Meniscus transplantation using the femoral distractor.

Accurate tunnel placement, graft passage, and secure suture fixation are key elements in meniscus allograft transplantation. We describe the use of a femoral distractor in meniscus transplantation. Joint distraction on the side of the transplantation by the femoral distractor can dramatically improve visibility and joint access. The distractor is applied after all necessary preparatory work. The distal femoral pin is placed in the supracondylar region on the side corresponding to the side to be transplanted. To avoid injury to the peroneal nerve, the proximal tibial pin is placed medial to lateral for both medial and lateral transplantations. The tibial pin is placed at a level approximately 1 to 2 cm below the tibial tubercle. The knee is then held in the flexion angle that affords the best visualization arthroscopically (typically between 60 degrees and 90 degrees of flexion). Gradual distraction is then applied with the distraction rod until adequate visualization is obtained. The case then proceeds with tunnel or trough creation, graft delivery, and peripheral repair. The improved visualization and access provided by the femoral distractor markedly simplifies the more challenging aspects of meniscus transplantation, helping to ensure precise tunnel placement, facilitate graft passage, and aid in accurate suturing.