Joint Preservation Techniques for the Knee in 2025: The Utility of Biologics, Osteotomies and Cartilage Restoration Procedures (2025 Annual Meeting)-Joint Preservation Techniques for the Knee in 2025: The Utility of Biologics, Osteotomies and Cartilage Restoration Procedures

Video Transcription

Video Summary

The session is an interactive instructional course on knee joint preservation, emphasizing that patients mainly want to know whether treatment will help, whether doing nothing will worsen things, and whether they can return to activity. The speakers stress managing expectations, noting many cartilage defects and meniscus tears are asymptomatic, and nonoperative care can be appropriate.<br /><br />They frame joint preservation as treating the knee “like an organ,” meaning cartilage procedures must be considered alongside alignment, meniscus status, ligament stability, and subchondral bone health. Surgical options discussed include cartilage repair/restoration (from simple debridement to cell-based implants and osteochondral allografts), meniscus repair/transplant, osteotomy, and biologics.<br /><br />Technical pearls focus on combining procedures: careful patient selection, clear team planning, appropriate positioning, and choosing whether to stage operations. When multiple procedures are done together, sequencing matters (often meniscus work first; cell-based cartilage procedures last to avoid damaging the implant; osteotomy timing depends on access and implants). Avoiding tunnel/screw conflicts in ACL plus osteotomy or meniscus transplant cases is highlighted.<br /><br />Biologics are presented as largely paracrine “signals” (MSC as “medicinal signaling cells”), with mixed but evolving evidence for BMAC in osteochondral graft integration and for treating subchondral insufficiency. Emerging scaffold/cell technologies are reviewed.<br /><br />Evidence and panel opinion suggest combined procedures can improve outcomes, but meniscus transplantation is generally reserved for symptomatic patients, as it is a “bridge” with finite longevity and unclear prophylactic benefit. Osteotomy is repeatedly emphasized as a powerful, sometimes standalone, solution—especially for load-related pain.

Asset Caption

Rachel M. Frank, M.D., FAANA | Brian J. Cole, M.D., M.B.A., FAANA | Seth L. Sherman, M.D., FAANA | Michael J. Alaia, M.D.

Keywords

knee joint preservation

cartilage repair and restoration

meniscus repair

meniscus transplantation

high tibial osteotomy

knee alignment correction

ACL reconstruction planning

combined knee procedures sequencing

subchondral bone health

biologics and BMAC

patient selection and expectation management