Isolated Lateral Meniscal Allograft Transplantation With an All-Soft Tissue Graft and Centralization

The meniscus-deficient knee, especially in the lateral compartment, is prone to early degeneration, cartilage loss, and pain. Meniscus allograft transplantation (MAT) with an all-soft tissue graft and centralization is a technique used to treat unicompartmental pain and improve outcomes.

Isolated lateral MAT with centralization is indicated for unicompartmental pain in a meniscus-deficient knee without significant articular cartilage loss, limb malalignment, or ligamentous instability.

For MAT preparation, an osteotome is used to remove the anterior and posterior meniscus roots with small wafers of bone to preserve the entire meniscus length, and the meniscus is transected at the meniscus-capsule junction. Sutures are passed through the anterior and posterior roots for later transtibial fixation. Knee arthroscopy is performed, and the lateral meniscus is debrided to a stable rim. A suture is passed through the lateral capsule, just anterior to the popliteus, for centralization. A targeting guide is used to drill a tunnel from the anteromedial tibia to the lateral edge of the lateral plateau, and the centralization suture is retrieved into the tunnel. Then the posterior root insertion is prepared, and an anatomic tunnel is drilled. MAT is delivered into the joint via the posterior root suture through our previously established portal. Meniscus repair all-inside devices are used to fixate the MAT to the capsule in a vertical mattress configuration. Then the anterior root tunnel is prepared and drilled. MAT anterior root is shuttled into the tunnel. The centralization suture is first tied down over a button on the anteromedial tibia, followed by the posterior root over a separate button, and the anterior root over a third button at 60° of knee flexion.

MAT relieves pain and restores meniscal function in a meniscus-deficient knee. Clinical studies have demonstrated good long-term survivorship rates with improvements in functional and patient-reported outcomes after MAT. Centralization is used to decrease the size of the lateral compartment, improving MAT compartment fit and decreasing extrusion.

All-soft tissue MAT with centralization is a viable option for the treatment of the meniscus-deficient knee with isolated lateral compartment pain without ligamentous instability, malalignment, or focal cartilage loss.

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