AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 3B: Knee: Pediatric/Adolescent/Collegiate

Video Transcription

Video Summary

The conference session included expert discussions on pediatric and adolescent knee surgeries, focusing on ACL reconstruction, discoid lateral meniscus, unstable osteochondritis dissecans (OCD), patellar instability, and treatment approaches for complex cartilage injuries.<br /><br />Dr. Steve Aoki reviewed various ACL reconstruction techniques for skeletally immature patients, emphasizing growth plate considerations, surgical options (IT band extra-articular, all-epiphyseal, transphyseal), and technical nuances to reduce growth disturbances. He supports using lateral extra-articular tenodesis (LET) in adolescents with high-risk features to lower re-tear rates.<br /><br />Dr. Tom DiBerardino discussed discoid lateral meniscus pathology, its predisposition to tears even from low-energy mechanisms, and the role of meniscal allograft transplantation (MAT) in young patients with post-meniscectomy syndrome. He highlighted the need for early intervention to preserve joint health and optimize outcomes.<br /><br />Dr. Catherine Logan presented on unstable OCD lesions, detailing clinical presentation, imaging evaluation, and fixation strategies. She advocated thorough arthroscopic assessment, lesion bed preparation, and internal fixation with appropriate fixation devices, followed by tailored rehabilitation protocols.<br /><br />Dr. Lee Pace tackled patellar instability in open growth plates, underscoring the dominant role of trochlear dysplasia, patella alta, and malalignment. His algorithm recommends fixation or correction of major anatomic risk factors in skeletally immature patients with adjunctive MPFL reconstruction, and he described a safe pediatric MPFL technique.<br /><br />A debate contrasted LET inclusion and omission in adolescent ACL reconstruction. Dr. Aoki favored LET for enhanced rotational control and reduced re-tear, while Dr. Henry Burke advised reproducible transphyseal ACL reconstruction without LET, citing limited pediatric LET evidence and emphasizing growth plate protection.<br /><br />Further discussion on a Division I athlete with multiple failed OCD surgeries and varus alignment evaluated osteochondral allograft (OCA) alone versus OCA plus high tibial osteotomy (HTO). Dr. Tracy Loyer recommended OCA alone for quicker return to play and lower complication risk; Dr. Vidal emphasized HTO to address malalignment biomechanically crucial for graft success and failure prevention.<br /><br />Dr. Pace demonstrated a physis-sparing ACL technique combining IT band tenodesis and a horizontal femoral socket with intraoperative imaging to avoid growth plate injury.<br /><br />Panelists concluded with case-based management of large osteochondral fractures in adolescent patients, favoring fixation when cartilage quality permits and discussing individualized approaches to patellar instability and cartilage restoration.<br /><br />Overall, the session spotlighted nuanced surgical decision-making tailored to growth and anatomic variables to optimize long-term knee function in young athletes.

Asset Caption

Introduction by Moderators: Tamara A. Scerpella, M.D., Matthew A. Tao, M.D.

Keywords

pediatric knee surgery

adolescent ACL reconstruction

growth plate considerations

lateral extra-articular tenodesis

discoid lateral meniscus

meniscal allograft transplantation

unstable osteochondritis dissecans

arthroscopic fixation techniques

patellar instability

MPFL reconstruction

osteochondral allograft

high tibial osteotomy