Complete removal of the meniscus (meniscectomy) often leads to early-onset of osteoarthritis due to changes in contact mechanics 1,2. To counteract these changes, the removed meniscus is often replaced with an allograft. Many variables can affect the surgical outcome of meniscal transplantation (bone geometry, graft size, fixation technique, level of activity, limb alignment, etc.) 3,4,5. Among them, the method of fixation is the most readily controlled. Two commonly used techniques are: (i) trans-osseous suture fixation via bone plugs, where bone plugs are machined at the anterior and posterior horns of the graft and implanted into appropriately sized tibial bone tunnels, and (ii) suture fixation at the meniscal horns, where the sutures are drawn through tibial bone tunnels and tied over a bone-bridge. But the mechanical consequences of these fixation techniques, specifically, how they affect knee mechanics are unclear.

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