AANA24 Hip All-Access Pass-CONCURRENT SCIENTIFIC SESSION 3A: Residents and Fellows Clinical Showcase

Video Transcription

Video Summary

The session featured presentations and debates on advanced orthopedic topics, focusing on articular cartilage repair in the knee, return to sport after shoulder instability surgery, revision hip arthroscopy for borderline dysplasia, and ACL reconstruction graft choices.<br /><br />First, a study comparing outcomes of osteochondral allograft transplantation (OCA) and autologous chondrocyte implantation (ACI/MACI) for patellofemoral cartilage lesions showed similar overall functional results and return-to-sport rates, with OCA patients reporting higher pain in trochlear lesions, possibly related to fewer concomitant corrective procedures.<br /><br />The second presentation explored return to sport rates after arthroscopic anatomic glenohumeral ligament reconstruction (AEG) versus Bankart repair for anterior shoulder instability with bone loss. The AEG group had a higher return to sport rate (75% vs. 50%) and substantially fewer redislocations, indicating AEG's superior efficacy in high-risk, collision athletes.<br /><br />A third study examined midterm outcomes after primary versus revision hip arthroscopy in borderline hip dysplasia, revealing comparable survivorship and functional results but inferior pain resolution in revision cases at 4.5 years follow-up.<br /><br />Two debates then addressed optimal treatments in challenging clinical scenarios. For a 26-year-old rugby player with anterior shoulder instability and 15% glenoid bone loss facing imminent competition, participants advocated either arthroscopic Bankart with remplissage or open Latarjet procedure, with most favoring the Latarjet for its lower recurrence and cost-effectiveness despite higher complication risks.<br /><br />In a case of a 29-year-old female with acute proximal ACL tear and a seven-month deadline for an intense skiing trip, the debate weighed bone-patellar tendon-bone (BTB) autograft, quadriceps tendon autograft with lateral extra-articular tenodesis (LET), and primary ACL repair. The BTB graft was favored for superior fixation, rapid bone healing, and historic success facilitating early return to sport, narrowly winning the vote. However, alternatives like quad tendon with LET or ACL repair were noted for potentially lower donor site morbidity and quicker rehabilitation.<br /><br />Overall, the session highlighted patient-specific factors, surgical technique nuances, and evolving evidence guiding individualized treatment to optimize functional outcomes and sport resumption in orthopedics.

Asset Caption

Moderators: Jocelyn R. Wittstein, M.D., Christopher J. Tucker, M.D., FAANA

Keywords

orthopedic surgery

articular cartilage repair

osteochondral allograft transplantation

autologous chondrocyte implantation

shoulder instability surgery

arthroscopic glenohumeral ligament reconstruction

Bankart repair

hip arthroscopy

anterior cruciate ligament reconstruction

graft choices