All right, thank you and thank you for the Academy for allowing me to present this to you today. Dr. Latterman has already presented to you some of the early data on this and some of the information about the implant. The important thing to please recognize is that at the present time it is not FDA approved and that still is an ongoing process. One of the questions that we have to address is what do you do with patients that have pain after meniscal surgery? And what this implant was designed to do is to try to fill this void that was previously alluded to. The implant itself was designed to replicate the function of the normal meniscus and there were two parts of the study. You heard about the venous study, there was also another branch called the mercury trial in which time there were multiple sizes available and these sizes were based on both MRI determination and also sizing at the time of implantation. The implant itself, as you saw earlier, is made from polymers, a polyethylene embedded material. And you can see that it's very pliable and as Dr. Latterman alluded to, it does not shatter because of its flexible nature. The design of this was hopefully to provide cartilage-friendly pain relief by mimicking the physical and mechanical properties of the normal meniscus, more evenly distributed the stress across the joint, absorb some of the strain that would otherwise be transferred to the articular cartilage and therefore function in the absence of a normally functioning meniscus. The surgical technique, what we're going to do is look at the video of doing this, but just prior to that, you're going to prepare the joint arthroscopically, you confirm the preparation, you also confirm at that time that the patient is indeed a candidate to this. We'll then go through the implantation of the device as well. So the video is going to go fairly quickly, it takes a lot longer than six minutes, but here we go. So here we are debriding the meniscus and you want to breed this back to approximately about a one millimeter rim. Very importantly on the posterior horn of the medial meniscus, realizing that there is this ramp type of effect, so you want to make sure you get all the way into the back area of there so you don't provide a ramp for the implant to actually dislocate out the posterior portion. So once you get that debrided back to where you want to, you have a sufficient meniscectomy, it's important to really examine through the notch area as well. So what we'll do is we'll look through the notch to get to the posterior horn of the meniscus and make sure there's no additional tissue sitting there. Again, additional tissue will provide a ramp effect that allow that meniscus to displace. So you can see here we still have a little bit of extra tissue there that's going to be needed to be debrided out of there. We'll also do a medial notchplasty. Again, what this is doing is you're trying to provide enough room for the implant's medial border so that it does not rub and break down. So we'll create a medial notchplasty going inferior and slightly anterior to the posterior cruciate ligament, but also on the posterior notch, especially if there's any type of osteophytes that are coming around the posterior aspect of the femoral condyle, we'll be very aggressive about trying to debride them. Again, you want to create a very nice smooth path for that implant to sit. So we've moved that osteophyte, and you can actually almost see all the way around to the posterior edge of the femoral condyle. So here you can see that posterior cruciate ligament attachment sitting above here, and we've cleaned that out and made a nice smooth edge for that to sit. The notchplasty is created on more of the superior aspect of the notch. Again, as the knee goes into extension, we don't want the top portion of the implant hitting against that and causing damage to it as well. So again, we're not taking a lot. This is really only several millimeters, but we're creating just enough room, especially on the top portion of the notch as you go superiorly for that implant to kind of sit up and through there. And you'll be able to do this as well once you have the implant in there to make sure that there's a trial that goes in first, make sure there's not any impingement on that. Now we've created that nice open space through there. Then we'll proceed with the arthrotomy. And as we got better at doing this, we can make a smaller and smaller arthrotomy. But you'll make basically a medial parapatellar tendon arthrotomy, carry that out through the subcutaneous tissue and open the joint. Once the joint is opened, you'll be able to test the pressure of the intermeniscal ligament, making sure that's intact. There's a specifically designed rasp that basically is the same exact shape as the medial border of that implant. And so we'll use this to A, kind of clean out that area, make sure it's a nice smooth area for the implant to sit. But also you can actually leave that in there and flex the knee and extend it to make sure that that implant is not going to be impinged as that medial border is the same size. If you need to, you can pie crust to open it up. So the trials will come and there's a device that's used to hold the trial, usually taking the knee and going from flexion to extension with some valgus stress allows this implant to sit in there. It's free floating. So once it captures into there, it's going to be constrained by the femoral pressure on the tibia and keep it into place. The first few times you do this, it does take a little kind of learning curve how to ease it in there very well. But once you get that down, you can see it's a little pressure and there's this pop sensation and it goes in. The trial implant, it doesn't show here, but you can check it with the range of motion arthroscopically. And again, you can see where that medial border, we don't want it to impinge upon the roof or the medial aspect of the joint. You can also look at this fluoroscopically as there's a marker on these to check on its motion as you're going through inflection and extension to make sure it's not subluxating or impinging at all upon the joint. Once you've decided that this trial is going to work well and it's not impinging, it's not overhanging on the sides, it's not lifting off as you go from flexion and extension, you go ahead and remove the trial and a separate device for doing that as well. And again, you just reverse the forces that you just put on it and it pops out. Then you'll take the actual trial itself, which will not have any type of markers on it. It's more smooth and clear. You'll go ahead and implant that as well. And then you go ahead and check for the range of motion of the implant, again making sure that it's adequate in the position. You want to make sure there's no lift off of the anterior portion of it. You want to make sure it's not subluxating posteriorly and it's not overhanging on the borders and not getting impinged on the roof. And so that implant's sitting there fairly nicely. And again, you can see how it's a fairly clear substance. To reiterate what Dr. Latterman said, if the implant tears, it's more of a stress, repetitive stress injury and you get almost like a break in the tissue, but it doesn't shatter or fall apart at all. Again, very important to make sure there's no medial overhangs so that it's sitting in the appropriate position. And postoperatively, we let these people weight bear with crutches for balance and support. Plus or minus whether they need some type of knee brace for additional support. And we really want to encourage early range of motion so we don't get any scarring, especially of the anterior fat pad that could cause further impingement on the implant. Thank you.

implant

meniscal surgery

normal meniscus

surgical technique

flexible polymer material