Medial Meniscal Transplant: Technique Video

Meniscal transplantation is a relatively new treatment modality for managing symptomatic meniscal deficiency. The technique differs between lateral and medial meniscal transplants. Medial meniscal transplant fixation techniques include bone bridge, bone plug, and soft tissue options. The goal of this surgical video is to highlight the bone plug fixation technique for medial meniscus transplantation.

Indications for this procedure include age younger than 50 years, activity-limiting pain, meniscal deficiency, normal or correctable alignment, ligamentous stability, articular cartilage congruity in addition to predicted compliance with rehabilitation, and realistic postsurgical activity expectations. While these principles apply to both medial and lateral meniscus transplantation, we focus on the medial meniscus in this presentation. Contraindications include asymptomatic lesions, advanced osteoarthritis, alignment that is not correctable, ligamentous instability, irreparable cartilage damage, infection, and inflammatory arthropathy.

The bone plug paradigm for medial meniscal transplantation involves a more anatomic reduction and fixation method for transplant placement. After the graft is prepared with anterior and posterior bone plugs and a nonabsorbable locking suture, the posterior bone plug is reduced, and then an inside-out meniscal repair technique is completed in a progressively anterior fashion. Following this, the anterior bone plug recipient site is prepared, and then the transplant is fixed at this site.

Meniscal transplantation demonstrates reasonable pain improvement and survivorship at mid-term outcomes. Risk factors for failure include female sex, severe cartilage damage, and obesity. Further research on outcomes based on the type of reduction technique is warranted.

A meniscal transplant is a potential option for young patients with minimal arthritis and symptomatic meniscal deficiency who have had nonoperative management that has been unsuccessful.

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