Save the Meniscus: A Case-Based Discussion on the Management of Complex Meniscal Pathology (2025 Annual Meeting)-Save the Meniscus: A Case-Based Discussion on the Management of Complex Meniscal Pathology

Video Transcription

Video Summary

This expert panel discussion focuses on recent advances and challenges in managing complex meniscal pathology, emphasizing meniscus preservation. Dr. Kathy Koiner reviews bucket handle meniscus tears, comparing all-inside and inside-out repair techniques, highlighting similar failure rates (~10-30%), cost, technical demands, and rehabilitation uncertainties. She advocates hybrid repair approaches and marrow venting to enhance healing. Dr. Adnan Sethna discusses ramp lesions, emphasizing their high incidence (25% in ACL injuries), frequent misdiagnosis due to limited MRI sensitivity, and the importance of arthroscopic posteromedial compartment evaluation. He favors suture hook repairs via a posteromedial portal over all-inside devices due to better biomechanical outcomes and advocates adding an anterolateral ligament reconstruction to reduce failure risk. Dr. Marion, presenting on root tears, explains their biomechanical role in hoop stress dispersion and the deleterious cartilage effects of root disruption, akin to total meniscectomy. Root tears are often missed on MRI, making careful intraoperative assessment critical. She describes trans-tibial pullout repair techniques, post-op protocols emphasizing non-weight bearing and limited range of motion, and notes superior outcomes compared to non-operative care. Dr. John Miller focuses on radial meniscus tears, illustrating advanced repair strategies including "hashtag" suture patterns and trans-tibial tunnels to optimize biomechanical stability. He stresses individualized treatment based on tear complexity and patient factors. Dr. Brian Cole discusses meniscal allograft transplantation indications, techniques, outcomes, and orthobiologics such as marrow venting, PRP, and fibrin clot augmentation, noting mixed evidence but potential benefits for enhancing repair. Panelists highlight variable post-op rehab protocols tailored to tear type, patient compliance, and tissue quality, often balancing protection with early motion. They acknowledge ongoing challenges in meniscus centralization techniques, segmental allografts, and biologic adjuncts, emphasizing the need for further high-quality studies. Overall, the session underscores the critical importance of accurate diagnosis, patient selection, surgical technique, and evolving adjunct therapies to optimize meniscal preservation and knee joint health.

Asset Caption

Mary K. Mulcahehy, M.D., FAANA | Adnan Saithna, M.D., FAANA | Katherine J. Coyner, M.D., M.B.A. | John R. Miller, M.D. | Brian J. Cole, M.D., M.B.A., FAANA

Keywords

meniscal pathology

meniscus preservation

bucket handle meniscus tears

all-inside repair

inside-out repair

ramp lesions

arthroscopic evaluation

root tears

trans-tibial pullout repair

radial meniscus tears

meniscal allograft transplantation