APEX Knee Navigating Pearls and Pitfalls-Biologics Options

Video Transcription

Video Summary

A surgeon-led panel discusses biologic augmentation in two knee cases. Case 1 is a 20-year-old Division I hockey goalie with a bucket-handle medial meniscus tear treated with inside-out repair. Panelists debate techniques to improve healing—meniscal rasping versus preserving tissue in acute tears, capsular stimulation to promote synovial blood flow, and routine notch microfracture/marrow venting. PRP is considered optional given low-level evidence; some favor adding PRP (sometimes with thrombin) either intraoperatively or post-op, while others note uncertainty. Fibrin clot is highlighted as an inexpensive, potentially more predictable option, though supported mostly by small series. Emphasis is placed on higher failure rates of medial versus lateral repairs due to poorer vascularity.<br /><br />Case 2 is a 48-year-old woman with lateral knee pain and MRI showing a large lateral femoral condyle marrow lesion/subchondral insufficiency fracture with intact meniscus. Initial management includes bracing, protected weight-bearing, metabolic workup (notably vitamin D), and conservative care. Persistent symptoms may prompt focused shockwave therapy or arthroscopy plus interosseous bioplasty (decompression with bone marrow aspirate concentrate/DBM). Subchondroplasty is viewed less favorably. Root-tear–associated marrow lesions are generally treated by repairing the root and unloading, without directly addressing edema.

Asset Caption

Moderator: Brian Chilelli, M.D.
Panel: Patrick A. Smith, M.D., Giovanna Medina, M.D., Ph.D., Ian Hutchinson, M.D., Eric Matthew Berkson, M.D.

Keywords

biologic augmentation

meniscus repair

bucket-handle medial meniscus tear

PRP (platelet-rich plasma)

fibrin clot

interosseous bioplasty