No, I want to thank Eska for being here. This is really great and really appreciate you coming over here and speaking to us. It's awesome, especially as we're on our 50th anniversary, very special, so thank you. My question is for David and meniscal allograft transplants. Now when I was traveling, they didn't seem to be quite as popular as when I was a godfather in 2018. The tissue banks, are they available in every country, only in certain places, or are they increasing in number, and how are they regulated? This is the big question, and this is why Eska is trying to promote huge work on the use of allografts and the necessity to be able to use allografts, because there is a high diversity in different countries, and I would say if I have to speak about France, it's very tough to get some allografts. If you go to Italy, I think it's more easy. If you go to Belgium or Germany, probably it's more difficult. So you see, it's still not very easy. So we have to fight and we have to promote that, and that's why we, in this allograft initiative, was a very powerful tool to go to EU, and we still need to work on them to do that. Do you have a problem that you have in your countries? I have been travelling for three weeks and a half in your country, and I think it's a big problem. Because in some countries it's so difficult, and there's no regulation on the EU level, and this makes it quite hard for the doctors, and what we basically are trying with this initiative is, not necessarily the health authorities telling us what we have to do, or what we shouldn't do. So we created the initiative to, first of all, find out how much is the demand of getting allografts. And for instance, Fresh Fertil is one graft in Germany, which has sold its best graft in 100 years. And then, of course, with these results we have on the initiative, we have to go to the authorities and to China, and try to convince them that we need to change the rules, that we are able to first get access, and then secondly, to actually treat the patient, because it's still very long. Thank you. A question for Thomas. If you have a knee with a meniscectomy, and you have this lesion, do you still perform the articular cartilage procedure, or do you want to do something to restore the meniscus? That was the last words, of course. Look at the joint. First comes the alignment. So if it's malaligned, you have to correct the alignment. Then you have to do something about the meniscus. And if it's malaligned, the meniscus is missing, or any language there, of course it will fail. Of course. It's not working. Go ahead. Thank you for the symposium. I thought that was excellent. You know, I totally agree. You know, when you have malalignment, you need an osteotomy to correct the alignment. The question was really for all of you. At what age, so say you had a root tear in a 50-year-old, and they had various knee. When do you do the root repair with the osteotomy? If you have a meniscal deficient knee, and they need a meniscal transplant, what age is the cutoff where you just do the osteotomy, or you do both the osteotomy and meniscus transplant? And same for Thomas, for cartilage lesion. That seems to be the biggest problem I have, deciding when to just do the osteotomy, or when do you add the other procedures? Thank you. and some participants were only in Europe. Yeah, basically I can also agree that that was the conclusion. In Germany we have the difficulty to restore the meniscus because we basically have no meniscus allopaths. The synthetic meniscus are really not working. The root fixation probably, it's also the biological age, with only the age of 50. If you think of the overweight 50-year-old lady, you know the root chambers of the jungle need to be corrected to totally out of plasticity. So we have to discuss the modification in the biological construction. We must be really prepared and try to avoid it totally. We must say, okay, it's a conservative, and then probably we'll get it to plasticity. You guys are very diplomatic. So, in other words, there's no age cutoff. Okay. So the osteotomy will be definitely the key. If you want to have a mat, it might be, but you have seen that on the right. Hi, Ken Zasloff, David, quick question, first of all I want to just thank everybody for coming and I want to thank ESCA for their relationship not only with ICRS but also with AOSSM, you guys are great about working with other societies, we really appreciate your input. David, when you, if you train in the US, most of us have been doing bone plugs or slot technique for meniscus transplant, but based on your data as well as Renee and Peter Verdung's data clearly the all soft tissue is just fine. Can you just tell us though, do you use tunnels for the roots when you do the all soft tissue with no bone plugs? But the same thing with the meniscus transplant, you use the same tunnel for the root or, yeah. And on the anterior, do you use a tunnel or you just do suture on the anterior root? Thank you. You mean, sorry, well Aaron has started to show us that for root repairs you need to consider that to prevent extrusion, is to try to centralize it, is that what you're talking about? And you would do the same thing, put an anchor into the tibial plateau and suture it, yeah, we're starting to do that, it's pretty early. We have the opportunity to have a special host of attendees in the room, so, Stéphane, How many hostotomies do you combine during the night, and is the HUV something that you take into account? Normally, especially on the lateral side, I do a meniscus transplant plus medial varus hostotomy, and on the medial side it depends on the degree of varus malalignment, but most of the time I do now and combine, because why I have to leave the knee without meniscus if I have the possibility to put, correcting the alignment and to put a new meniscus? When there is a varus knee more than three degree, you should do it. And I have no limits of age. I'd like to make a comment about the ramp lesions. Also, this was an excellent, excellent symposium, and you've shown my American colleagues that in Europe we really do good work. As a ski, as a football doctor in Madrid, we don't see as much as I did as a ski doctor in Lake Tahoe, these ramp lesions. In a skier with an effusion, at least 10% will either have a root or a ramp lesion, even if they don't have a cruciate ligament tear. The first thing that tears in the skier is the poster medial corner with valgus abduction stress. And the problem is that most MRI will not show you that lesion on the poster medial corner. So, you must do an arthroscopy. You must look at the poster medial, poster lateral corners, and you must dynamically probe the meniscus to see if it's stable. And I think you've mentioned that, but I want to emphasize that, especially because in skiers, at least 10% will go unrecognized. If you're living in the city and you see a skier come in, the MRI may be negative and you will have a repairable lesion at least 10% of the time. I totally agree. You have to have a high degree of suspicion as soon as your rotational mechanism is involved in the tournament. And that's correct. We see a lot of our Alpine skiers in the gesture series I'm showing. Obviously, we have a lot of Alpine skiers in there. Because in Geneva, we have all those skiers that are going to win the tournament. But in world football, alias soccer, you still have those types of injuries. Once again, as soon as your rotational mechanism is involved in the mechanism, you should really have a high degree of suspicion. If you have a player or if you're a skier that keeps posting you can play, even a couple of weeks after the tournament, then you should go in time. More questions? Burning questions? If not, since we are perfectly on time, thank you very much for coming.

meniscal allograft transplants

tissue banks

availability

regulations

alignment correction