All-Inside, All-Soft-Tissue, Anchor-Free Meniscal Allograft Transplantation

Meniscal allograft transplantation is an effective surgical option for patients with irreparable meniscal pathology, including chronic root tears, complex or radial tears, and prior meniscectomy. This Technical Note describes an all-inside, all-soft-tissue, anchor-free arthroscopic technique for meniscal allograft transplantation designed to maintain a truly minimally invasive approach. Standard anteromedial, anterolateral, and mid-medial collateral ligament portals are used to prepare the meniscocapsular junction and create tibial tunnels for the anterior and posterior roots. The meniscal allograft is sequentially implanted from posterior to anterior, with meniscus-to-meniscus hand-tied sutures providing secure fixation without the use of anchors. The technique allows precise graft adjustment to accommodate minor size mismatch and minimizes risks associated with anchor displacement or failure. Concomitant procedures such as ligament reconstruction or high tibial osteotomy can be performed simultaneously. This anchor-free, all-soft-tissue technique offers a reproducible, cost-effective alternative to conventional fixation methods while preserving minimal invasiveness and ensuring strong graft integration by continuous fixation of the allograft to the native meniscocapsular junction, anatomic restoration of both meniscal roots, and robust hand-tied suture fixation that provides controlled tensioning and uniform graft compression without reliance on anchors.