Lateral Capsulodesis to Mitigate Extrusion in Meniscal Allograft Transplantation: A Surgical Technique
Amy E. Steele, Allen Seo, Ran Atzmon, Corrin Tan, Kinsley Pierre, Wyatt Andersen, Seth L. ShermanBackground:
Meniscal allograft transplantation (MAT) is a vital joint-preservation strategy for symptomatic patients with meniscal deficiency. Graft extrusion, displacement of the meniscus beyond the tibial margin, remains a common complication that may compromise long-term outcomes. Adjunctive capsulodesis tightens the lateral capsule and secures the peripheral rim to limit this displacement.
Indications:
Lateral capsulodesis as an adjunct to MAT is indicated in young, active patients with symptomatic lateral meniscal deficiency and preserved or near-preserved articular cartilage (International Cartilage Regeneration & Joint Preservation Society grade ≤3, localized). Contraindications mirror those for MAT: advanced compartmental chondral degeneration and uncorrected malalignment. Staging arthroscopy is recommended to evaluate intra-articular status before transplantation.
Technique Description:
After diagnostic arthroscopy to confirm the meniscus-deficient state and debride remnant tissue, 2 spinal needles are used under arthroscopic visualization to localize the anterior and posterior junctions of the mid-meniscal body. A longitudinal incision is made over the lateral joint line, and the iliotibial band is split along its fibers, with the capsule carefully preserved. Two knotless suture anchors are placed into the proximal periarticular tibia at the localized positions and linked to create a tensionable, knotless capsulodesis. With the arthroscope in the anteromedial portal, sutures are tensioned under direct visualization, drawing the lateral capsule to the proximal tibia and eliminating peripheral laxity. MAT is then completed in standard fashion. Rehabilitation follows standard MAT protocol: foot-flat weightbearing for 6 weeks, passive range of motion at 7 to 10 days, full weightbearing at 6 weeks, and avoidance of weightbearing flexion >90° for 12 weeks.
Results:
Lateral capsulodesis, as a general surgical technique, has been shown to maintain a mean absolute graft extrusion of 2.2 mm, with a graft survival rate of 85.7% at 7 years. Effective MAT arrested joint space narrowing in 41% of patients. The technique adds minimal morbidity, as lateral exposure is already required for standard MAT.
Discussion/Conclusion:
Lateral capsulodesis is a straightforward, low-risk adjunct to MAT that directly addresses graft extrusion. While short-term clinical outcomes between extruded and nonextruded grafts can be similar, extrusion is significantly associated with joint space narrowing and accelerated arthritic change long-term. This technique offers a reproducible method to enhance graft containment and joint preservation.
Patient consent disclosure statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.