Arthroscopic meniscus transplantation without bone blocks

Abstract

Replacement of the lateral or medial meniscus with an allogeneic graft. Complete loss of inner or outer meniscus. Grade 3 to 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities > 5°, symptomatic instabilities. Knee joint arthroscopy via the high anterolateral standard portal and checking the indication. Thaw the allogeneic meniscus graft in NaCl at room temperature and incubate in vancomycin solution. Refreshment of the capsule and resection of remnants of the meniscus. Search for the insertion zones on the tibial plateau, debridement, insert atranstibial targeting device and drill target wires in the middle of the insertion zones. Overdrill the target wires with a4.5 mm drill. Short medial or lateral arthrotomy (approx. 2 cm). Reinforcement of the anterior and posterior horns of the meniscus graft with nonresorbable suture material (e.g. "fiber wire" size5). Insertion of K‑wires with thread loops into the tibial bone tunnel. The reinforcement threads of the meniscus transplant are drawn into the bone tunnel via the thread loops, and the meniscus transplant is drawn into the joint. Reduction of the meniscus base to the capsule and refixation of the meniscus to the capsule with "inside out" or "all inside" sutures. Six weeks partial weight-bearing using ahinged brace, then gradually increased load. Range of motion: 4weeks 0‑0-60°, then 2weeks 0‑0-90°, followed by no restrictions. In our hospital, 15patients (6 × medial, 9 × lateral) were treated using the described surgical technique. After aminimum period of 1year (mean = 14.2months), meniscus extrusion-measured in the MRI-averaged 2.7 mm. The Lysholm score rose from an average of70.2 (±7.4) to 90.1points (±10.6). In one case, due to an early reruption, revision with renewed meniscus refixation had to be performed 10days after the operation. In another case, meniscus resection was performed 6months after the meniscus transplant due to areruption. Thrombosis, infection and arthrofibrosis were not observed.