Step by step surgical video for a lateral meniscus transplant.

This video, titled "Step by step surgical video for a lateral meniscus transplant," demonstrates an arthroscopic lateral meniscal transplant using the bone slot technique. The patient is a young individual who previously underwent a subtotal meniscectomy (removal of most of the meniscus) elsewhere and developed subsequent bone swelling (edema) and knee pain.

The major surgical steps outlined in the video are:

• Surgical Alignment and Notch Preparation: The surgeon utilizes a spinal needle to establish the precise alignment for the bone slot. A shaver and bone cutter are used to clear space, allowing full visualization of the back portion of the tibial plateau while carefully avoiding damage to the ACL.
• Creating the Bone Slot: A guide system is used to measure the depth of the plateau to ensure safe drilling without exiting the back of the knee. The surgeon initial logs a trough using a 5.5 shaver, warning that placing the slot too high is a common error. The groove is refined into a precise dovetail shape using a power rasp, sequential manual rasps, and a bone dilator so that the transplant’s built-in bone block will fit smoothly.
• Graft Insertion: A small mini-arthrotomy (incision into the joint) is created to view the prepared bone trough. Suture tapes are passed through the back of the knee, and the meniscal allograft (with its attached bone spine) is carefully slid into the joint and tapped back using a mallet until it sits securely on the tibial plateau.
• Posterior Fixation: The rear portion of the transplanted meniscus is secured first using all-suture meniscal repair devices. The surgeon demonstrates a "crisscross technique" to securely pull down the posterior aspect of the meniscus without puncturing dangerous structures behind the knee.
• Rim Stabilization (Inside-Out Technique): Using a specialized zone-specific cannula system, the surgeon places multiple vertical mattress stitches along the superior and inferior outer edges of the meniscus. These are brought out through the lateral side of the knee and tied off to firmly anchor the entire meniscal rim.
• Final Check and Healing Augmentation: The surgeon probes the transplanted tissue to verify that the joint space is completely filled and there is no abnormal mobility. Finally, a microfracture procedure is performed in the knee notch to release bone marrow cells, which aids overall tissue healing.