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.

Meta Tag

Concept Arthroscopic Visualization

Concept ACL Reconstruction

Concept Patellofemoral Instability

Concept Osteochondral Restoration

Concept Cartilage Restoration

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

Arthroscopic Visualization

ACL Reconstruction

Patellofemoral Instability

Osteochondral Restoration

Cartilage Restoration