Arthroscopic Medial Meniscus Substitution Using Autologous Semitendinosus Tendon with Suture Tape Augmentation as an Alternative to Meniscal Allograft Transplantation: A Modified Technique

Irreparable meniscal tears and complete loss of meniscal tissue can accelerate osteoarthritis by disrupting normal load transmission within the knee. Although meniscal allograft transplantation (MAT) is commonly used for the post-meniscectomy knee, its clinical application is limited by graft availability, sizing logistics, cost, and potential disease transmission. Autologous tendon substitution has therefore emerged as an accessible alternative. This technical note describes a reproducible arthroscopic technique for medial meniscal substitution using an autologous semitendinosus tendon (ST) graft reinforced with suture tape augmentation. The procedure combines anatomic tibial bone tunnel fixation of the anterior and posterior roots with hybrid peripheral suture fixation-employing all-inside sutures at the posterior root and outside-in sutures at the mid-body and anterior horn-to optimize graft containment and restore hoop tension. Surgical indications, key technical steps, and pearls to avoid common pitfalls are detailed. By addressing the logistical and economic limitations of allograft transplantation, this technique provides a cost-effective, universally available, and biologically compatible option for medial meniscal reconstruction. This approach aims to restore knee kinematics and may help delay degenerative joint changes in young, active patients.