Lateral Meniscus Allograft Transplantation With Lateral Meniscotibial Ligament Reconstruction

Abstract

Meniscal allograft transplantation is one of the main treatments among meniscus-deficient patients. Our technique describes lateral meniscal allograft transplantation with the reconstruction of the meniscotibial ligament using arthroscopy. After arthroscopic evaluation of the joint, the tibial plateau is prepared by removing the meniscal remnant. The meniscotibial ligament is reconstructed by using an anchor with straps inserted perpendicular to the tibial plateau via an additional portal placed on the lateral side of the knee, and then the straps are passed through the previously prepared allograft body. The meniscus is passed through the arthroscopic portal and arranged in the anatomical position. Posterior and anterior horns are fixed using the bone bridge technique, and the meniscal body is fixed to the plateau by a reconstructed meniscotibial ligament. This is a highly repeatable technique that allows for stable attachment of the meniscus thanks to 3 attachment points.

Fig 1

The schematic drawing of prepared right lateral meniscal allograft. On the left side of the figure, the allograft is shown from above and on the right side in cross-section. Anterior and posterior roots are secured with Krackow stitches. The suture from anchor is stitched through meniscal body using a bare surgical needle.

Fig 2

All pictures are taken from the anterolateral portal view. (A) The tunnel for posterior root is drilled using a 4.5-mm drill and drill guide. (B) The posterior polydioxanone (PDS) loop is passed through the tunnel with Kirschner wire and retrieved through the anteromedial portal using an arthroscopic grasper. (C) The tunnel for anterior root is drilled using a 4.5-mm drill and drill guide. (E, F) The anterior PDS loop is passed through the tunnel with Kirschner wire and retrieved through the anteromedial portal using an arthroscopic grasper. (LFC, lateral femoral condyle; LIT, lateral intercondylar tubercle; LTC, lateral tibial condyle.)

Fig 3

All pictures are taken from anterolateral portal view. (A) Lateral meniscus remnant to be removed. (B) Removed lateral meniscus remnant with visible popliteal tendon. (C, D) Designating a place for the lateral portal using a needle and then creating lateral portal with the knife. (E) Placing the anchor perpendicular to the tibial plateau. (F) Sutures from the anchor. One of the anchor sutures is pulled out through anterolateral portal and used to suture the body of the lateral meniscal allograft (Fig 1); the other suture is pulled out through the lateral portal. (LFC, lateral femoral condyle; LTC, lateral tibial condyle.)

Fig 4

(A) Checking the stability of the graft using an arthroscopic hook. (B) Lifted graft with visible reconstructed lateral meniscotibial ligament. (LMA, lateral meniscus allograft; LTC, lateral tibial condyle; RLMTL, reconstructed lateral meniscotibial ligament.)