Medial Meniscal Root Repair and Double Medial Femoral Condyle Aragonite-Based Scaffold Implantation

Medial meniscal root tears often occur alongside cartilage lesions, leading to altered load distribution and accelerated joint degeneration. Addressing both pathologies is critical to restoring joint mechanics and improving outcomes. Cell-free aragonite-based scaffold implants are emerging as cost-effective, off-the-shelf options.

These scaffolds are indicated to address between 1 and 3 focal International Cartilage Repair Society grade 3 or 4 femoral lesions <7 cm² contained by a surrounding wall of vital bone of at least 2 mm without severe osteoarthritis.

Standard arthroscopic portals reveal a posterior medial meniscal root tear and 2 grade 4 chondral defects on the medial femoral condyle. The meniscal root is prepared with a ringed curette and shaver. Two 4.5-mm parallel transtibial tunnels are drilled, emerging at the posterior meniscal root insertion. Two sutures are passed through the meniscal root and fixated at the anteromedial tibial cortex with a PEEK suture anchor. The anteromedial portal is then extended to a parapatellar arthrotomy to reveal the osteochondral defects. The 2 aragonite scaffolds are then implanted according to standard steps. A perpendicular aligner is centered over the defect. Then, a K-wire is drilled into the defect, and a drill sleeve is positioned before drilling to a set depth with a drill bit. A reamer is introduced over the K-wire to establish the 2° taper of the socket. A cartilage cutter tool or scalpel is used to smooth the cartilage edges; the implant is then inserted manually and/or with a rubber tamper.

Aragonite-based scaffolds have demonstrated superior outcomes compared with microfracture in randomized trials, including higher Knee injury and Osteoarthritis Outcome Score and International Knee Documentation Committee scores, increased defect fill (>75% in 88% of cases), and lower failure rates. Integration with host bone and cartilage remodeling has been confirmed on imaging by 12 months, with clinical improvements sustained at 2 and 3 years.

This technique provides a single-stage, accessible solution for addressing combined medial meniscal root tears and focal osteochondral lesions. Aragonite-based scaffolds offer promising clinical and radiographic outcomes but must be used within defined indications as further comparative studies emerge.

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