2023 Annual Meeting Knee Access Pass-Discussion and Case Study

Video Transcription

Video Summary

The discussion focuses on complex knee surgery issues, particularly meniscus transplants, ACL reconstruction failures, and revision strategies. For meniscus transplants, severe focal cartilage defects (grade 3-4) warrant simultaneous cartilage repair and meniscus transplant, but diffuse arthritis with joint space narrowing contraindicates meniscus transplant, favoring osteotomy instead.<br /><br />Knee flexion angle during lateral meniscus inside-out repair is commonly at 90 degrees. The panel debates valgus deformity's role in ACL reconstruction failure; though theoretically possible, clinical experience is limited, with no clear biomechanical rationale established.<br /><br />ACL revision cases emphasize tunnel management; for tunnels under 15 mm, one-stage revision may be feasible, but larger or problematic tunnels favor two-stage revision with grafting (allograft bone dowels, impacted chips), often repairing concomitant lateral meniscus root tears during surgery. Repair timing varies but three months post-grafting is common.<br /><br />Lateral extra-articular tenodesis (LET) is widely endorsed to augment ACL revision, protect meniscal repairs, and improve rotational stability, particularly in young or revision patients.<br /><br />For young athletes with ACL injuries, repair alone is often insufficient; reconstruction with autograft (preferably quadriceps tendon) plus LET is standard. Caution is urged about returning young athletes to pivoting sports due to osteoarthritis risk.<br /><br />Consensus supports slope-changing osteotomies for certain indications, though evidence is limited regarding fixation site and outcomes.<br /><br />Overall, combined approaches addressing meniscal, ligamentous, and bony pathology—tailored to individual anatomy, cartilage status, and activity level—optimize outcomes in complex knee reconstructions.

Asset Caption

Moderator: Guillermo Arce, M.D.
Panelists: David H. Figueroa, M.D., Sabrina M. Strickland, M.D., Andreas H. Gomoll, M.D., Romaine Seil, M.D.

Keywords

meniscus transplant

ACL reconstruction failure

revision strategies

lateral meniscus repair

lateral extra-articular tenodesis

osteotomy

young athletes ACL injury