APEX Knee Navigating Pearls and Pitfalls-Tips and Tricks for Your Practice

Video Transcription

Video Summary

The speaker thanks course organizers and shares practical “pearls” from knee surgery. For patellofemoral assessment, they flex the knee ~30° and externally rotate to see whether symptoms change, helping judge distal malalignment. For all-inside ACL reconstruction, they mark the expected femoral tunnel position using an offset guide and a small “pinhole” before switching views to maintain anatomic orientation. In cartilage cases, when DeNovo graft is unavailable or not covered, they describe mincing a patient’s loose chondral fragment and securing it with fiber and glue for patellofemoral defects.<br /><br />Meniscus tips focus on visualization: use proper positioning (post vs leg holder, muscle relaxation), accessory portals, and scope switching. A spinal needle can deflect the meniscus to protect cartilage during trimming. “Pie-crusting” the superficial MCL with a beveled spinal needle under valgus load safely opens the medial compartment and may improve outcomes in root repairs.<br /><br />MPFL discussion emphasizes fluoroscopic femoral placement, minimizing patellar bone risk with onlay/anchors, and especially avoiding overtensioning; the speaker also demonstrates arthroscopic MPFL imbrication as a less invasive alternative in select cases. Cartilage/osteochondral allograft pearls include alignment films, expectation-setting, BMAC soaking, accurate sizing (confirm donor before reaming recipient), avoiding proud grafts, and suture “rescue” to pull a plug out if fit is imperfect.

Asset Caption

Moderator: Mark T. Wichman, M.D.
Panel: Zahab S. Ahsan, M.D., Joseph D. Lamplot, M.D., Sanjeev Bhatia, M.D.

Keywords

patellofemoral assessment malalignment

all-inside ACL reconstruction femoral tunnel pinhole technique

DeNovo alternative minced cartilage graft with fibrin glue

meniscus repair visualization accessory portals pie-crusting MCL

MPFL reconstruction fluoroscopic femoral placement avoid overtensioning

osteochondral allograft transplantation BMAC soaking graft sizing