questions, but we'll start off. Dr. Amendola, first question. It really is and forever a question from all the trainees. How aggressive are you in treating asymptomatic meniscal deficiency in a young patient? What's your trigger to move forward for the meniscal transplant? Yeah, that's a common question and I don't think there's a black-and-white answer. First of all, if they have, so if you have a young patient with valgus knees and they've had a lateral meniscectomy, I think invariably they're going to go on to get degenerative change. So I think rather than waiting for them to get symptomatic and cartilage wear, I would recommend having a meniscal transplant in those patients. If they have a normal aligned knee, I usually let them rehab completely and get back to activities and monitor them for the, you know, the first year or two. If they have any swelling, any pain, any symptoms with activity, that would be the trigger to do a meniscal transplant. In those patients, do you regularly follow them, get maybe follow-up x-rays at six months or a year? Yes, so if, you know, if I get a patient referred after someone has done a meniscectomy and I see them in clinic, I kind of go through the whole, you know, explanation. I said, why don't we see you back in six months and at that point re-evaluate them clinically. If they have muscle atrophy, if they have any effusion whatsoever, we'll, you know, get an MRI at that point and usually the MRI correlates with their thing, their symptoms and usually at that point I'm leaning towards recommending a meniscal transplant. If they're completely asymptomatic and they're completely symmetrical, then I'll tell them, you know, again, the patient to monitor carefully and probably see them back at one year and repeat the, repeat the evaluation. If they're completely well at one year, then I kind of let them go on their own and tell them to come back if they have any symptoms. Those are great points. Yeah, a question for Ned about does lateral, does medial or lateral meniscus deficiency matter for you? I find I'm colored or discolored by my discoid experience because they just, a lateral meniscus deficiency will degenerate sometimes in a year and so I've tended to be much more aggressive and I've transplanted lateral meniscus deficiency right away and there's even a Chinese paper that has, I realize it's one paper, but it's spoken in support of that. I don't, does that affect your decision at all? Yeah, I think that, I think you're, you know, I think you're absolutely right. I think the lateral side, I think, is much more dangerous than the medial side. I think the, you know, I have, I've had a lot of discoid menisci that have gone on to meniscal transplant. I've had a lot of discoid menisci that we've repaired that I've done very poorly because it's poor tissue and then gone back in and done partial meniscectomy and then gone in and done a transplant. So I think your approach is probably a touch a little bit more aggressive than mine, but I think you're on the right track. I agree with that. And then Dave, not treating a lateral meniscus tear. I just, I've never done that and I know Shelbourne's experience, but I guess there was that the presentation from Rush about the bulk of those meniscus transplants being in lateral meniscus tears, not discoids. I guess I'm just, I don't know, I have a hard time not, I understand there's some vascularity. We've all seen some of those healed, but yeah, I know. Is there a thought as to like what a threshold is? Sure, I think I can help with that and maybe I didn't describe it well enough, but the ideal candidate to leave alone is you're doing an ACL reconstruction, so you're correcting the pivot shift, so you're not going to have the same mechanism to pinch that meniscus anymore. It occurs where you get the bone bruise, you pinch the posterior horn. That's not going to happen again once you've fixed the ACL and it's posterior to the popliteal hiatus and these are typically incomplete tears. And if I invite you as you do ACLs to just go back there and carefully look and really get close with the scope and lift the meniscus, look underneath and on top and then look at how far they are out from injury and you'll be astonished how many times you'll see tears you're healing if you're six, eight weeks in. I think one more question from Dr. Spindler. Yeah, I think the, I enjoyed all the talks. Dr. Deded, that was a great talk. I think the small tear left alone is the one that's a centimeter. It can be in different places and Robbie Westerman published the Moon Group's response on that and the reoperation rate is exceedingly low, less than less than 10%, a few hundred and it's the one Shelbourne described back 10 years earlier. Thank you very much to all of our speakers. Wonderful videos and we appreciate your time and we will reconvene at 2.30 for the general session and the presidential address. Thank you very much.

asymptomatic meniscal deficiency

meniscal transplant

rehabilitation

follow-up evaluations

lateral meniscus deficiency