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Meniscal Tears
Updated: Oct 18 2016

Medial Meniscus Transplant

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Perform a thorough history and physical exam

  • history of previous surgeries
  • review imaging including standing full length xrays and MRI to determine other pathology
  • discuss the goals of surgery with the patient


Execute surgical walkthrough

  • describe steps of the procedure verbally to the attending prior to the start of the case
  • describe potential complications and steps to avoid them

Room Preparation


Surgical instrumentation

  • standard knee arthroscopy instruments
  • meniscal transplant set


Room setup and equipment

  • standard OR table with choice of leg holder or post


Patient positioning

  • supine
  • contralateral leg is placed in a well leg holder
  • foot of the bed is dropped

Scope Insertion


Mark out the anatomy of the knee

  • draw out the patella, patellar tendon, and joint line
  • mark the medial joint line incision for open meniscal repair and the anterior portals


Place anterolateral portal

  • an 11 blade is used to create the portal at a 45 degree angle into the joint just lateral to the patella tendon and just inferior to the distal pole of the patella
  • insert the blunt trocar at the same angle as incision


Place anteromedial portal

  • created under direct visualization once the medial compartment is entered
  • use a spinal needle to assess direction and appropriate superior/inferior direction.
  • visualizing the entrance from the lateral viewing portal
  • the medial portal should be located just superior to the medial meniscus

Diagnostic Arthroscopy



  • suprapatellar pouch
  • undersurface of the patella and trochlear groove
  • lateral and medial gutters
  • medial compartment
  • visualize the medial femoral condyle and follow it while bringing the knee into slight flexion and applying a valgus stress to the knee as you go into the medial compartment
  • the foot will be positioned on your opposite hip for control
  • medial meniscus, medial femoral condyle, and medial tibial plateau
  • once the anteromedial portal is created, a probe is used to assess the medial meniscus and cartilage
  • intercondylar notch – ACL/PCL
  • use probe to assess the ACL and PCL
  • lateral compartment
  • the surgeon can bring the leg into a figure-4 position or place the operative limb on the surgeon's hip to create a varus stress and flexion to the knee to enter the lateral compartment
  • lateral meniscus, lateral femoral condyle, and lateral tibial plateau
  • a probe is used to assess the lateral meniscus and cartilage

Medial Meniscus Graft Preparation


Thaw out the medial meniscus tissue

  • thaw out a size matched medial meniscus


Remove the soft tissues

  • remove any capsular tissue from the meniscus


Prepare the graft

  • the graft may be fashioned with appropriate sized bone plug (usually 7 mm in width) running from the anterior to the posterior horn insertion sites
  • mark the superior portion of the graft with a marking pen for reference in the joint
  • place a suture in the posteromedial meniscus where the posterior and middle thirds of the meniscus meet

Tibial Preparation


Remove the remaining medial meniscus

  • remove the remaining meniscus until there is a 2mm rim of tissue to suture the meniscal allograft to


Prepare site for bone plug

  • may perform a small notchplasty of the medial wall of the notch inferior to the posterior cruciate ligament insertion if needed
  • use a spinal needed to localize a plane between the anterior and posterior horns of the native meniscus and make a skin incision that will allow access to this location
  • create a reference slot with the burr connecting the anterior and posterior horns
  • measure and create a bony trough that is 1 mm wider than the bone plug (usually 8 mm for a 7 mm bone plug)


Perform a posteromedial incision

  • create a posteromedial incision to pass sutures for an inside out fixation of the graft
  • the dissection is carried down to the capsule and a retractor is used to protect the neurovascular structures and to aid in retrieval of the long needles for a standard inside out repair

Delivery and Fixation of the Medial Meniscus


Deliver the meniscal allograft into the knee

  • a passing suture is placed through an inside out technique in the posteromedial knee mirroring the location of the suture that is placed in the meniscal allograft at the junction of the posterior and middle thirds.
  • pass the suture on the allograft though the knee from inside out using the passing suture
  • insert the meniscus and bone plug into the knee through the incision created in line with the anterior and posterior roots of the meniscus, while using the suture to help pull the meniscus into the joint
  • the meniscus will need to be reduced to the capsule which id usually done with a technique similar to reducing a bucket handle meniscus using a valgus force along with flexion and extension
  • cycle the knee to allow the meniscus allograft to site in the appropriate position.


Fix the graft into the knee

  • an interference screw can be used for fixation of the bone plug
  • use multiple vertical mattress inside out sutures on the superior and inferior articular surfaces of the allograft to fix the periphery of the tissue to the capsule
  • the sutures are passed out the posteromedial incision and will be tied over the capsule with the knee in extension

Wound Closure


Close the portals

  • use portal stitches


posteromedial incision

  • close the sartorial fascia deep
  • inverted interrupted sutures for subcuticular layer
  • absorbable or nonabsorbable suture for the skin
Postoperative Patient Care
Private Note

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