is positioned in the anteromedial portal. (B) Anterior tunnel drilling: the tibial guide is set to 70° and inserted through the anteromedial portal; the arthroscope is positioned in the anterolateral portal.

Fig 3

Passage of the graft into the right knee joint. (A) The posterior root sutures have been passed transtibial. Traction is applied to assist with graft reduction. (B) A KingFisher retriever/grasper is then used to advance the bone block to an intra-articular position near the tunnel.

Fig 4

Lateral meniscus allograft after transplantation viewing from the anterolateral portal.