Transosseous Equivalent Meniscus Allograft Transplantation Using an All-Suture-Based Anchor Technique

Meniscal allograft transplantation is a surgical solution for symptomatic meniscal deficiency aimed at restoring native knee biomechanics and tibiofemoral contact pressures with the goal of slowing the progression of osteoarthritis. Anatomic fixation of the meniscal root is essential to a successful outcome as this normalizes native tibiofemoral contact pressures, restores hoop stresses, and improves graft survivorship. This is a technically challenging procedure with various techniques described that focus on the use of osseous and soft tissue-only fixation strategies. This technical note describes an all-inside method of posterior and anterior meniscal root fixation in the setting of a medial meniscal allograft transplantation using an all-suture-based transosseous equivalent fixation strategy that provides anatomic fixation while minimizing the tunnel and implant convergence concerns that often occur during concomitant realignment or instability surgery.