AANA Lab Course 913 - Advanced Knee Course-Roundtable Discussion, Interesting Cases from Home

Pdf Summary

This presentation by Dr. Michael A. Zacchilli, an Orthopaedic Surgery & Sports Medicine expert, focuses on challenging knee cases encountered in sports medicine, emphasizing osteochondritis dissecans (OCD), patellar instability, and outcomes following complex knee surgeries.<br /><br />The first case involves a 17-year-old elite soccer player with an OCD lesion after knee trauma causing pain, locked knee, and restricted motion. Imaging confirmed OCD, and after management including protected weight-bearing and monitoring, the patient returned to competitive play by 8-9 months, highlighting successful conservative treatment for selected lesions.<br /><br />Data from 58 patients involving osteochondral allograft transplantation (OCA) with or without bone marrow aspirate concentrate (BMAC) showed high rates (~86%) of graft bony integration and cartilage fill at six months on MRI with no significant differences between groups, suggesting both strategies yield similar early imaging outcomes.<br /><br />A second case details a 39-year-old female with persistent burning pain and discomfort following tibial tubercle osteotomy and chondroplasty, complicated by saphenous nerve hyperesthesia related to hardware. Despite prior treatments and persistent symptoms, multidisciplinary evaluation and targeted treatment improved symptoms and functional status by three months post intervention.<br /><br />A third example concerns a 28-year-old NYPD officer with chronic patellar instability and multiple redislocations despite prior lateral release and chondroplasty, with significant functional impairment. Imaging showed increased tibial tubercle–trochlear groove (TT-TG) distance. The case underscores challenges in managing recurrent patellar instability in active, young individuals desiring return to sport and occupation.<br /><br />Outcomes data for knee preservation surgery demonstrate moderate survivorship at five years (64-92% depending on subgroup), and risks for failure include malalignment and older age. Osteochondral allograft transplantation shows significant improvements in patient-reported outcome measures such as KOOS, IKDC, Tegner-Lysholm, Oxford, Cincinnati, VAS, and SANE scores, signifying substantial functional gains.<br /><br />Overall, the cases and studies affirm that individualized, multidisciplinary approaches are critical in treating complex knee pathologies in athletes and active individuals, balancing surgical techniques, rehabilitation, and realistic expectations to optimize return to sport and quality of life.

Asset Caption

Panel: Bonner, Sgaglione, Arendt, LaPrade, Johnson, Heard, Richmond, Dodds, Shelton, Koh, Beach,
McMillan
Moderator: Michael A. Zacchilli, MD, Etan P. Sugarman, MD, Seth L. Sherman, MD

Keywords

Osteochondritis dissecans

Patellar instability

Osteochondral allograft transplantation

Bone marrow aspirate concentrate

Knee trauma

Tibial tubercle osteotomy

Saphenous nerve hyperesthesia

Knee preservation surgery

Functional outcomes

Multidisciplinary treatment