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Hybrid Meniscal Allograft Transplantation via Posterior Bone Plug and Anterior Soft Tissue Fixation
Nicholas R Kiritsis1, Caleb D Puckett1, Thomas W Mason1
1Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Background:
Lateral meniscal allograft transplantation (MAT) is a technically challenging procedure that can improve the meniscal load-bearing function and stability in patients after meniscectomy, despite some difficulty in resolving compartmental knee pain. In contrast to early studies, more recent literature suggests that a hybrid MAT with posterior horn bone block and anterior horn fixation with a push-in suture anchor may limit the rate of degeneration and development of osteoarthritis of the affected area.
Indications:
Indications for MAT include isolated lateral compartment knee pain with post-activity effusion, arthrosis, or desired high levels of low-impact athletic activity, as in this 21-year-old Division I field hockey player. Although well described in the current literature, nuances in the fixation for MAT, with posterior bone plug and anterior soft tissue fixation, are variable and not as well defined.
Technique Description:
The patient was placed in the supine position. The allograft was prepared with a 7-mm bone plug for the posterior horn and all soft tissue fixation for the anterior horn. The meniscal allograft was inserted through the anterolateral portal, and inside-out sutures were placed in a vertical mattress fashion circumferentially. A 4.75-mm PEEK SwiveLock anchor was placed on the anteromedial tibia for fixation of the posterior horn, and outside-in repair was performed on the anterior horn using a meniscal mender kit and polydioxanone suture fixation.
Results:
Outcomes after MAT are positive, with patients reporting lower visual analog scale pain scores and improved Lysholm functional scores. Motion and functional testing are nearly equal to those of the contralateral limb, and >80% of patients are satisfied with their procedure.
Discussion/Conclusion:
MAT with posterior bone plug and anterior soft tissue fixation is a viable treatment option for patients with lateral meniscal deficiency.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
