APEX Knee Navigating Pearls and Pitfalls-Challenging Cases

Video Transcription

Video Summary

The transcript captures a sports medicine panel discussing several challenging knee cases and debating when to treat aggressively versus conservatively.<br /><br />First, a 14-year-old boy with an abnormal-appearing kneecap and suspected congenital patellar dislocation had full motion and intact extensor function. With a minimalist family declining MRI and specialist referral, he was cleared for sport and followed. Two years later MRI showed extreme patella alta and redundant tendon, yet he remained only mildly symptomatic; the panel emphasized uncertain natural history and the risk of “making it worse” with surgery. Ultimately, nonoperative management and physical therapy were chosen, and he functioned well at 18.<br /><br />A second case involved a 14-year-old girl with severe recurrent patellar instability, high BMI, valgus, patella alta, trochlear dysplasia, and an osteochondral defect. The surgeon performed cartilage debridement/biopsy, tibial tubercle osteotomy with distalization, and MPFL reconstruction. She later sustained a tibial fracture, prompting discussion about stress risers and avoiding or tapering distalization cuts. Trochleoplasty was debated as powerful but technically demanding, with mixed long-term arthritis data.<br /><br />Later, revision ACL topics included CT assessment of tunnel widening and a single-stage technique using a fast-setting polymer bone graft substitute to allow immediate redrilling for BTB revision. Another complex athlete had ACL failure plus lateral meniscus root tear and lateral femoral condyle defect; revision ACL (often BTB or quad), root repair, and cartilage restoration (e.g., OCA) were discussed, with strong support for adding LET/LAT and interest in internal bracing to reduce failures.

Asset Caption

Moderator: Nicholas A. Sgaglione, M.D.
Panel: Jason L. Koh, M.D., Joseph D. Lamplot, M.D., Eric Matthew Berkson, M.D., Sherwin S.W. Ho, M.D.

Keywords

congenital patellar dislocation

patella alta

recurrent patellar instability

MPFL reconstruction

tibial tubercle osteotomy distalization

trochlear dysplasia trochleoplasty

revision ACL reconstruction tunnel widening CT

lateral meniscus root tear repair

osteochondral defect cartilage restoration OCA