AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 4A: Knee and Cuff Arthroscopy All-Stars

Video Transcription

Video Summary

The session focused on current advances and considerations in treating complex knee and shoulder injuries, with an emphasis on meniscus tears, cruciate ligament reconstruction, shoulder instability, and rotator cuff management.<br /><br />For complex meniscus tears, particularly horizontal and root injuries, recent trends favor repair over meniscectomy to preserve tissue and joint mechanics, especially in younger patients without significant osteoarthritis. Suturing techniques, including circumferential and transosseous repairs, aim to restore contact area and reduce degeneration, with arthroscopic partial meniscectomy remaining standard but increasingly complemented by new repair materials. Ramp lesions—hidden meniscal tears associated with ACL injuries—require careful diagnostic arthroscopy and repair to prevent graft failure and instability.<br /><br />In ACL reconstruction, graft choice remains individualized. Quadriceps and bone-patellar tendon-bone grafts provide biomechanical properties closer to native ligaments, favored in younger, active patients, while hamstrings and allografts suit moderate or lower activity levels and older patients. Anterolateral tenodesis is recommended in revision cases, patients under 25 engaging in intense sports, or those with rotational instability, helping reduce graft failure rates.<br /><br />Regarding shoulder instability with borderline glenoid bone loss (10–20%), emerging consensus lowers the critical threshold to around 10%. Treatment options include arthroscopic Bankart repair with augmentation, open bone grafting (like distal clavicle autografts), or newer hybrid techniques balancing benefits and complications.<br /><br />For massive rotator cuff tears with muscle atrophy and retraction, partial repairs combined with biceps tenodesis and subacromial decompression can yield pain relief and functional improvement. Innovative graft reinforcements using biceps tendon or fascia lata patches show promise but lack consensus on optimal materials.<br /><br />A novel digital auscultation technique ("knee voice") was introduced to assess patellofemoral cartilage damage non-invasively by analyzing joint sound patterns, demonstrating diagnostic accuracy comparable or superior to MRI and potential utility in treatment planning and monitoring.<br /><br />Finally, meniscal transplantation is validated for symptomatic meniscal deficiency in young, stable, aligned knees with mild cartilage damage. Arthroscopic techniques with bone plug fixation and peripheral skirt augmentation improve graft fixation and reduce extrusion, showing 60–75% survival at 10–15 years and slowing osteoarthritis progression.<br /><br />Overall, personalized approaches integrating advanced diagnostics, repair techniques, and tailored graft or surgical choices are shaping modern management of knee and shoulder injuries in 2024.

Keywords

complex knee injuries

complex shoulder injuries

meniscus tear repair

cruciate ligament reconstruction

shoulder instability treatment

rotator cuff management

arthroscopic meniscectomy

ACL graft selection

anterolateral tenodesis

borderline glenoid bone loss

meniscal transplantation