• Age (relative) 14-55 years

• Pain localized to joint line

• Previous surgery

• Status of articular cartilage

• 45-degree posterior-anterior weight-bearing radiograph

• MRI

• Arthroscopic findings

• Alignment (long cassette)

• Within 3 degrees of normal knee.

• If >3 degrees, osteotomy should be considered.

• Graft choice

• Fresh frozen allografts

• Donor age 15-35 years

• Size matched

▪ Radiographs vs MRI

• Nonirradiated

• 2-0 synthetic, nonabsorbable braided suture on a 10-in straight-cutting needle

• No. 2 synthetic, nonabsorbable braided suture

• No. 0 synthetic, nonabsorbable braided suture

• Specific cannulas, various flexion angles

• Popliteal retractor

• Anterior cruciate ligament (ACL) guide, tip-to-tip

• 3/32-in (or 2.4-mm) guide wires

• Standard arthroscopic equipment/setup

• Standard arthroscopic rasp

• 30- and 70-degree arthroscopes

• Supine.

• Pneumatic leg holder (Fig. 38-1).

• As an alternative, sandbags attached to the bed at multiple flexion angles can be used.

• No tourniquet is used.

• All planned incisions are marked.

• This may be difficult if there are multiple prior incisions.

• The goal is to have 6-cm skin bridges between adjacent incisions.

• This sometimes requires using a less than ideal prior incision and creating a skin flap.

• The meniscus is detached from bone.

• Soft tissue is debrided from the meniscal rim.

• A no. 2 nonabsorbable suture is secured to the anterior and posterior roots.

• Graft passage/fixation.

• Three or four no. 2 nonabsorbable sutures are placed in the posterior horn (vertical mattress stitch).

• The anterior and posterior horns and top of the meniscus are marked with a marking pen (Fig. 38-2).

• The anterior horn is marked with a “T.”

• Transosseous fixation using combined arthroscopic and open approach

• Arthroscopy

• Diagnostic arthroscopy

▪ Standard anteromedial/anterolateral arthroscopy portals are used.

▪ The articular cartilage of the medial compartment is assessed to reconfirm that the patient is a candidate for a meniscal allograft.

• If the above criteria are met, the meniscal allograft is thawed.

▪ The degree of meniscal deficiency is documented.

• Anterior-to-posterior measurement of the medial compartment is made to confirm that the allograft is appropriately sized and matched to the patient (Fig. 38-3A and B).

• If appropriately sized/matched, the medial meniscal rim is prepared and preserved.

▪ Insertion sites are preserved.

▪ Excellent tissue is needed to anatomically/biomechanically secure the transplant.

• Posterior tunnel placement

▪ A reverse notchplasty can be done with an osteotome if overgrown osteophytes are present anteriorly (Fig. 38-4).