AANA25 Knee Access Pass-GENERAL SESSION: Knee Joint Preservation (Main Stage)

Video Transcription

Video Summary

The session, moderated by Brian Cole, focused on knee joint preservation, emphasizing the translational research and clinical application of osteochondral allografts (OCAs). Cole reviewed 25 years of research on OCAs, highlighting the necessity of minimizing graft cell death, improving graft integration (e.g., via pulse lavage and bone marrow concentrate), and optimizing storage and surgical techniques. Clinical outcomes reveal a roughly 35% failure rate over five years, but early success predicts long-term benefit. Secondary OCAs for osteochondritis dissecans (OCD) perform comparably to primary OCAs, with slight superiority in patient-reported outcomes for primary interventions. A new aragonite-based biphasic osteochondral scaffold shows equal or better results in female patients compared to males, contradicting prior trends of poorer female cartilage repair outcomes. Adam Yanke advocated a conservative “do less” approach, showing that many cartilage lesions improve with debridement alone and emphasizing careful selection for osteotomies based on alignment. Conversely, Michael Alea supported “do more,” arguing for comprehensive correction of all contributing pathologies (alignment, meniscus, cartilage) to preserve joints long-term. Seth Sherman presented innovation in treating subchondral insufficiency using biointegrative fixation nails (“kneebar”) to provide mechanical stability and biological healing. A debated clinical case focused on whether treating bone (alignment, unloading) or joint structures (root repair, cartilage) was more critical, with Jason Dragoo arguing for joint restoration with meniscal repair and cartilage restoration, while Seth Cole stressed the importance of unloading and addressing malalignment. The audience voted in favor of the joint-focused approach.

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Keywords

knee joint preservation

osteochondral allografts

graft integration

clinical outcomes

osteochondritis dissecans

biphasic osteochondral scaffold

cartilage repair

alignment correction

biointegrative fixation nails