IC 05-2026-Save the Meniscus: A Case-Based Discussion on the Management of Complex Meniscal Pathology-IC 05-2026-Save the Meniscus: A Case-Based Discussion on the Management of Complex Meniscal Pathology

Video Transcription

Video Summary

This transcript is from a Saturday morning instructional session on complex meniscal pathology, featuring four sports-medicine surgeons discussing repair strategies for bucket handle tears, ramp lesions, root tears, and radial tears.<br /><br />Dr. Koiner reviewed bucket handle meniscus tears and compared all-inside, inside-out, and outside-in repair methods. She emphasized preserving meniscus tissue when possible, noting that current evidence supports both all-inside and inside-out repairs, with all-inside techniques increasingly common. She shared surgical pearls on visualization, implant placement, accessory portals, marrow venting, and rehab.<br /><br />Dr. LeClair focused on ramp lesions, calling them difficult to diagnose and frequently missed on MRI. He stressed the importance of the Gilquist maneuver for posterior compartment visualization and reviewed repair options including inside-out, all-inside suture devices, and anchor-based techniques. He also discussed pie-crusting the MCL to improve access and noted that long-term failure rates remain concerning.<br /><br />Dr. Mulcahy presented medial meniscus posterior root tears, using a middle-aged woman case to highlight classic imaging findings like the ghost sign and meniscal extrusion. She explained the biomechanics of root tears, why early repair matters, and discussed trans-tibial pullout versus anchor-based repairs. Rehab protocols were debated, especially weight-bearing restrictions, and centralization was mentioned as an emerging but not routine technique.<br /><br />Dr. Ernat covered radial tears, including tears associated with ACL injuries and L-mort lesions. He reviewed tear patterns, MRI clues, and repair constructs such as vertical, horizontal, hashtag, and tunnel-based techniques. He emphasized tailoring repair strategy to tear location, tissue quality, and associated ligament injury.<br /><br />The session ended with audience Q&A on age and BMI cutoffs, timing of surgery, rehab, and centralization. The panel generally agreed there are no strict age or BMI cutoffs; decisions should be based on tear type, joint health, patient goals, and biologic context.

Keywords

meniscal pathology

bucket handle tear

ramp lesion

meniscus root tear

radial tear

all-inside repair

inside-out repair

MRI diagnosis

surgical technique

rehabilitation protocols