Joint Preservation Techniques for the Knee in 2024: The Utility of Biologics, Osteotomies and Cartilage Restoration Procedures (2024 Annual Meeting)-Joint Preservation Techniques for the Knee in 2024: The Utility of Biologics, Osteotomies and Cartilage Restoration Procedures

Video Transcription

Video Summary

This comprehensive session at ANNA 24 focused on joint preservation, cartilage restoration, osteotomies, and associated biologic treatments, featuring renowned experts Michael Alea, Seth Sherman, and Armando Vidal. They emphasized treating the knee as an organ—considering cartilage, meniscus, ligaments, alignment, and biology—to optimize outcomes rather than treating isolated symptoms. The discussion addressed when to use surgical procedures such as osteochondral allografts (OCA), meniscus transplants, and osteotomies, and the importance of patient-specific decision-making often guided by staging procedures.<br /><br />Osteotomy, particularly patient-specific instrumented techniques, was highlighted as a powerful, durable tool for offloading or correcting malalignment affecting cartilage and meniscus health, especially in younger, active patients. Despite historical concerns, data support osteotomy’s role in returning athletes to high-level activity with appropriate counseling about risks such as hardware irritation or joint line obliquity. Staging surgeries are recommended when multiple complex interventions, including ligament reconstruction, meniscal transplant, and cartilage restoration, are needed, especially if osteotomy is involved.<br /><br />Biologic adjuncts like bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), and newer scaffolds can support healing and integrate grafts but have evolving and sometimes inconsistent evidence. Techniques such as pulse lavage combined with CO2 flow can improve graft porosity and biologic uptake.<br /><br />Case discussions underscored the complexity, including balancing one-stage versus staged procedures, managing bipolar defects, and tailoring treatments for patellofemoral pathology. Consensus stressed the necessity of offloading malalignment and preserving meniscus when possible, with a personalized approach to cartilage repair—ranging from autologous cartilage procedures to OCAs.<br /><br />Overall, the session integrated cutting-edge surgical, biologic, and planning technologies, advocating a holistic, patient-centered approach to joint preservation with transparent counseling about realistic outcomes and potential need for reoperation.

Asset Caption

Rachel M. Frank, M.D., Moderator | Armando F. Vidal, M.D. | Seth L. Sherman, M.D. | Michael J. Alaia, M.D.

Keywords

joint preservation

cartilage restoration

osteotomies

biologic treatments

osteochondral allografts

meniscus transplants

patient-specific instrumented osteotomy

bone marrow aspirate concentrate

platelet-rich plasma

staging surgeries

patellofemoral pathology

autologous cartilage procedures