AANA Lab Course 913 - Advanced Knee Course-My Tips on Combining Cartilage with Other Procedures Faculty Lecture

My Tips on Combining Cartilage with Other Procedures Faculty Lecture_ Patrick W. Joyner, MD, MS

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Dr. Patrick W. Joyner shares insights on combining cartilage restoration with other knee procedures, emphasizing the importance of comprehensive planning for successful outcomes. Citing Saris et al. (OJSM 2018), he notes that cartilage restoration failures often involve malalignment (56%), graft failure (27%), meniscal deficiency (19%), and ligamentous instability (5%), underscoring that cartilage issues rarely exist in isolation.<br /><br />Key advice includes always having a detailed surgical plan, along with contingencies, to maximize first-time success. When performing osteochondral autograft transfer systems (OATS), the approach balances protecting the cartilage repair with not compromising concurrent procedures like ligament reconstruction or osteotomies. Dr. Joyner prefers to do OATS first—whether autograft or allograft—except in patella cases where tibial tubercle osteotomy (TTO) is done first to improve exposure.<br /><br />Similarly, for meniscal allograft transplantation (MAT), he tries to perform it before other procedures to avoid compromising the graft but notes exceptions, such as avoiding deep knee flexion after MAT. Coordination with ligament reconstruction and osteotomies requires careful sequencing to protect all repairs.<br /><br />A case example involves a 30-year-old surgical intern with a right knee osteochondritis dissecans lesion treated with medial femoral condyle OATS, pre- and post-operative imaging illustrating the result.<br /><br />In conclusion, Dr. Joyner stresses addressing alignment, ligamentous instability, and meniscal pathology alongside cartilage restoration. Preparation is critical: having a well-devised, visualized surgical plan and back-up strategies fosters positive outcomes. With thorough readiness, these complex combined cases can be rewarding.  <br /><br />Contact: Patrick W. Joyner, MD, 919-257-8397, pumpingiron165@gmail.com.

Keywords

cartilage restoration

knee procedures

osteochondral autograft transfer system (OATS)

meniscal allograft transplantation (MAT)

ligament reconstruction

osteotomy

malalignment

surgical planning

osteochondritis dissecans

medial femoral condyle