Table 2.

Pearls, Pitfalls and Risks

Pearls • A CT scan of the graft is recommended to properly measure its size • Figure-of-four position allows for easy opening of the lateral compartment • Two surgical teams working in parallel optimize operating times • Resect the least amount of bone possible • Measure the anteroposterior depth with a screw-measurement device • Use passing sutures to help in fixing the meniscus to the capsule • Keep the meniscal horn insertion and the meniscotibial ligaments intact • Remove all the remaining soft tissue and use high-pressure pulsatile irrigation to eliminate any trace of blood and living cells other than chondrocytes • The washing can be performed with the graft introduced in a long and thin recipient (e.g., a plastic recipient of a 1-L saline solution with the top cut-out) • If coronal laxity is observed after the introduction of the graft and collateral ligament insufficiency has been ruled out, try an extra layer of bone autograft below the fresh allograft • Close the capsule with transosseous sutures through the graft

Pitfalls and risks • As a fresh graft can be only stored for a period of 14 d, hospital activity as well as surgeon and patient availability may call for cancelling the procedure • Transplanting a graft thicker than the recommended 10 mm carries a high risk of nonintegration and bone resorption • There is a risk of popliteal vessel injury if not properly protected during recipient site preparation • If the graft falls on the floor, immediately perform a new washing process with the high-pressure pulsatile irrigation system for 20 min and then leave the graft in a solution consisting of 1 g/100 mL vancomycin for 10 min • Potential risk of infectious disease transmission in all fresh allografts

CT, computed tomography.