AANA/SOMOS Enduring Knee Program 2025-Discussion/Case Presentations: Complex Knee Pathology

Video Transcription

Video Summary

A panel of orthopedic sports surgeons moderates an interactive “complex knee pathology” case session, emphasizing audience participation and practical decision-making.

<strong>Case 1:</strong> A 17-year-old male has bilateral osteochondritis dissecans (OCD): a painful left lateral femoral condyle lesion after two failed surgeries and a less painful but unstable right medial femoral condyle OCD. The group debates which knee to address first, balancing symptoms versus salvageability and rehab/weight-bearing constraints. The team ultimately scopes both knees, fixes the unstable right OCD fragment with screws (metal vs biocomposite debated), confirms healing by CT and removes hardware, then later treats the left with a fresh osteochondral allograft.

<strong>Case 2:</strong> A 35-year-old woman sustains a first-time patellar dislocation with a small patellar fracture and cartilage injury. Panelists discuss early fixation, cartilage options, and whether to add MPFL reconstruction. The treating surgeon initially observes; the fracture heals malunited, causing instability and a large patellar cartilage defect. She later undergoes fresh allograft cartilage restoration plus MPFL reconstruction, with technical discussion of arthrotomy layers and anchor placement.

<strong>Case 3:</strong> A 39-year-old woman has a multiligament knee dislocation (ACL/PCL tears, tibial-sided MCL avulsion, capsule disruption, meniscus tear). One-stage versus staged reconstruction is debated; surgeon repairs MCL/capsule and meniscus acutely, then performs delayed ACL (quad autograft) and PCL (allograft) reconstruction.

<strong>Case 4:</strong> A Division I soccer player with a small cartilage lesion but large bone marrow edema is discussed. While many suggest debridement/retrograde drilling, the surgeon performs a single-plug autologous OATS to enable return in ~5 months, noting donor-site morbidity risks (especially in smaller females).

Additional cases cover failed trochlear MACI with progression, single-stage ACL revision using calcium phosphate tunnel grafting, patellar instability with jumping J-sign treated with isolated MPFL due to patient preference, and pushing indications for medial meniscus root/radial repairs even in older, arthritic patients.

Asset Caption

Moderators: Kevin F. Bonner, M.D., FAANA., Grant Cochran, M.D.
Panel: Nicholas A. Sgaglione, M.D., Andrea M. Spiker, M.D., FAANA, Eric W. Carson, M.D., Shawn M. Gee, M.D., Reed M. Heckert, M.D., David J. Tennent, M.D.

Keywords

complex knee pathology

osteochondritis dissecans (OCD)

femoral condyle lesion

osteochondral allograft transplantation

patellar dislocation

MPFL reconstruction

multiligament knee dislocation

ACL/PCL reconstruction

autologous OATS (osteochondral autograft transfer)

cartilage restoration (MACI) failure

medial meniscus root/radial repair