Arthroscopic techniques and instruments for meniscal allograft transplantation using the bone bridge in trough method

Abstract

The aim of the current study was to investigate the construction of the bone bridge and tibial plateau under arthroscopy during meniscal allograft transplantation, in order to simplify and enhance the accuracy of bone bridge fixation intraoperatively. A traction line passed through the attachment of the anterior and posterior horns of the superior meniscus to the bone bridge was used to pull the bone bridge into the knee joint cavity and fix the anteroposterior horns of the meniscus. At the junction of the body of the meniscus and the posterior and anterior horns of the meniscus, a traction line was created at the anterior and posterior 1/3 of the meniscus to pull and fix the meniscus. Under the arthroscope, the aiming device was placed on the tibial plateau. The direction and width of the guide plate were identical to those of the bone trough of the tibial plateau. The bone tunnel was made using the guide needle and a 9-mm hollow drill, the piston rod was inserted, and the arch-shaped bone knife was inserted along with the piston rod to construct the 9-mm bone trough of the tibial plateau. The periphery of the meniscus was sutured to the joint capsule. These surgical techniques and instruments could standardize meniscal graft transplantation and avoid the incidence of surgical errors caused by mismatched size and shape of the bone bridge and bone trough. This would make the surgery more convenient, safe and accurate. The four-point fixation of the tibial plateau contributed to preventing the reversal of the meniscus during transplantation, and partially reconstructed the coronary ligament of the meniscal tibia, which probably enhanced the stability of the meniscus and minimized the risk of extrusion of the meniscal allograft. The bone bridge and bone trough of the tibial plateau were properly constructed under arthroscopy. Dynamic monitoring of surgical indications, explicit preoperative preparation and standardized surgical procedures could achieve high efficacy and excellent fixation effect during meniscal graft transplantation. The four-point fixation of the tibial plateau maintains and enhances the stability of the meniscal allograft, reduces the risk of meniscal extrusion and ensures the postoperative recovery of meniscal function.