title: Transpatellar approach in lateral meniscal allograft transplantation using the keyhole method: can we prevent graft extrusion?
abstract: OBJECTIVE
  technique for guide wire placement during meniscal allograft transplantation (MAT) is usually based on the parapatellar approach that is not in the anatomical direction of meniscal horn bony insertions. Here, we present a surgical technique to achieve the correct anatomical position of the meniscal graft using the transpatellar approach.
  
  
  METHODS
  a guide wire was introduced through the patellar tendon in the direction of the meniscal insertion sites passing the lateral tibial spine. The insertion plane of the guide wire was approximately at the medial aspect of the tibial tuberosity and slightly medial to the midplane of the patellar tendon. After confirmation with C-arm, the guide wire was cut at the level just beneath the patellar tendon. The knee was then brought to the extension position which lessened the tension of the patellar tendon and retracted it to the medial aspect to expose the end of the guide wire. Drilling and insertion of bone block was performed accordingly.
  
  
  RESULTS
  eleven consecutive patients with total or near-total meniscectomy of the knee underwent MAT with the described technique. The mean extrusion taken on 1-year postoperative non-weight-bearing MRI was 1.6 mm (range 0.5-2.9 mm). None of the patients presented with symptoms requiring a secondary surgery at the time of review.
  
  
  CONCLUSIONS
  the described technique focuses on achieving correct positioning of the tibia tunnel through the patellar tendon and tunnel reaming in the extended knee position via the mini-open parapatellar approach during lateral MAT. This "transpatellar approach" could be an effective method for anatomical placement of meniscal graft.
authors.affiliation: Department of Orthopedic Surgery, Seoul Veterans Hospital, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Korea.
authors.forename: Jung-Ro
authors.initials: JR
authors.lastname: Yoon
authors.forename: Taik-Seon
authors.initials: TS
authors.lastname: Kim
authors.forename: Young-Mee
authors.initials: YM
authors.lastname: Lee
authors.forename: Hyoung-Won
authors.initials: HW
authors.lastname: Jang
authors.forename: Young-Chan
authors.initials: YC
authors.lastname: Kim
authors.forename: Jae-Hyuk
authors.initials: JH
authors.lastname: Yang
mesh_terms: D000328:Adult; D001864:Bone Wires; D005260:Female; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000637:transplantation*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D014184:Transplantation, Homologous / Q000379:methods*
references.citation: Am J Knee Surg. 1996 Winter;9(1):35-6
references.pmid: 8835028
references.citation: Knee Surg Sports Traumatol Arthrosc. 2008 Jun;16(6):553-60
references.pmid: 18350276
references.citation: Cell Tissue Bank. 2010 Feb;11(1):75-85
references.pmid: 19387868
references.citation: Clin Orthop Relat Res. 1997 Jun;(339):163-73
references.pmid: 9186215
references.citation: Clin Sports Med. 2009 Apr;28(2):215-22, vii-viii
references.pmid: 19306731
references.citation: AJR Am J Roentgenol. 2004 Jul;183(1):17-23
references.pmid: 15208101
references.citation: Clin Orthop Relat Res. 2001 Jun;(387):171-7
references.pmid: 11400879
references.citation: J Knee Surg. 2008 Apr;21(2):163-72
references.pmid: 18500070
references.citation: Clin Sports Med. 2009 Apr;28(2):259-83, viii
references.pmid: 19306734
references.citation: Arthroscopy. 1995 Aug;11(4):386-94
references.pmid: 7575868
references.citation: J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:109-18
references.pmid: 16510805
references.citation: Knee Surg Sports Traumatol Arthrosc. 2006 Aug;14(8):694-706
references.pmid: 16463170
references.citation: Arthroscopy. 2008 Oct;24(10):1115-21
references.pmid: 19028163
references.citation: Ann R Coll Surg Engl. 2009 Jul;91(5):361-5
references.pmid: 19409145
references.citation: Am J Sports Med. 2009 Nov;37(11):2134-9
references.pmid: 19542303
references.citation: Sports Med Arthrosc Rev. 2007 Sep;15(3):121-5
references.pmid: 17700371
references.citation: Knee Surg Sports Traumatol Arthrosc. 2007 May;15(5):476-92
references.pmid: 17333124
references.citation: Arthroscopy. 1995 Dec;11(6):684-7
references.pmid: 8679029
references.citation: Knee Surg Sports Traumatol Arthrosc. 2004 Mar;12(2):130-5
references.pmid: 12756521
references.citation: Am J Sports Med. 2002 Mar-Apr;30(2):174-81
references.pmid: 11912084