Name: All-Inside, All-Arthroscopic Meniscal Allograft Transplantation
Uploaded: 2026-09-28T00:00:00Z
Channel: Arthrex
Description: Michael A. Zacchilli, MD (New York, NY), demonstrates an all-inside arthroscopic medial meniscal allograft transplantation (MAT) technique with the SutureLoc™ implant for root repair and FiberStitch™ 1.5 implants for capsular fixation.

Knee

<p>Michael A. Zacchilli, MD (New York, NY), demonstrates an all-inside arthroscopic medial meniscal allograft transplantation (MAT) technique with the SutureLoc™ implant for root repair and FiberStitch™ 1.5 implants for capsular fixation.</p>

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VID1-009849-en-US | A | All-Inside, All-Arthroscopic Meniscal Allograft Transplantation

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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All-Inside, All-Arthroscopic Meniscal Allograft Transplantation

Speaker  Hi, this is Doctor Michael Zukile from New York. Today we'll be following a case of a medial meniscus allograft transplantation utilizing an all arthroscopic all inside technique. This on the back table we'll see our meniscus prepared with a FiberLoop SutureTape for both the anterior and posterior roots. On the anterior root that's utilized for eventual all knotless suture fixation. On the posterior root, this is a ripstop, which will help support our fixation with a SutureLoc device at a position between 15 to 20mm from the posterior root. You'll also note our SutureTape passage stitch, which will be utilized during graft passage and then sacrificed. So we're going to orient ourselves to the patient here. This is a healthy patient. Great knee. We can see the cartilage surfaces are intact. Importantly when we're considering to do a transplant. We've already checked and made sure that we're ligamentous stable. The ACL is in good condition. Again, no full thickness defects in this case. This patient is status post a complete meniscectomy. And we've already gone ahead and cleaned up the residual meniscus, leaving only that 1 to 2 millimeter rim Circumferentially that's going to be really important to maintain that because that's going to maintain our circumferential integrity and our hoop stresses after our transplantation. We'll also expose both our posterior root and our anterior root. We'll notice our posterior root here. Very importantly just posterior to the medial tibial spine. Speaker  And the position of it is actually anterior to the PCL. Common error would be to place this too medially in the knee. We want to make sure we're meeting the anatomic position. Similarly in the front we follow the anatomy of the native meniscus here. And we're going to just look down right over the top again for this particular technique. The whole key is maintaining ideally the native root insertions. We're going to fixate those first. And that's going to create our hoop tension. And so following those native fibers we're going to carry those down into the anterior tibia. We've completed a fat pad resection in this area. And we can really note how anterior that root falls relative to the ACL, really almost directly in front of the ACL itself. We're going to create our knotless anchor fixation point in a position just lateral to the most medial extent of the root. And so we've demarcated that here. And that will allow us to adjust the tension on our graph to account for any size differential. And then finally, again this rim is completed. Expectation for our traction stitch will be placed at a position roughly 15 to 20mm from the posterior root adjacent here. So we have our root guide in place anatomically just in front of the PCL. We want to make sure we're drilling a relatively high angle, usually somewhere around 80 degrees or so to make sure we're not skiving, and that as this exits into the knee, it's centered in the footprint there. Speaker  At this point, we've retrieved the wire loop. We're going to go ahead and exchange that for a FiberLink allows for a little bit smoother passage of our SutureLoc anchor. And then we'll go ahead and use that FiberLink to pass the SutureLoc in a standard fashion. I'm going to want to watch our anchor sink below the subchondral surface. And once in position, we'll go ahead and deploy that and achieve subchondral fixation on that cortex. Pull ourselves back and ensure a solid fit. And we're secure for that posterior root. So coming through that same PassPort, we'll bring our ZoneNavigator and this will be to place our traction stitch again a position about 15 to 20mm from our root. We know that as long as we're behind the semimembranosus here, this can be placed percutaneously. And it's one of the key factors that allows us to utilize a fully percutaneous technique for this case. We can palpate the posterior medial tibia, and as long as we're behind that semimembranosus, we're safe. And this obviates the need for a posteromedial incision completely. We can retrieve that transcutaneously. And here we have our traction stitch. So at this point, we're going to manage our sutures and remove the PassPort to allow for graft passage. Speaker  My knotless anterior anchor is going to go over here to my assistant, my passage traction stitch there. And I'll maintain control here of our SutureLoc. And we'll go ahead and take that PassPort out. Now as we do that, we're going to independently control each of these. Making sure we have all of the involved stitches and we're independently controlling those with snaps externally. Take our traction stitch. And that leaves us with our SutureLoc centrally and these are all independently divided. I also want to make sure here that the Arthrotomy is big enough to allow for the passage of the graft. We should be good in this case. So at this point, we're going to initiate our posterior root fixation. Utilizing the suture locks. The repair stitches will be placed in a Mason Allen configuration around our preexisting RIP stop. That's going to maximize the strength of our repair configuration and also improve the overall tear out resistance for the root. We know that our posterior roots and transplants fail most commonly in this location. We want to maximize that. So at this point we're going to manage our traction stitch, rotate the graft to match the patient configuration. Our traction stitch is coming posterior posterior medially rather. And our previously placed SutureTape from our meniscal repair with the ZoneNavigator can just be placed in this position. And that's all we need to do there. Speaker  At this point we're going to place our passage stitch placed a barrel knot into our suture repair stitch here. We can use that to dilate our capsule before passing the traction stitch and just tie a simple knot here. Now, with the graft adjacent to our root, this is a good time to finalize our repair stitches for the SutureLoc, and we'll do that one at a time here. So for graft passage we're going to maintain the position of our graft and then alternate tension on our SutureLoc repair stitches doing our deep blue mason Alan first, followed by the white and alternating fashion. As we do that, the traction stitch will maintain by my assistant here right before we actually bring the graft in all the way, we want to make sure it doesn't flip. As you can see, it's trying to do that here. Maintain that position and tuck it behind the condyle can assist there again alternating our blue and whites. And then once we're close should just slide on back there, apply final tension to the suture locks and tuck that anchor in before we pull full tension on our traction stitch. And we can really see the stability of that fixation. If I bring my probe in between the rip stop and the Mason Allen configuration. So we can see here anatomic position, excellent tension with that SutureLoc device. Speaker  And this is really where the key to this comes into play. Because as we're going to establish our anterior fixation with our knotless device, we'll be utilizing the native hoop stresses of our graft to set our attention. And so now we can see we've converted our posterior fixation SutureLoc. We have our traction stitch in place, and we've converted our anterior knotless anchor here and secured it provisionally. The goal here is that that's got some ability for modification. And we can set native root stresses or hoop stresses rather. And you can see here that that meniscocapsular junction looks just like a bucket handle tear. And so the hoop stress set between our roots for this graft match the native capsule nicely. And at this point we're just going to go ahead and complete our peripheral fixation, our meniscocapsular fixation with our FiberStitch. It's important to understand when you're using these FiberStitch is that they act both as a fixation technique, but also as a reduction tool. And so we want to identify our native position, really reduce that meniscocapsular junction. And I like to set my capsular stitch first. This sets the height of my transplant right at the edge of that residual. And then again identifying the position of our graft. That's going to reduce nicely there. Placing this posterior medial stitch first is really important because that sets the tone similar to closing a closing in skin incision. Speaker  We want to reduce equally across the full length of the meniscocapsular junction. We'll go ahead and tension this provisionally and then finalize our tension. And here we can see that FiberStitch we're going to complete similar fashion again noting there's almost a native reduction of this graft to the patient's capsule. And so we really know we've set that hoop stress with our root positions correctly. At this point. The traction stitch can be removed and that can be completed fairly easily. And so now, free of any posteromedial incision, we're prepared for a peripheral fixation just as if it was a bucket handle. And here's our final construct of our all arthroscopic all inside meniscus transplantation. You can see we've augmented the initial FiberStitch circumferentially with additional meniscocapsular stitches. We have a nice stable repair, our reconstitution of our flounce sign. So our hoop stresses are great. And we've converted that knotless anterior root stitch here as well. We can see that root reconstituted right in front of the ACL footprint. So this is anatomic. And we'll go through just an anatomic reduction in a range of motion. And we'll identify how that stays inside our joint. We don't see any extrusion. Nice and stable repair all through range. And all accomplished without an additional posteromedial incision and all with suture fixation.

All-Inside, All-Arthroscopic Meniscal Allograft Transplantation

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