2021 Annual Meeting Knee Access Pass-Case Panel Discussion: Controversies in Articular Cartilage Surgery

Video Transcription

Video Summary

The video discusses complex knee cases involving young patients with discoid meniscus and osteochondritis dissecans (OCD) lesions. The first case features a 20-year-old male with valgus malalignment and subtotal lateral meniscectomy in adolescence, leading to lateral compartment joint damage. Experts emphasize addressing underlying valgus deformity with distal femoral osteotomy (DFO) and meniscal transplantation before treating cartilage defects, recommending staged procedures and careful patient-centered planning.<br /><br />The second case involves a 16-year-old basketball player with bilateral, symmetric biconcave OCD lesions, challenging to treat due to lesion location and extent. Surgeons discuss the difficulty of salvaging fragmented lesions, the role of autograft bone grafting, and the importance of radiographic imaging including CT arthrograms to plan repair or replacement with osteochondral allografts (OCA). They highlight the use of guided growth for alignment correction to avoid complications.<br /><br />The third case is a 24-year-old female with chronic lateral OCD and cystic bone disease. Panelists agree on combining OCA with valgus-correcting osteotomy to restore alignment and fill cysts, favoring neutral or slight varus alignment. Technical strategies for graft placement and bone defect management include using bone marrow aspirate concentrate (BMAC) and autogenous bone grafts.<br /><br />Overall, the panel stresses early intervention, individualized treatment plans, the integration of alignment correction, meniscal restoration, and cartilage repair, and the balance between staged versus combined surgery for optimal outcomes in young patients with complex knee pathology.

Asset Caption

Jack Farr, MD; Andreas Gomoll, MD; Christian Lattermann, MD; Bert Mandelbaum, MD; Nicholas Sgaglione, MD; Riley Williams, MD

Keywords

discoid meniscus

osteochondritis dissecans

valgus malalignment

distal femoral osteotomy

meniscal transplantation

osteochondral allografts

bone marrow aspirate concentrate