Table 2.
Pearls, Pitfalls, and Risks
| Pearls |
| The posterolateral joint line should be identified with a probe through the regular portals to define the best location for the lateral approach. |
| During debridement of the remnant meniscus, the surgeon should leave a 1-mm rim of bleeding meniscal tissue to prevent displacement of the allograft. |
| A 90° curette should be used to detach the posterior horn attachment to improve visualization of the tibia's back wall. |
| The surgeon should use his or her finger to feel the posterior capsule while it is pierced by the hemostat. This aids in the precise placement of the passing sutures. |
| The edges of the meniscal allograft should be marked to help orientation. |
| The posterior sutures should be tied in a cross-matched fashion to create a stronger construct. |
| The distance between the sutures should be 3-5 mm. Usually 6 vertical mattress sutures are placed in the superior and inferior surfaces of the meniscus between the anterior and posterior fixations. |
| Pitfalls and risks |
| Failure to address concomitant conditions such as instability and malalignment may lead to poor results. |
| Patients with grade IV chondromalacia must be evaluated for a concomitant cartilage–resurfacing procedure. Otherwise, they are not good candidates for MAT. |
| MAT in patients with open physes can lead to growth arrest. |
| Injury to the common peroneal nerve is a risk in posterolateral approaches. The surgeon should keep the lateral dissection anterior to the biceps tendon and lateral head of the gastrocnemius to avoid the nerve. |
| Before creating the trapezoidal trough that will receive the bone portion of the graft, the surgeon should measure the length of the tibial plateau and use a calibrated device leaving a 2-mm posterior back wall to avoid posterior trough blowout. |
| Stiffness can occur if the patient is not able to follow the established rehabilitation protocol. Assisted mobilization should be initiated on the first day postoperatively and should be limited to 90° for the first 2 weeks. |
MAT, meniscal allograft transplantation.