Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation.

Abstract

This study aimed to investigate the graft maturation and safety of single-incision bone bridge lateral meniscus allograft transplantation (LMAT). This study involved 35 patients who underwent LMAT between 2019 and 2020. All patients completed at least 2years of follow-up (median 34months; range 24-43) and underwent preoperative magnetic resonance imaging (MRI) to assess the trajectory safety of the leading suture passer and all-inside suture instrument (Fast-Fix). Graft status was evaluated according to the Stoller classification. Based on preoperative MRI measurements, the expected trajectory of the leading suture passer did not transect the common peroneal nerve (CPN), with the closest distance between the expected trajectory and CPN being 1.4mm and the average distance being 6.8 ± 3.2mm. The average distance from the lateral meniscal posterior horn (LMPH) to the popliteal neurovascular bundle (PNVB) was 7.4 ± 2.6mm and the nearest was 4.8mm. The expected trajectory of the all-inside suturing instrument did not transect the PNVB when the distance was at least 12mm, from the most lateral margin of the posterior cruciate ligament (PCL). Grade 3 signal intensity in the posterior third of the allograft on MRI was observed in 6 of 35 (17.1%) patients. Amongst the grade 3 signal intensities in the posterior one-third of the allografts, 3 of the 35 (8.5%) LMATs had a distorted contour. The single-incision bone bridge LMAT technique introduced in this study is a convenient approach that preserves neurovascular safety and provides good results for the distortion of the posterior horn of the allograft and graft maturation. The safety zone for the penetrating devices during the procedure extended from 12mm laterally to the most lateral margin of the PCL to the medial margin of the popliteal hiatus. IV.