the final warriors. Excellent. So we're going to talk about my experience with ACL primary repair and the role of age. I finally have enough patients where we could analyze the data and see the role that age plays on the outcomes. These are our disclosures. So in the past five or ten years, there's been a big interest surge in primary ACL repair. The past, the results were kind of sketchy. And currently, we've figured out that the secret sauce is if we can do this isolated on proximal tears with good to excellent tissue quality and in the acute or subacute setting, perhaps we could have better results. In fact, a recent meta-analysis that we did showed a re-tear rate of about 6 to 14 percent. Excellent outcome measures. And this procedure is dramatically less morbid than the reconstruction and very few complications. We know that in the younger age groups that ACL reconstruction is associated with a significant risk of re-tear, regardless of the graft. Some grafts are better. But overall, I think it really is buggering us all to try and figure out how to lower the failure rate in the children. But it's really not known for ACL repair. There is one study out there that suggests rather high failure rates, but the literature is rather scant. So the goal of our work was to assess the outcomes of ACL repair in a larger cohort and understand the role of age. Retrospective work, looking at my patients from 2008 to 2017. Isolated ACL injuries, minimum two-year follow-up. Two techniques, just simply because the technology got better, I started off with a dual suture anchor repair technique. And when the internal brace technology came out, I added that to it. We looked at three age groups, under 21, 22 to 35, and over 35. Looked at failure rates and outcome measures. This is the first 113 patients that I did ACL repair on. I'm closing in on about 400 right now. And we had 100 percent follow-up, which is really nice. Under 21 years of age, we had about 27 patients, 22 to 35, 24 patients. And over 35, we had the most, 62 patients, as those patients in that age group tend to tear it approximately more often. The only significant differences in the demographics were the age, as you might expect. And we've had a much higher Tegner activity score in the youngest patients. The overall failure rate or re-injury rate was 11.5. Under 21, we found a 37 percent failure rate, 10 out of 27. But over 21, only 3.5 percent of the patients had a re-injury. Looking at re-operation, complications, and contralateral failure, there were no significant differences, and these were all quite low. We found no differences between repair and repair and internal brace, although admittedly the numbers are rather small. Looking at the outcome measures, uniformly, they were excellent, and if you analyze the numbers in the patients who did well, we found no significant differences between any of the age groups. The limitations of this study are obvious. Retrospective design with some selection bias. The group sizes weren't uniform. We didn't have pre-injury outcome measures. Two different techniques, although they are very similar, and the follow-up is short, but I always say, you never get to long-term follow-up unless you start with short-term follow-up. So the conclusions are that primary repair leads to a higher failure rate in young active population, especially young females with high Tegner scores. However, we should note that there's very low failure rates in patients over 22 years of age. Only 3.5 percent out of 86 patients had a re-injury. This information is here for me to share with you, my colleagues, so you can learn from my vast experience with ACL repair, and also that patients can understand better what they're getting into. And obviously, larger cohorts and longer follow-up are needed in this work, and I guarantee you that I will be back to share my experience with you. Thanks for your time. Do you want me to stay up? Thank you.

ACL primary repair

age and outcomes

proximal tears

re-tear rate

ACL reconstruction