APEX Knee Navigating Pearls and Pitfalls-Biologics Options

Video Transcription

Video Summary

A surgeon presents “biologic cases” with a panel. Case 1 is a 20-year-old Division I hockey goalie with a bucket-handle medial meniscus tear treated with inside-out repair. The panel debates augmentation: meniscal rasping/capsular stimulation, shaver debridement, notch microfracture (marrow venting), PRP (timing varies), thrombin mixtures, and fibrin clot as an inexpensive option. They note evidence is low-level but includes reviews and a study suggesting benefit for isolated medial repairs. Emphasis is placed on the medial meniscus’ higher failure rate and poorer posterior horn vascularity; many would “do everything” to maximize healing.<br /><br />Case 2 is a 48-year-old woman with lateral knee pain and a large lateral femoral condyle marrow lesion consistent with subchondral insufficiency fracture. Initial management includes unloading, bracing, crutches, metabolic workup, and vitamin D testing/supplementation. Persistent symptoms prompt interosseous bioplasty (BMAC/DBM) after diagnostic arthroscopy; outcomes are good. Root-tear–associated marrow lesions are treated by root repair and protected weightbearing, often without directly addressing the lesion.

Asset Caption

Moderator: Brian Chilelli, M.D.
Panel: Patrick A. Smith, M.D., Giovanna Medina, M.D., Ph.D., Ian Hutchinson, M.D., Eric Matthew Berkson, M.D.

Meta Tag

Biologics 1

Keywords

1

bucket-handle medial meniscus tear

inside-out meniscus repair

meniscus repair augmentation (PRP, fibrin clot, marrow venting)

medial meniscus healing and vascularity

subchondral insufficiency fracture (lateral femoral condyle)

interosseous bioplasty (BMAC/DBM)