Name: Graft Preparation and Passage for a Meniscal Allograft Transplantation Using the SutureLoc™ Implant
Uploaded: 2024-12-23T00:00:00Z
Channel: Arthrex
Description: Walter R. Lowe, MD (Houston, TX), demonstrates a meniscal allograft transplantation using the SutureLoc™ implant for soft-tissue fixation of the posterior horn and bone plug fixation of the anterior horn.

<p>Walter R. Lowe, MD (Houston, TX), demonstrates a meniscal allograft transplantation using the SutureLoc™ implant for soft-tissue fixation of the posterior horn and bone plug fixation of the anterior horn.</p>

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VID1-006892-en-US | A | Graft Preparation and Passage for a Meniscal Allograft Transplantation Using the SutureLoc™ Implant

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Graft Preparation and Passage for a Meniscal Allograft Transplantation Using the SutureLoc™ Implant

Hi, this is Doctor Walt Lowe from Houston, Texas. And today we're going to show a medial meniscal transplant. You can see here that we've already sort of prepped this knee. And I'll give you a little guided tour here through it. We've completed the meniscectomy around the entire circumference of the meniscus. As we go through there. I've already prepared the bed where we're going to put it in, but I'll show you a little more about that in a second. It's very important as we go through this to most important first step is just getting the position of the posterior horn and the anterior horn. Right. So I've prepared this area, but I think good to just show it again in that taking a little arthroscopic curette and just made a footprint here for the bony attachment posteriorly. So I still use bone both anteriorly and posteriorly, but just a little wedge back here. So I make a footprint and you can tell. And I think this is a very good view. I'll kind of look at it with the NanoScope through a 70 degree view. You can see that this is right where the medial meniscus root attaches posteriorly. So it is a little anterior to what you would expect it is. And if you don't recognize that, you will start the extrusion process of these transplants just by putting it in the wrong place. So once I've prepared that with the Curette and got it ready, then the PoweRasp really does a nice job of flattening this surface out so that my bony piece will fit down in this prepared area. So just a quick review. Here's where we're going to put the posterior plug back there pretty much out to the rim all the way around. Flip the scope around and we'll see all the way anteriorly. Now that we've had the posterior footprint prepared and ready to go, We're going to move to the back table and I'll show you how we prepare the meniscal transplant graft. Get getting ready for his implantation. Okay, so now we're at the back table and going to be preparing the medial meniscus transplant graft for us to implant later. We've done a little bit of work ahead of time. We've prepared the anterior plug. You can see that I still use a bony socket anteriorly. It's fixed with a number two FiberLoop that is basically loop up flipped over and tighten down. So you can see that suture fixation. You know we've got the bone plug for the anterior horn prepared already. Kind of flipped this over to show you we've marked the undersurface of the transplant graft with the P that just says posterior. So we know that goes in back and just little dots along it. So we always know which side goes up and which side goes down. That sounds silly, but it can really get confusing sometimes in the knee as you're trying to reduce the meniscus. So those little marks become very helpful. Now we're going to focus on the posterior bone preparation because this is what's different. This is going to be a little thin bony wedge that we can use the SutureLoc to pull down onto the surface posteriorly where it goes. So we still maintain some bony fixation, but have the fixation of the SutureLoc right up underneath the subchondral bone. So we can do osteotomies. We can do all kinds of other things with this without fear of disrupting our sutures. So let's go ahead and prepare that posterior bone you can see marked out sort of the outlines of how we want to fashion this bony component of the transplant. And we've marked it big. So we can start with something we can work for, and then kind of sculpt it down to match the area on the posterior part of the tibial plateau, where it's going to fit in as the posterior root attachment of the medial meniscal transplant. Now you can see we have sort of our bony piece ready to shape up to put in. And it's really important, I think, you know, just as advice on how to do this, we try to get this done while they're bringing the patient back to the room, putting them to sleep, so that by the time we're actually ready to start the case, that this is already done and it hasn't delayed your case if you're having to prepare this by yourself. So this is sort of the base we're working from. But to do what I want to do with it, it has to be a lot thinner. And so this will just end up just being a very thin, bony piece that you can actually pass needles through, pass needles with a Scorpion through to pass your sutures. Because to have this pull this piece down into the bed, we're going to put it, it has to be a mattress type suture with both of the SutureLoc sutures. So we're going to now we're going to take what we have to work with and move it down to the final implant. So we're in the final stages of getting this meniscal allograft transplant ready to implant. And you can see we've really thinned down this wafer. And this is going to be the size that we implant for our posterior root attachment. And just finishing up, thinning this out and getting it very smooth with the bur. Okay. This is the final prep of the graft. And we're ready to take the next steps to implant it in the knee. You can see the anterior horn is a typical cylindrical plug into a socket up front. And then this very thin wafer in back will be what we use the SutureLoc to sink down into the prepared bony bed for it as the posterior root attachment. And while we're waiting to implant this, we'll put a few drops of ACP on each bony piece, getting ready to implant it. Once we're ready. Okay, so we're ready to put the transplant piece in. And so now I just have to get some sutures ready to help me pull it in. So you can see I've sort of previously placed a blue suture, a TigerWire, and another suture up here at the front. Those are all just to help me reduce. And if I like these two posterior ones, I'll tie it together at the end. If I don't, then we'll just place our other, you know, a meniscal repair sutures as we go. And so we're just attaching this loop to a similarly placed blue suture on the transplant. And then we'll just pull that through. And we can clamp this. You always got to make sure you don't have any little soft tissue bridges. So I'll just do these one at a time. And then we'll attach the TigerWire to it with the second suture in. And then the last. So once we have these sutures passed, and this is just to help us manage the tissue of the transplant as we reduce it into the joint. Step one here is we'll start with our SutureLoc. I always go blue first, white second. And that way I kind of always know what I'm doing. We see the posterior side of the implant here versus the top here. And we're going to come up over and down. So you can see the wafer was thin enough that I could pass my suture through with a Scorpion. And I think that's sort of the test. Now we're going to do the same thing and turn the Scorpion upside down and go back. Through it. So we create this kind of horizontal mattress suture through it. So now we've loaded it to the passing suture. And now we'll sort of provisionally reduce this suture. You can see this transplant piece always stays very close to the little arthrotomy here, because you just don't have much room to get all this done. So now we sort of have these two mattress sutures in this little thin bone wedge. Will attach the next one, and then we'll show passing the graft. You want to get this passed completely through for fixation, but you don't want to pull it too tight. So now we're just going to kind of shuttle this down in. You know now we've reduced this posterior piece into its bed. You can see I can sort of if you focus up close on that route, I'm really pulling hard. And I got no motion there. And then we'll come in and try to pull it back. You see, I got it down really good. Try to loosen it up. I'll retension again and focus back on that route and see. Even doing that, I got very little movement. Second time around, we can sort of flex and extend the knee. Usually I'll cycle a few times, go back and look at it. Retention again just pulling on blue and white outside here. And so that's down and I think looks beautiful. So now we can see how the meniscus reduces with our two more posteriorly placed sutures. You can see this meniscus without really much done yet is already pretty well reduced. So it's really important right now that we get the anterior bone plug placed. Because that's going to let us bring the capsule to the meniscus rather than take the meniscus out to the capsule as one of the many strategies to decrease the extrusion of this. Now we have the the anterior piece of the meniscus transplant that we're going to drill the hole for. So there's always sort of a judgment of reducing. And much like how posterior and then moving a little far anterior on the back of that eminence is for the posterior horn. The anterior horn goes way more lateral than you would think, but your meniscal transplant has to match that deal, and you can see how it doesn't go here. It goes way over there. Okay. And that'll really help us reduce the extrusion down the line too. So I've already drilled the socket for the anterior bone plug. And then just with a little two four drill to score the cortex, I've passed the lasso up into that. And now we'll load the anterior bone plug on this lasso. And that'll help us seed it and fix it anteriorly. And I'll just start reducing this in. This is a very tight fit. And then just tap that in gently. Good a little more. So now you see the the bone plug is seated in its socket. A band can pass underneath so you can see it better. And then I'll just use dog bones. Swivelock sort of your choice to fix it on the on the anterior surface of the tibia. Okay. So we've put some sutures all the way around. Now we still have the anterior horn left to fix, which you can put sutures in from inside out from outside in. You know, use anything you like to fix that anterior horn. Pretty easy. You can see, after all that manipulation, there's poster horn again with SutureLoc will retension it. So go ahead and pull blue white. You know, and I think the important thing with this is just tension retention. Tension retention. So I think that looks beautiful at the end. Once we have things fixed, then we'll drop our needle in and get in and around the bone plug and deploy some ACP we previously soaked the graft in.

Graft Preparation and Passage for a Meniscal Allograft Transplantation Using the SutureLoc™ Implant

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