2022 Specialty Day Access Pass-Session II: Meniscus/Cartilage

Video Transcription

Video Summary

The session on meniscus and cartilage pathology highlighted comprehensive approaches for diagnosis and treatment, emphasizing individualized patient care. Rachel Frank introduced cartilage pathology, stressing cartilage's critical role and discussing treatment algorithms considering defect size, location, alignment, meniscus status, prior treatments, patient goals, and implant availability. She advocated for staging scopes via in-office arthroscopy to accurately assess lesions before surgery. Treatment options span from simple debridement, marrow stimulation (microfracture), augmented microfracture, cell-based restorative procedures like MACI, minced cartilage products, to reconstructive techniques, notably osteochondral autografts and fresh osteochondral allograft transplantation—the latter being favored for larger, complex defects.<br /><br />Seth Sherman addressed the importance of diagnosing and treating medial meniscus ramp lesions, often hidden, especially in ACL-deficient knees, emphasizing all-inside repair techniques with excellent outcomes. Karen Sutton discussed medial meniscus root tears, advocating for repair over meniscectomy or conservative treatment in most cases to prevent osteoarthritis progression, with surgery being favorable even in mild arthritis.<br /><br />Kevin Bonner supported fresh osteochondral allograft transplantation for its restoration of hyaline cartilage and subchondral bone, high survivorship, and better outcomes over microfracture and ACI/MACI, especially in athletes. Dave Flanagan highlighted MACI's long history, simplified techniques, efficacy, especially in patellofemoral lesions, accelerated rehab, and durability, though recognizing osteochondral allografts as a go-to for compromised subchondral bone.<br /><br />Biologics for degenerative knees were covered by Katherine Logan and Jorge Chahla, focusing on PRP and bone marrow aspirate concentrate (BMAC). PRP, particularly leukocyte-poor, was shown effective in early osteoarthritis with multiple injections recommended. BMAC shows promise but requires more robust evidence; adipose and synovial stem cell therapies are emerging but need further validation. Both experts stressed conservative management first, using biologics as adjuncts.<br /><br />Al Getgood emphasized the necessity of addressing malalignment via osteotomy—medial opening wedge for varus and medial closing wedge distal femoral for valgus deformities—to improve joint preservation success. Modern digital planning and patient-specific instrumentation enhance accuracy.<br /><br />Panel discussions concluded that successful meniscus and cartilage treatment requires managing patient expectations, carefully selecting procedures based on individual pathology, alignment, and biology, and ensuring proper rehabilitation. Conservative management remains first-line for degenerative tears, with surgery for those who fail conservative measures. Osteochondral allografts and MACI complement each other, with graft choice guided by lesion depth and location. Biological therapies are adjuncts pending further evidence, while realignment osteotomies play a pivotal role in joint preservation.

Asset Caption

Moderators: Cassandra A. Lee, M.D., Clayton W. Nuelle, M.D., FAANA

Keywords

meniscus pathology

cartilage pathology

in-office arthroscopy

microfracture treatment

MACI

osteochondral allograft transplantation

medial meniscus ramp lesions

medial meniscus root tears

biologics for knee osteoarthritis

osteotomy for malalignment

patient-specific instrumentation