Okay, good morning. Thanks for showing up so bright and early to our ICL. I hope everyone had a good night last night and is ready for a great day today at the combined meeting. Today we have a really wonderful panel with world-renowned experts in the field of joint preservation, cartilage restoration, osteotomies, meniscus preservation. And we are going to spend the next hour, hour and a half, talking about joint preservation techniques for the knee in 2021, the utility of biologics, osteotomies, and cartilage restoration procedures. And this is really a hot topic. There's a renewed interest in all of the areas that we're going to discuss today. And I'm honored to be standing alongside our panelists, Dr. Armando Vidal from the Stubman Clinic in Vail, Dr. Seth Sherman from Stanford University in California, Dr. Michael Leah from NYU in New York, and I'm Rachel Frank from the University of Colorado. So to set the stage, we all have some disclosures, some of which are relevant to the content of this, nothing from a bias perspective per se, but we all do some work with some companies that focus on joint preservation. So cartilage pathology is common. When you scope the knee three out of four times or up to three out of four times, you're going to see a cartilage defect for any reason whatsoever. The big take-home point that I think all of us want to leave you with is not every single lesion needs treatment. In fact, most cartilage lesions are asymptomatic and don't require treatments. And when we think about what patients really want to know, we have to take a step back and we have to think, what are they coming in to see us for? Because sometimes some of the surgeries we're offering them are monster surgeries with long recovery processes and a difficult guarantee of return to sport. Often we can't guarantee a return to sport. So what do they really want to know? What they want to know is if I have surgery, how long does it last? Or am I going to need a tune-up or a repeat surgery in a couple of years? If I have surgery, can I get back to doing what I love? Can I go skiing? Can I play tennis? Can I hike? Can I get back to cutting, pivoting, division one athletics? And if I do nothing, is that OK? Is it OK to coexist with my symptoms? So remembering that most patient defects are asymptomatic, setting the stage, understanding their goals, and setting appropriate expectations are key. When surgery is the answer, what does it come down to? Well, typically it's a combination of these techniques because we really have to think of the joint as an organ, as opposed to just a meniscus, or just cartilage, or just an alignment issue, or just a biologic issue. But often we have to combine all of these things in order to get the end results that we want. And the big question is, what do we really know about these procedures? How are they technically executed, and what outcomes can we expect? And that's what we'll hear about later today. I do want to make a quick pitch for non-operative treatment. I think for all of us, at least on the panel, this is a big part of our practice. It's about loving these surgeries and doing those osteochondralographs, which are quite satisfying and nice. Not always is that the most appropriate step, particularly if you haven't tried non-operative treatment. So weight loss and activity modification are recommended by the Academy. But I think practically, it's also a good recommendation for us to have with our patients. And then the use of physical therapy, icing, anti-inflammatories, unloader bracing. I'm a big believer in unloader bracing, particularly if I'm going to do an osteotomy. And then injections. So those can all be very helpful with regard to non-operative treatment. You really want to maximize that before we get into some of the surgical options. But we're here to talk about surgery. We're here to talk about when, how, and why. And so I'll leave you with this slide as we pass it off to our first speaker. And we have to consider all of these things when we talk about joint preservation. Alignment. If you do a cartilage procedure without addressing the alignment, your two-year outcomes will be great. But your five-year outcomes will not be great. And we want long-term relief, if we can, for these patients. If you don't have a ligament that's supportive of your knee, whether it's a cruciate or collateral, any meniscus or cartilage construct is doomed to failure. If you put in a fresh piece of cartilage or a cellular-based cartilage transplant, but you don't have a meniscus to help protect it, and you're not unloaded in that compartment, you may have a problem with the duration of cartilage repair and restoration. And then finally, appreciating and understanding the role of the subchondral bone. Not every bone marrow edema or lesion on an MRI is symptomatic or relevant, but many are. And so we have to pay attention to those before we determine which cartilage procedure is ideal. So with that, we'll get to the meat. And I welcome up Dr. Armando Vidal from the Steadman Clinic.

joint preservation techniques

knee

biologics

osteotomies

cartilage restoration procedures