AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 3E: Knee

Video Transcription

Video Summary

The session covered various advanced topics in ACL and knee surgery, presenting mid- to long-term outcomes, surgical techniques, and innovations.<br /><br />Sebastian Rilke from HSS discussed five-year follow-up results of selective primary ACL repair in 108 patients, showing durable outcomes with significantly lower failure rates in patients over 21 years old (8.6%) compared to those under 21 (37%). No additional failures occurred beyond two years, and patient-reported outcomes remained excellent. He emphasized age as a key factor and suggested further research into refining indications, particularly for younger patients.<br /><br />Crystal Perkins presented on adolescent ACL reconstruction using quadriceps tendon autografts, reporting a low 4% arthrofibrosis rate and 3% graft failure within 12 months. Strategies contributing to success included careful graft sizing, advanced tibial clearance, post-op bracing locked in hyperextension, and focused physical therapy targeting early knee extension.<br /><br />Adnan Zeitner analyzed nearly 5,000 ACL reconstructions, finding a 39% incidence of medial meniscus lesions, especially ramp lesions often missed without comprehensive posterior medial compartment evaluation. He showed delays beyond 12 months increase meniscal and cartilage lesion risk, emphasizing early surgery to preserve meniscal health.<br /><br />Jonathan Haskell compared meniscus repair with biological adjuvants: marrow venting and platelet-rich plasma (PRP). While all treatments improved outcomes, marrow venting alone showed the lowest failure rate (10%) though differences were not statistically significant.<br /><br />Eric Milliron demonstrated meniscus repair failure rates remain low (~23%) at over 10 years, with most failures occurring within three years and sustained positive patient-reported outcomes.<br /><br />Aaron Critch validated a model predicting leg length changes following distal femoral osteotomy. Opening wedge osteotomy lengthened the leg (~4.7 mm) while closing wedge shortened it (~2.6 mm), aiding surgical planning though clinical impact remains uncertain.<br /><br />Jairo Triana showed longer time intervals between cartilage biopsy and autologous chondrocyte implantation resulted in worse clinical outcomes and lesion progression, highlighting the importance of minimizing delay between stages.<br /><br />Seth Sherman reported that adding pressurized CO2 lavage during osteochondral allograft preparation improves graft absorption capacity, potentially enhancing biologic loading and integration.<br /><br />Harris Sloan introduced nanowarming vitrified large osteochondral grafts, improving cell viability versus traditional methods, aiming to overcome preservation challenges and reduce graft wastage.<br /><br />The session concluded with clinical insights on anterolateral ligament procedures, emphasizing their role in reducing graft failure and rotational instability, and highlighted pearls, pitfalls, and learning curve considerations for complex knee surgeries, including meniscal repair, osteochondral grafting, and patellofemoral procedures, stressing careful patient selection, surgical technique, and close follow-up for optimal outcomes.

Asset Caption

Moderators: Simon Goertz, M.D., Jason M. Scopp, M.D.

Keywords

ACL repair

knee surgery

selective primary ACL repair

age factor in ACL outcomes

quadriceps tendon autograft

arthrofibrosis rate

meniscus lesions

medial meniscus ramp lesions

meniscus repair

biological adjuvants

distal femoral osteotomy

autologous chondrocyte implantation

osteochondral allograft

anterolateral ligament procedures