Nick Smith presented at the Imperial Sports Knee Meeting 2026 – an excellent meeting bringing together leading sports knee surgeons, researchers and therapists to discuss contemporary challenges and innovations in sports knee and joint preservation surgery.

The conference featured high-level discussion across ACL surgery, meniscal preservation, cartilage restoration, osteotomy and biologic augmentation, with a strong focus on practical surgical decision-making and the future direction of knee preservation techniques.

Meniscal Transplantation – Technique Tips and Tricks

Mr Smith’s presentation focused on meniscal transplantation, sharing practical surgical technique tips, graft preparation strategies and technical pearls developed through one of the largest meniscal transplant practices in Europe.

Meniscal transplantation remains an important treatment option for carefully selected patients with symptomatic meniscal deficiency, particularly younger and active individuals where preservation of the joint is the priority.

The presentation explored several key technical aspects of surgery, including:

  • Graft preparation
  • Portal positioning
  • Soft tissue clearance
  • Root tunnel creation
  • Graft insertion techniques
  • Optimising graft positioning and “fit”
  • Fixation strategies and tensioning

A major theme of the talk was that successful meniscal transplantation is not simply about inserting the graft, but about restoring knee biomechanics as accurately as possible while minimising graft extrusion and overload.

The presentation also reviewed current evidence surrounding fixation methods and discussed the biomechanical advantages that may be associated with bone plug fixation techniques in selected cases.

Technical Pearls Discussed

Several practical intra-operative tips generated excellent discussion, including:

  • Preparing the graft before patient preparation to improve theatre efficiency
  • Using a lateral viewing portal to optimise visualisation
  • Keeping anterior root sutures out of the working area until final graft seating
  • Allowing graft “fit” to determine fixation order
  • The importance of careful soft tissue clearance and trephination

The session generated excellent debate around graft fixation, root positioning, extrusion prevention and how technique refinement may improve longer-term graft function and survivorship.

Chairing the Cartilage Session

In addition to presenting, Mr Smith also chaired the cartilage restoration session, which was one of the standout parts of the meeting.

The session covered a broad range of topics surrounding the management of larger cartilage lesions and joint preservation surgery, including:

  • Osteochondral allograft transplantation
  • Autologous chondrocyte implantation (ACI)
  • Biological augmentation
  • Combined osteotomy and cartilage restoration
  • Treatment strategies for complex and bipolar lesions
  • The future of cartilage repair technologies

There was extensive discussion around patient selection, rehabilitation, biological enhancement and the increasing importance of treating the “whole knee environment” — including alignment, meniscal function and ligament stability — when managing complex cartilage pathology.

Innovation and the Future of Knee Preservation

A recurring theme throughout the meeting was how sports knee surgery continues to evolve towards increasingly personalised and biologically focused treatment strategies.

There was significant discussion around:

  • AI and data-driven decision making
  • Biological augmentation
  • Advanced imaging and graft assessment
  • Rehabilitation optimisation
  • Earlier intervention to preserve joint health
  • Improving long-term outcomes in younger active patients

The meeting highlighted the rapid pace of innovation within sports knee surgery and the growing emphasis on combining biomechanics, biologics and surgical precision to improve patient outcomes.

A Valuable Meeting

The Imperial Sports Knee Meeting 2026 provided an excellent forum for discussion, debate and shared learning among surgeons with a strong interest in sports knee and joint preservation surgery.

Mr Smith’s contribution to the programme through both his presentation on meniscal transplantation and chairing the cartilage session reflected the increasing international interest in advanced knee preservation techniques and contemporary meniscal surgery.

#ISKM 2026

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