Speaker: Avoid scuffing the articular surface when treating lesions of the knee

LAHAINA, Hawaii — Decision-making can be difficult in cartilage restoration and in cartilage and bone restoration procedures, according to a presenter at Orthopedics Today Hawaii 2017.

Jack M. Bert, MD, said current literature shows that in a study of 31,516 arthroscopies performed by 136 surgeons, 19% of cases had at least one grade IV lesion. In addition, researchers of another study found of 1,000 consecutive arthroscopies, 61% of patients had some type of chondral or osteochondral lesions. In a study of 1,309 arthroscopies performed by five surgeons, 61% of patients had a chondral injury and grade III/IV lesions were found in 74% of patients older than 60 years. Additionally, in a study of 1,010 arthroscopies, 85% of patients older than 50 years had grade II changes or more.

Jack M. Bert

“We are going to see these continuously as we do surgery,” he said.

In medial collateral ligament (MCL) release, Bert said scuffing the articular surface should be avoided. To avoid scuffing or “arthroscraping” the articular surface in a tight knee, he recommended surgeons use a “pie crust” technique, which is repetitive puncturing with a spinal needle, for partial release of the MCL; use an electrocautery technique to partially release the MCL; or use a microfracture pick to release the menisco-capsular junction inferior to the meniscus.

Bert said one of the keys to remember when performing a meniscectomy is to place the knee holder close to afford valgus stress, as well as to “pie crust” the MCL, ideally with an 18-gauge needle. – by Kristine Houck, MA, ELS

Reference:

Bert JM. The treatment of chondral and subchondral lesions of the knee: A case-based approach. Presented at: Orthopedics Today Hawaii 2017; Jan. 8-12, 2017; Lahaina, Hawaii.

Disclosure: Bert reports no relevant financial disclosures.