Repair of a Chronic Large Meniscal Defect With Implantation of Autogenous Meniscal Fragments Using a Tubular-Shaped Fibrin Clot

Abstract

We present a technique to implant autogenous meniscal fragments using a fibrin clot to repair a large degenerative meniscal defect. A total of 25 mL of the patient's blood is agitated for 10 minutes using a stainless steel swizzle stick in a sterile glass syringe. The elastic fibrin clot subsequently adheres to the stick in a tubular manner. Using arthroscopic debridement, native meniscal tissue is resected. The meniscal fragments are packaged into the tubular-shaped fibrin clot, and the tube is tied at both ends using 4-0 absorbable sutures. A repair suture is prepared using the inside-out meniscal repair device and woven into the margins of the tubular-shaped fibrin clot. The packaged graft with the tubular-shaped fibrin clot is placed with a horizontal suture across both edges of the meniscal defect and secured with a supplemental vertical suture using an all-inside meniscal repair device. Follow-up arthroscopy performed 6 months postoperatively reveals regeneration of meniscus-like tissue. It is ideal to treat large degenerative defects with meniscal preservation, and the present procedure has the advantage of tissue regeneration with native meniscal tissue and growth factors obtained from the fibrin clot using a simple technique. This method could prove helpful in patients with degenerative meniscal defects.