Arthroscopic Technique with Bone Plugs

Abstract

Correct anatomical positioning and peripheral fixation of the graft are two key points of meniscal allograft transplantation. Some experimental studies have indicated that mechanical function is better when the graft is secured with bone plugs. Bone fixation preserves the anatomical shape and allows more accurate allograft positioning. Two possible techniques can be used. The first one is the trough or bridge-slot technique, which is more commonly used for lateral than for medial meniscus transplantation. In this technique, the shape of the meniscus and the anatomical relationship between the anterior and posterior horns are preserved. It is technically demanding and can cause damage to the tibial plateau. The second type is the bone-plug technique using two bone plugs on each meniscal horn, secured in two bone tunnels created at the anatomical attachment site of the native meniscus. There exist many variations of this technique. In the present chapter, an all-arthroscopic technique which can be used for both the lateral and medial meniscus is described.