Okay, thanks Lee. So I'll just get right into the case. So that's a 21-year-old college soccer player, has an acute ACL tear, and you see this lateral meniscus tear in the posterior horn. So sagittal image there, you can see kind of some vertical signal away from the root, large effusion there. You can see the axial. There's something going on in the posterior horn, can't quite tell. And then these are two coronal cuts that I think help you. One showing kind of the tear, and then the right showing the root that is attaching to the bone. So I'll just give you five seconds, just think to yourself, you know, what's this diagnosis? And then I'll show you a scope video, and then you can talk amongst your groups. Okay, so here's the diagnostic scope. This is the lateral compartment we're probing, and you can see, again, this tear pattern that correlates well with those MRI findings. Questions are what is this, and what would you do for this tear pattern with your acute ACL? So we'll give you a few minutes, and then we'll reconvene to talk about it. Okay, so we'll come back as the main session. So Jim Carey, what did your group decide? What are you going to do with this tear in this college soccer player? Well, we discussed like a trans-tibial, like for the root repair, and bringing sutures through the flap attached to the root, as well as the posterior horn, bringing it down, and then doing a radial repair, like side to side, to try and preserve the tissue and the function. So you're going to repair it. Anybody not going to repair this tear? And then, what do you tell this patient, you know, this is a college soccer player. They're going to be in the training room. They're going to be comparing their ACL, of course, to their teammate's ACL that is going to be weeks ahead of them. What are you telling them about rehabilitation after surgery and kind of the long-term picture? Yeah, they're going to be slower, of course, probably six weeks slower compared to their teammates because they're going to have early, you know, protection of their weight bearing and their deep flexion where their teammates won't have that, and it seems to be that six weeks sticks with them for their return to play. So would anybody repair this and not protect their rehab a little bit more than ACL? Okay. So here's what, you know, this tear is, the lateral meniscus oblique radial tear. For me, these are just really quick pearls. You have to identify this kickstand fragment. Sometimes it's small. Sometimes it's large. Sometimes it's scarred into the ACL stump. This is one that's kind of mildly scarred in the stump. I've had ones that have been significantly scarred in. There's probably some that have ended up in shaver tubing over time by fellows that you don't even know. You're like, where's the meniscus fragment? So I think it's important to identify that kickstand fragment, bring it down. And then for me, I'm going to use kind of an all inside knot tying. There's several devices. The reason I like this one is because that fragment near the root is very small and it's hard to control. Some people like traditional all inside devices. I think that's absolutely fine. Just for me, I can kind of grab it and control it, and then it's just a very small perforation. So then we're just tying this really side to side. And then oftentimes these will over reduce. So here I put two stitches in and I've over reduced it. Don't worry. Just drill your ACL or cycle the knee. These will come back into really anatomic reduction. That's something that Pat Smith taught me. In terms of healing, here's a second look on a case that we did. If you look in the literature, 97% MRI healing. And second look arthroscopy, really near complete healing. So this is a very favorable synovialized healing area that they seem to do fairly well. I won't, should I cut it there, Lee? I'll just say one thing that, you know, there's been this question of, you know, what does leaving, debriding, or repair them do? So this was just, they hit the press yesterday. Pat Smith presented on the podium. But when you look at removing these, they do affect your anterior drawer by about two millimeters. They affect your pivot shift by about a millimeter and a half. So if you're removing that little bit of stump, you're leaving 1.5 millimeters of pivot shift in that patient. Which for a college soccer player, you know, is the difference probably between success and failure. So I wouldn't, I wouldn't do that. So thank you, sir. Thanks, Aaron.

ACL tear

lateral meniscus tear

MRI images

treatment options

trans-tibial approach