AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 4F: Leading-Edge Military Treatments

Video Transcription

Video Summary

The session covers diverse topics relevant to arthroscopic surgery in military populations, focusing on complex knee and shoulder issues. Dr. Mark Slabaugh opens with meniscus repair, advocating for repair over partial meniscectomy to preserve function, especially in active military members. Despite advances and known benefits, repair rates have remained low, with partial meniscectomy leading to increased osteoarthritis and reoperations.<br /><br />James Bailey discusses arthritis in active-duty soldiers, emphasizing careful evaluation including age, job demands, history, and imaging. Nonoperative and surgical treatments range from injections (steroids, viscosupplementation, biologics) to debridement, microfracture, and cartilage restoration techniques like ACI and osteochondral allografts. Outcomes vary, with complexities heightened in the military population.<br /><br />Brian Waterman reviews shoulder instability management, highlighting the importance of assessing bone loss via imaging. He details surgical options like the Latarjet procedure to restore stability and reduce recurrence, acknowledging limitations and risks such as osteoarthritis and graft resorption.<br /><br />Chris Tucker reports on extensor mechanism ruptures (patellar/quadriceps tendon), common in military personnel. Both suture-anchor and transosseous repair techniques show comparable outcomes biomechanically and clinically, though military patients tend to have poorer results due to occupational demands.<br /><br />Dr. Hunter outlines the Military Advanced Surgical Treatment (MAST) program, a collaborative initiative to enhance arthroscopic skills of military surgeons via courses, fellowships, and funded research, supported by complex grant processes.<br /><br />Jean Paskowski shares insights into military surgical careers, highlighting varied pathways and challenging conditions including austere environments. She discusses unique demands like managing complex cases and the camaraderie inherent in military teams.<br /><br />Travis Decker spotlights innovation in military medicine addressing tough pathologies like shoulder arthritis and instability. He emphasizes leveraging existing knowledge, managing patient expectations, and using advanced imaging and patient-specific instrumentation to improve accuracy in osteotomies and joint preservation.<br /><br />The session concludes with a challenging patellar instability case involving prior surgeries and arthroplasty, underscoring complexities in evaluation and management including alignment issues, the need for osteotomies, and soft tissue reconstruction to improve outcomes in active service members.

Asset Caption

Introduction by Moderators: Jeanne C. Patzkowski, M.D., FAANA, Jonathan F. Dickens, M.D., COL, USAR, Travis J. Dekker, M.D., FAANA

Keywords

arthroscopic surgery

military populations

meniscus repair

partial meniscectomy

osteoarthritis

arthritis evaluation

nonoperative treatments

cartilage restoration

shoulder instability

Latarjet procedure

extensor mechanism ruptures

Military Advanced Surgical Treatment (MAST)

patellar instability