So we're going to talk about a meniscus root. We've covered a bunch of the principles here, disclosures. So a 45-year-old female, three months after an initial injury, stepped up just camping out in the woods in Vail, felt a pop, posterior medial knee pain, squats, ADLs, lit walking. Can deal with it, but it just doesn't like it, does not like where she's at. Here's the hip to ankle, right at the medial tibial spine. Maybe a small hint of some early changes on the medial side. Maybe more than a small hint of medial changes. And here's the MRI. All right, discussion. Classic. Yeah. That's me. Vegan bacon. So I think the answer could be, okay. We're going to keep moving for the sake of time here. Yeah, just for sake of time, so you probably picked up on this MRI now that it's like staring you in the face. As you know, you see some of this changes, degenerative changes, patellofemoral joint Forty-five, female, no problems until three months ago, Scott. Super active, 5'7", 115 pounds, hikes, bikes, walks, skis, snowboards, kids that are teenagers, wants to hang out with everyone, but that patellofemoral joint's real, it's not symptomatic or has no symptoms. She had no medial-sided pain before, none. All right. So here's what we found interop. Who's repairing? Those folks. Jorge, what are you telling her? One is that, you know, to your point, to your point, Matt, which I think it's important, when you look at the alignment, although it's not majorly wrong, it's majorly different from the contralateral side, right? So well, not that much. It's on the medial side. That's why I was scrutinizing yours, because that edema changes in the medial side. But you see, you can see the changes there. I mean, look at the small cystic changes in the plateau and femur. I would still repair it. This is a classic, though. I mean, these are the ones you scratch your head about. The only thing that concerns me in this case, Matt, is the medial femoral condyle edema. So just like we've seen in other joints as well, whenever you have bone marrow edema, those are the ones that we get more concerned about. So here you go. You can see the changes in the medial compartment already, mostly on the femur. And here's a tape-type suture using luggage tag technique. I generally use two to three to four of these. I use smaller and smaller ones as these sutures have gotten smaller. I like the smaller constructs. And then do either one or two tunnels. There are a lot of different ways to do this. I'm doing this in a one-tunnel technique. And the other thing I will sometimes do here, because even with the probary, it's not 100% normal. Right with the probary, it's not just right at the root. You have that meniscus capsule posteriorly, and there's some that will actually resect the ligaments back there, and others that try to preserve anything that's there, but a lot of times it's not. But sometimes some all-inside or even inside-out sutures to supplement this. But she's going down a path like we chatted about in some of the other cases. Thoughts? Matt, can you tell us what you would... Sorry, Scott. Yeah. Centralization suture, Scott. Yeah. What would you tell us? Anchor. What would you do to... What would you... How would you think about when to do an osteotomy? What would be your variables, symmetrical or asymmetrical, degree and so forth, with no prior history? What would push you to do an osteotomy? Right. I mean, it's always hard when someone comes into your clinic, they only have about three months of pain, no issues. But then you start unfolding and peeling back the layers of the onion to get to the sweet spot, and she's got degenerative changes in multiple compartments now, and she's got a small alignment issue. If she was in the 20-25% category and more varus, I think you may want to kick the can down the road and get them to come to the realization osteotomy is going to be very powerful. It's a very, very good operation for someone like this, and especially from a pain and overload situation, just like was mentioned in the other case with Jorge and others. It's a tough decision. It's really hard to have it three months after they've had no issues prior. All right. Should we go to the next one? Yeah. Yeah. Why don't we do this? You do a marrow venting there? Yeah. Yeah. Sorry. Yep. Didn't have all of it. Marrow venting, notch, PRP, inside-out PRP, or outside-in PRP injection, inside-out PRP injection with a very small 25-gauge needle, PRP marrow venting with a 4-5K wire deep into the notch. I don't even use a microfracture all, but I get really deep in with a K wire and say a few prayers. Thanks.

meniscus root injury

posterior medial knee pain

MRI scan

surgical technique

osteotomy