Table 4.

Pearls and Pitfalls

Pearls	Pitfalls
Create a large anterolateral portal to ensure easy passage of instrumentation and graft throughout the procedure	Failure to adequately expose the posterolateral capsule and protect posterior structures; places neurovascular structures at risk of injury
Leave a 1-mm peripheral rim of normal meniscus to aid in obtaining secure allograft fixation and prevent extrusion	Transtibial fixation in patients with open physis can lead to growth arrest
Prevent tunnel coalition by exposing the anterior tibial cortex, drill from different portals, set the drill guide to different angles, and maximize the distance between anatomic root positions	Fixation failure can occur if the patient is not able to comply with the rehabilitation protocol
With the meniscal bone blocks reduced, clamp the transtibial sutures and place 1 (or 2) central sutures through the premarked meniscal body; confirm an accurate reduction before knot-tying	Failure to identify/address concomitant pathology (i.e., ligamentous instability; full-thickness cartilage defects) will lead to poor outcome