impressed. Our speakers, number one, were phenomenal, and number two, stayed on time for the most part. And we have time for questions. And you guys sent in a lot of questions, so I want to get to the first one that got upvoted by so many people. And we're going to go down the panel, so we'll start with Dr. Rodeo. So I'm going to ask you, when you do PRP for NeoA, we'll just say for NeoA, do you do a series of three injections? So just say how many injections you do and how far apart you do them. And if it's one, just one. We'll go down the row. I generally do one injection. I will check with the patient. If they really have a good response, I'll leave it at that. If it's seven to 10 days, it's kind of equivocal. We'll have talked about it up front that we could extend it to a series of three injections. I'll do this typically one or two weeks apart. Then you have the cost issues. Let's keep going down the line. So how many injections? I'm going to ask each person the same question. Normally, I do one. One? One. OK. Same here. Just one. One. One so far. Three. And there's a clinical study to support that. There's also a basic science model on guinea pig to support that as well. So the basic science model was in 2019. Patel is the lead author on that. And there's a couple clinical trials that compared one versus three. So I do a three injection series at one week interval. And I think that's supported by a basis of evidence to make that statement. Let me ask one more practical question. Sorry, Seth. I know you were going to jump in. But Adam, if you were doing three one week apart, but a patient's going on vacation, they're going on a cruise, because patients ask this. And they're coming back in three weeks. Are you going to do the next one then? Or do you base it on clinical symptoms? I go ahead and commit them to the three injection series. And then just practically speak, when are you going to be available? And seven to 20 days within the previous injection. Or five to 20. Like to ask some questions specific to the studies. Let's start with Adam Yanke and Nicholas. Just curious about the addition of the CO2. Thoughts about why did some have that versus the other? Any differences between them? Thoughts about the cystic changes from perhaps that? Or did you have more integration because you can get more biologic into the OCAs? Just give us some guidance, current concept, thoughts on that. Yeah, I think that's a big confounder in our study. Because we had some of our surgeons who did use that technique and some who didn't. It became more prominent during the end of the study. And I think a subgroup analysis, if we had a larger sample size, would be insightful. With regards to the effect of PRP, excuse me, the effect of the CO2 on uptake of the bone marrow aspirate concentrate. But maybe I'd defer to Dr. Yanke if you have any other input on that. Yeah, no, I think that's accurate. I mean, I think in the total study, I think there was three. So it's a small number, so I don't think it had an effect either way on the study. But I do think it has a role. And obviously, visually, it looks drastically different. So I think the amount that you're delivering to the site is different. But it should be looked at separately. I'd like to ask one follow-up as far as bone marrow aspirate concentrate and taking it for that particular study from the iliac crest versus distal femur or tibia, which you presented. And this can be for others on the panel as well. Does it make a difference and where should we be taking it from? There has been some evidence that you get an improved cellular population from iliac crest harvest sites. That's certainly a little bit controversial. From my perspective, which is certainly level six evidence, harvesting cells from the eventual recipient site to me is a little bit counterintuitive, but adding cells from another location to bolster the cellular population at the site, to me, makes a little bit more sense. So harvesting cells from the distal femur when you're subsequently implanting into the distal femur, I'd rather harvest from a separate site and introduce additional cells into the milieu. There's actually good data demonstrating much better cell yields from the axial skeleton, vertebral bodies and pelvis. It kind of has a fall on there, I want to ask you, did you characterize at all your bone marrow aspirate that you used to soak these grafts in? We didn't specifically in that study, which is a weakness. You know, for any of these things, we have a treatment, because we're we don't really know what we've treated our bone, our graft with, or my patient. I mean, we're the same, I suffered the same limitations, but I really encourage us to do, have some characterization of central markers of purity, potency, activity, something, or else it's kind of hard to really move forward. That's a great comment. We did a separate study looking at characterization of a lot of them for a separate use, and the standard deviations of all of them, and were so far all over the place that we stopped looking at it, which is probably not the right move, but the, obviously you do want to correlate that and find a mechanism, and especially for finding real results, but it's amazing the variability that we were seeing when we looked at BMAC in particular. We are essentially running out of time, but we have one final question for our hamstring hematoma question. Is there a, is there an absolute time period in which aspiration and or injection is not suggested? So duration from injury to procedure. Yeah, so we, in that study, really tried to aspirate like every patient within a week, and that's kind of our cutoff. It gets more difficult, the hematoma gets solid and complex pretty quickly. So we have a one-week cutoff. And then outside your study, practically speaking, you have a pro-athlete with a grade one, or a pro-athlete with a grade two plus, three minus, who were resting for a week, and then you have a pro-athlete with a grade two plus, three minus, who were resting, but on that higher end of the spectrum, maybe an empty junction injury, and it's playoff time, and this athlete wants to get back, even if it's one day quicker, one week quicker. Are you advising this treatment in that case? No, so a grade one in general, no, because the PRP would really flame up the injury more than anything. And grade two plus, I mean, it really depends on the location and how bad it is, but that's still in the spectrum where we would potentially do it. Well, we are at time. I want to thank all of you. If you look around, this is standing room only. We are so impressed that you guys came post-Prandial, after lunch, to join us. Thank you for our speakers, and all of you have a great time in Colorado. Thanks. Thank you.

Platelet-Rich Plasma

PRP injections

NeoA

CO2 in PRP injections

bone marrow aspiration