CHEN Xing-zuo, ZHANG Jin, LIN Peng, ZHANG Hui, HONG Lei

WANG Xue-song, SONG Guan-yang and FENG Hua

    Meniscal allograft transplantation (MAT) may offer an attractive alternative to restore the normal biomechanical structure of knees. The mean early failure rate (≤2 years) of MAT is approximately 10%.1-3 A successful outcome of MAT depends on the ligamentous stability of knee, limb alignment, graft types, and graft fixation methods.4,5 Graft fixations include the meniscal horns and the peripheral rim. Techniques for fixation of the peripheral rim include sutures or a meniscal repair device such as FasT-Fix (Smith & Nephew Inc, Andover, MA, USA). Here we present an unusual case of early graft failure using FasT-Fix sutured to the peripheral rim of the graft.
    A 28-year-old male was referred to our center complaining of recurrent pain, swelling, and instability for 3 months after accidentally spraining his right knee. His medical history included injury of the medial meniscus of the right knee 3 years ago. A total open meniscectomy was performed by a local hospital. On physical examination, the right knee presented with mild effusion and tenderness on the medial joint line, marked anterior laxity (positive Lachman and pivot-shift test), the end-point was soft, and the side-to-side difference was 5 mm as measured by KT-1000 (MeDmetric Inc, San Diego, USA). Magnetic resonance imaging (MRI) demonstrated increased signal intensity of the anterior cruciate ligament (ACL) on T2-weighted images, and also indicated an absence of the medial meniscal tissue (Figure 1A and 1B).
     It was decided to perform a medial MAT combined with single-bundle ACL reconstruction arthroscopically. During the surgery, arthroscopic findings showed grade II cartilage damage on the medial compartment of the femur and tibia according to Outerbridge classification (Figure 1C). Debridement was performed over the surface of the damaged cartilage.