Thank you very much. It's a great honor to be here talking about the meniscus in this session. So our mission, of course, is meniscus preservation. And unfortunately, we see these cases of young knees with repairable meniscus tears that still get taken out. And we meet them not perhaps 10 years down the road, but just 10 months down the road. And we can see forever an altered trajectory. And I know some people think maybe you can't tear your meniscus if you don't have any of it left. But that's really not the approach we want to take here today. So we've heard about the ABCs of meniscus repair, anatomic reduction, biologics, of course, and circumferential compression. And I'd like to spend the next few minutes talking to you about things in the pipeline that are going to help us with each of these elements. So first is anatomic reduction. And when we look at the biggest threat to anatomic reduction, it's really extrusion of the meniscus. We know as the meniscus is extruding with root tears, radial tears, and in our transplants, it's becoming biomechanically ineffective. So we combat this through arthroscopic centralization. That is reattaching and tightening the meniscus tibial ligament attachments, particularly on the medial side of the knee. So here's an example of the most common construct. We see this a lot with root tears. So here we're repairing the root. But more importantly, we're trying to combat that extrusion, place an anchor in the body, as well as the junction of the posterior horn and body, trying to bring that meniscus back into the joint. I think what's most gratifying from an arthroscopic approach is that you can see immediate change in position of that meniscus. And here's a look at the final construct with our centralization anchors and our root repair. So does it work? We just presented this work at ORS meeting. And this biomechanics study shows that if you perform centralization and root repair in the extruded meniscus with a root tear, you do restore a meniscal position both at 0 and 90 degrees of loaded flexion. Why does this all matter? Well, it matters, of course, because if an extruded meniscus is persistent, it just won't be chondroprotective. This is perhaps one of the best studies on long-term chondroprotection following meniscus transplant. And at 10 to 14 years, these authors found that, in fact, there was zero chondroprotection if the meniscus was extruded greater than 3 millimeters. Less than that, it certainly did serve to have some chondroprotection. So here's our transplant on the medial side. We use bone plugs. We use peripheral stabilization. And you can see this transplant is extruded a few millimeters here at time 0. So we're also centralizing these transplants. Again, 2 to 3 millimeters will make or break the biomechanical protection and chondro effect of the meniscus. What about biologics? Well, we've heard a lot about biologics. Seth Sherman did a great job talking about marrow venting and PRP. And I think the nice thing for us as surgeons is that we are growing in evidence. So this is hot off the press. This is our work in Markov modeling, showing effects for both PRP and marrow venting with isolated tears. And both were effective. And PRP was cost-effective for preventing a re-tear with an isolated repair. When we look at MSCs, we've shown some success in FDA IND studies for culture-expanded MSCs with cartilage regeneration. We're now turning that focus to meniscal repair and regeneration, showing that you can complementary expand these in the meniscus. We're also able to load them in scaffolds with dry seating, as well as meniscus transplants. Obviously, this is a few steps removed down the pipeline from regulation. But nonetheless, we're working on it. So then what about circumferential compression? I think we're learning on the lateral meniscus, we need to preserve the normal mobility of the meniscus. If we over-constrain it to the capsule, we'll create an extruded situation where we can even create perforation stress risers. Ripstop, we're adding to most constructs where we're worried about the meniscus pulling through degenerative meniscal tissue. So I think we have our Japanese colleagues, Professor Kuroda from Kobe and others, have really popularized these ripstop techniques, in particular, the cross-tie grip technique being the most effective. So here's a root repair in degenerative tissue. You can see we're adding these root, these cross ripstop constructs with all of our root repairs. Here's a younger meniscus that's healthier, but certainly worried about suture pulling through with this large radial tear. So here we perform a formal tie grip technique to get an excellent repair. And this has improved our healing rates and saved the meniscus in a lot of these young patients. Here's a more complex radial tear, perhaps a little bit of obliquity and some vertical longitudinal component, that again, we would not get an effective repair without a ripstop technique. We're seeing faster return to activity, as well as higher healing rates with these constructs, just much, much better than what we were doing a few years ago. What about if the meniscus is gone and the patient presents to you? Well, we've had some partial meniscal substitutes available to us for some time in this country. When we look across to our European colleagues, they're developing non-biodegradable, complete meniscus replacements. There's three clinical trials undergoing right now, currently, that will continue to follow. In this country, the PCU, the polycarbonate urethane interposition, has a big FDA meeting next month. The Sun and Venus trials, some of them this panel were involved with and has had shown really good results. And maybe patients that are a little bit older that have some cartilage wear that you wouldn't consider as transplant candidates. So we look forward to the potential use of this later this year. So in conclusion, I think when you look at the pipeline, it's an exciting time to be a meniscus surgeon. There's improvements coming for our ABCs with anatomic reduction, biologics, and compression. We're looking to really improve those meniscus transplants and partial and complete replacements could be headed to an OR near you very soon. Thank you very much. Thank you.

meniscus preservation

anatomic reduction

biologics

circumferential compression

meniscal repair