Isolated meniscal allograft transplantation with suture-based fixation of a bone bridge: 15 cases with a 2-year minimum follow-up

Figure 1 Harvesting and intraoperative sizing of meniscal allograft with attached bone block. A: Harvesting of meniscal allograft with intact bone block from the bulk tibial allograft. Special care is taken to maintain the attachments of the anterior and posterior horns; B: Intra-operative measurement of harvested meniscal allograft with attached bone block using a commercially available sizing/prep guide. Most bone grafts will be 7-8 mm wide, 45 mm in length, and 1 cm in depth.

Figure 2 Prepared meniscal allograft with bone bridge and pre-passed fixation sutures. Fully prepared meniscal allograft with the corresponding bone bridge 2 sutures are passed through the bone bridge and 1 peripheral traction suture is placed prior to graft passage.

Figure 3 A demonstration of various incisions that may be required to facilitate efficient performance of our described technique. AL: Anterolateral portal site; AM: Anteromedial portal site.

Figure 4 Creation of tibial bone trough for meniscal allograft bone bridge fixation. A: Bone trough cuts made using a reciprocating saw. The senior author performs these cuts freehand. However, there are commercially available guides for this as well; B: Completed bone trough creation. The back wall of the posterior aspect of the tibial plateau is then carefully removed with an osteotome to avoid vascular injury; C: Completed bone trough shown through a larger arthrotomy for full demonstration. The senior author makes use of a much small arthrotomy/trans patellar incision for graft passage and trough creation.

Figure 5  Bone tunnels are drilled anteriorly and posteriorly in the base of the trough using an anterior cruciate ligament guide.

Figure 6 Posterior and anterior meniscal graft passing sutures during graft preparation. A: Posterior passing suture has been placed and brought through the trans patellar/arthrotomy incision; B: Completed passage of both anterior and posterior passing sutures.

Figure 7 Final reduction and fixation of the meniscal allograft following transplantation. A: Meniscal allograft that has been fully passed and reduced into anatomic position; B: Completed meniscal allograft transplantation with soft tissue fixation present using a combination of horizontal and vertical mattress sutures.