Now, obviously, we're not going to be able to do four complete ligament reconstructions in the space of 30 minutes, but what we are going to show you is a process that both Volker and I would go through when dealing with these difficult, challenging cases. And first thing we'll often do is we'll have our process, we'll have essentially our menu written up on the board in the OR that allows us to collect our thoughts, make sure that our team is on board, we can talk through everything that we're going to do in terms of our process, as well as our graft choices, what we need for our grafts, what we also need for our fixation devices. And of course, when we're dealing with whether it's a KD4 or even a KD3, there's a lot of tunnels and there's a lot of problems. So we're going to show you some maybe key steps that we can try and stay out of trouble. And Volker is just going to show you really just an example on the femur. Yes, I think this board is critical and it helps everyone in the OR be on the same page. So you see a bunch of little pins in here. I know this looks a little bit crazy, but the attention would be basically on two pins. So in my case, I will do the PCL-MCL portion of this procedure. You can see on the PCL, what I do is I basically drop my hand and on my MCL, I will elevate my hand so that these two tunnels don't collide. This tunnel and that tunnel. Al? And then on the lateral side, the big concern for me when doing post-lateral corner with an ACL, here's my ACL pin and there's the risk of tunnel coalition with my fibular collateral ligament tunnel at the level of lateral epicondyle. So what I really want to do is drop the pin about 30 degrees proximal, 30 degrees anterior. But we're going to demonstrate that in the cases. So we're going to move our camera over to our first knee specimen. Both the knee specimens that we're using are right knees. And so this is a right knee. I've already done the lateral approach. This is a very extensile approach for the purpose of the demonstration, but essentially it's a curvy linear approach. It's based really quite anterior over Gertie's tubercle. That way, then when the skin, the push to your skin flap drops back, you're not constantly fighting to be able to get access. The first incision that we're going to make is we're going to work out, we're going to decompress our common peroneal nerve, which is just underneath the biceps. So I often find it just at the level of the fibular neck. If I can feel it at the fibular neck, then I'm going to trace it more proximally. And then once we've done that, I can then create this window here, and you can see there's a window essentially in between soleus and the lateral head of gastrocnemius. That allows me into the back of the fibula and onto the posterior lateral aspect of the tibia. Now I'm going to switch around a little bit, so hopefully the camera can come in and see it. Perfect. I've already drilled my first tunnel. So my first tunnel is in the fibula. So you can see here's the scope obturator there in the fibular tunnel. You can see it's dropped about 30 degrees, anterolateral to posterior medial. I've already made an incision through biceps bursa, and I tagged my lateral collateral ligament. Okay. Now from here, I'm then going to drill my, I'm going to drill my tibial tunnel. Hopefully you'll be able to see this without me getting in the way. So we're just going to retract. This is our next incision, which is just basically on the medial border of Gertie's tubercle, lateral border of the lateral of the patella tendon, and I'm aiming, I'm aiming towards my finger and I'm looking basically to get the entry point, the exit point of the posterior lateral tibia about a centimeter medial to the obturator, which I can feel in my finger, and then about a centimeter proximal. And once I've hit that, okay, I can feel, I can actually feel with my finger that the space between the two points, and then I'm going to drill up my tunnel. So the next one comes in, my Volker's going to load this up for me, but I've got my finger back there. I would not recommend anybody else drilling onto your finger. You want to basically, if you feel that the pin is moving, you can always switch that up for a, a curette just to protect. And then as I get a little bit further back, I'm going to just run back onto the cortex. What I often do is take the drill off and I'm going to walk that in all the way to the back. I can take my pin out and then I can run the drill at the back, make sure I go through the pulpitius muscle belly, clear all the tissue away. Okay. And then we're going to pass the ultragraft. So then we're going to have a little passing device that goes in through the tunnel. And if I've done a decent enough clearance, I can then just pull that essentially out. And that's our first part of our post-sciatica corner. Okay. We're going to now move to the medial side. So we're just going to swing around. Volker. So on the medial side, we also did a pretty extensive approach here for you, but I do large incisions. We dissected the sartorius fascia out here quite carefully, which is often scarred in. So you've got to spend some time. The PES and serinus tendons are down here. So this is your inferior border of your approach. The remnant MCL that is usually stretched out or completely gone. In this case, I split. And then I put two anchors in. The first anchor goes about 4.5 centimeters distal to the joint line, right over the PES in the posterior part of the tibia. And on that anchor, I will anchor my, in this case, hamstring tendon. I then do an isometric test to find out what the femoral position is. And for this, we're going to go and we put three pins in here for demonstration purposes. And the pin is going to be in the center of the medial epicondyle. So I'm going to have a suture here. I can clip my suture, if I can, like this, then you can give me extension, please. You can see I have very little movement. So this is basically an isometric position. Then I can change this out and find out the most isometric spot. So if I go a little bit more anterior, right here, you can see what happens. If you can see it through the camera, so I extend it all the way, you see there's a lot of movement. So this is a very much inappropriate position. And the same would go for the posterior most of these three pins. So the middle one is where we want to go. I'm just going to demonstrate for you. If you go a little bit to posterior, the same thing will happen. So there you can see there's about a centimeter or so movement. Okay. So from here, what we'll do is we'll just exchange this for a K-wire, we drill over with a seven millimeter reamer. And as I said before, I will drop my hand a little bit to avoid the PCL tunnel. So this comes out. I will take a beef pin instead. I keep my eye on the money. We go in the same spot, drop my hand and come out on the lateral side. Then I over ream it with a seven millimeter reamer. The length is at minimum 25, but we usually go about 40 or so so that we don't dead end dock the graft end. There you go. 30, 35. There you go. That's it. And then a suture gets passed and that's part of the procedure. So from here, we'll go into the scope next. Let's see a K-wire, I mean a coca real quick. So you'll notice that we've started with our extra articular approaches and there's pros and cons to either going extra articular or intra articular. First I like to go extra articular because I've made my incision. I can essentially then, if there's any fluid extravasation that's safe, it's coming out of the knee onto the floor rather than into the calf. So my preferred approach certainly is extra articular first, but now I'm going to go back to the lateral side and we're going to do a lateral capsulotomy. So you can see I've made the incision in, so can we go to the outside view please? And then we're basically, we've made the incision through IT band and now I'm going to do a capsular, a capsulotomy, which is going to get us down right down onto the, maybe just push it over a little bit. And we're going to get this right down onto the articular margin. We're going to get a little bit of fluid in the face. Just turn that water off for me for a sec. OK, so and what we're looking for here is our, there's the articular margin right there and then we're looking for the popliteal sulcus and that's basically the anterior fifth of the popliteal sulcus. So we're going to pass the popliteus pin first. Can I have a pin driver please? OK, so that's anterior fifth popliteal sulcus. OK, so that's my zero, zero. I'm going to go about 30 and 30 and that's going to create, pass my pin. Now, this pin is generally not a problem, so I'll usually just go straight to drilling the tunnel. And so for the graft that I like to use, I usually just drill a six millimetre drill because I do a single graft, semi T autograft, PLC reconstruction, which I'm going to demonstrate in a second. But we'll just drill this socket up. That's fine. OK, and then we would pass a passing suture. OK, now for the purpose of the demonstration, then what we're going to do is we're going to drill our fibular collateral ligament. As Volker said, as we already talked about, the problem area of the tunnel coalition with an ACL and the fibular collateral ligament on the femur is, of course, on our lateral epicondyle. OK, and the coalition between that combination inside and out. OK, that and my ACL tunnel. So I'm going to, I've got the scope in the knee, so Volker's holding on to the scope. I keep the scope in the knee at this time and I'm looking up the ACL tunnel and now I can pass my pin and I can make sure that that pin has got no tunnel coalition. OK, so it passes all the way across. We then take a 4.5 millimetre drill, which is right here, because I'm going to be using an adjustable loop device to be able to tension my fibular collateral ligament, which I'll show in a moment. We're going to drill all the way across. You can see with that tunnel, no, no coalition. And I'm going to go all the way across to the far side. OK, and then we'll take our other drill and we'll drill up again. Again, this would normally just be about a six millimetre drill, six millimetre socket. You just drill across, no tunnel coalition. So we're golden. OK, next, what we're going to do is prepare the femoral tunnel for the PCL. So you can take a look here if you see the scope view. This is a nice view of the PCL. Oftentimes when the PCL is completely torn, the femoral insertion site is still intact. So I'm going to go and use the shaver and clean up a little bit around my tunnel. Right here, I usually try to preserve that PM bundle if I can. Can you see a spinal needle? I will use an inside out approach for this. So I will use a second portal. I localise with the spinal needle where I would like to go, which is right here. It's at the one o'clock position, about five millimetres posterior to the cartilage margin. This is a big knife. Yeah, that's fine. Very good. Now I take a beef pin, please. I want to adjust my lens a little bit, so I take a beef pin. Give me the beef pin into the hand. There you go. Perfect. And then just come over here and place the drill if you could. So here's one o'clock, this is about five millimetres posterior. Tell me when you start spinning. No, you need to drill this in first. No, you need to drill it in first. Tell me when you start spinning. OK, you got it. OK, just drop your hand and then go all the way out the skin. I use an ender button, so I usually do an outside in measuring guide. I'm going to skip that step and then you can over drill it right now with the 11. What I like doing is using an 11 millimetre graft. I have a nice, large Achilles tendon allograft for this case. That's my go-to graft. You can even go 12 if you wish. And you can just come in. Protect the scope lens while you do this here. This is very narrow space with the two portals being very close to each other. Looks like it's a little bit dull. Or maybe Al, you're weak. Are you weak? I'm weak. I think that's what it is. All right. Yeah, that's all right. It's pretty dull. I think I think we get the idea, we get the idea. So we keep that and just leave it right now. I want to show you one more thing here. So Gilchrist portal is when you go between the medial condyle and the posterior medial bundle of the PCR. So I go through posterior into the posterior compartment. You can see here, this is the posterior medial meniscus root. That's the lighthouse. And then you can see on the left side of the picture here on the lateral side, the PCR come in. Can I see another spinal needle? And so here I will establish my posterior medial portal. I will palpate with my finger, make sure I'm high and posterior when I come in. I use a spinal needle. To me, this is just slightly too posterior. So I'll just change my angle slightly. There you go. I leave the needle in. I take an 11 blade. In this case, I can take the 10 blade. That's OK. I will leave the needle in place. Oh. And then I go along the needle with my blade so I don't get lost in the back of the knee. Because this 10 blade, I am getting lost a little bit, but it's OK. So here we go. So now I established my portal. I don't put a cannula in here. I will basically just accept it as such. Then I can go in with my shaver. And as you know, in the posterior knee, you will not touch the capsule or face you with the shaver ever posteriorly. So now I can change my lens. I go down to the PCR and I start working with the shaver and also with the radio frequency wand and clean up the PCR insertion. Again, do not go to the capsule. Now, if I move the camera back anteriorly, I'm now behind in front of the PCR. I go above it. Now I have the septum here, so I need to come through the septum. I can do this with a shaver and clear the space from posterior and knowing that this is not the capsule, but the septum. OK, I'm going to go to the other knee right now. OK, so we're not going to switch over to a second knee that we've prepared and we've prepared most of the tunnels here. The last thing we want to do is just do the tibial tunnel for the PCR. So again, it's the right knee. So three tunnels or all tunnels have been made except of the PCR tibial tunnel. Come to my right side. So I'm now with my 30 degree lens through the notch. Now this is a four ligament notch. There's nothing left. You can again see the posterior medial meniscus root. Here's the stump of the PCR still present. So I go deep to it. You can see the number 20 here. So I'm going to go nice and low. I go over my aiming device and and look down. I'm just at the border of the capsule and I can see through the popliteus muscle. So you can go ahead and place a pin. This step I usually do under fluoroscopy. Al, do you use fluoroscopy? I do not use fluoroscopy if I get a good visualization. For me, I would be looking directly at the pin coming out here, not this particular view. If you can't get a good view of your pin coming out so you can't do it safely, then you should use fluoroscopy for sure. Yeah, so in my case, I use fluoroscopy every single time. I think it's safer to do it that way, especially if you work with residents and fellows. So now that we're at the second cortex, I'm going to remove the tip aimer. I'm going to use this spoon so I can catch the pin. So if you will advance the pin for me. Let me see. I usually use a 70 degree here, but I think we can get it done with a 30 as well. So here's my pin. If I change my camera now, you advance the pin and it's captured now by this little spoon. Again, I would check now with the lateral C-arm shot, make sure I'm in. Now we're going for an 11 millimeter tunnel. So in the case of an 11 tunnel, what I usually do, give some counter pressure, thanks. What I usually do is I start with an 8 millimeter reamer because you do not want to plunge in the slightest. So I start with an 8 millimeter reamer. I go by hand on the second cortex and then I go with the 11 reamer and ream it over. It's an additional step, but safety first on the tibial PCL. You can go on power. Should I trust you? I don't really trust anyone. I'm not so sure. I don't know. Am I trustworthy? Who knows? There we go. Perfect. Now spin it a little bit while you're there so you can kind of rasp the killer turn that John Bergfeld always talked about. Very good. So once this is done, you can put the shaver in. Will you hold this spoon for me? Perfect. Clean out the tunnel a little bit. Be very, very careful not to go over the shaver too far out so I don't want to violate the capsule in the slightest. Be careful with the suction as well. Okay, good. Now I use a passing device through this tunnel. I'm gonna bend it a little bit. Ah, it's easy. Thank you. It's good to use the PCL tunnel for that. Now, do you have the spoon still there? Get rid of that. And pull on that black suture a little bit. Thank you. Now this little trick that I like to use where you basically just engage whatever your passing device is into this PCL elevator. So you just basically engage it in the hole there and then we can push pull. And as I pull out and Volker pushes, then we can deliver it into the middle of the knee. So now we can just take a- Hold it. Hold that for you. So now we take this like a little shoulder loop, you know, grasper. Just turn the water off so we don't have all these bubbles there. And pull that. Hold the scope for me for a second. And then can you get the PCL graft? And so now I can rasp that killer turn one more time. Oh, can I? There you go. Okay. Then we will deliver the graft. So we made here in this case, a Achilles tendon allograft 11 millimeters with a 20 by 11 millimeter bone block. But we deliver it with a soft tissue side first. Can you see the outside? Then you can see there's like a 120 millimeter soft tissue graft tubularized with a bone block 10, 11 by 20 and an ender button BTB on the femoral side. So you can go ahead and pull this down. Yes. Yes. Wrecking the place. So now I'm pulling the graft in. Al, will you pull distally a little bit for me? Hold on. Turn the water on again for me. Okay. Don't pull too much. Don't pull too much. Okay. Stop right there. So one trick is to not pull this graft out too deep. Instead with your finger, push the bone block into the notch because now it gets a little bit tricky because you don't want to have struggles putting the bone block into the femoral tunnel. Now what I'm going to do is take this ice tongue again. I'm going to deliver the passing stitch that we previously passed here into the femoral tunnel. You got it? Perfect. And then go ahead and pass these sutures in. There you go. About four inches or so worth. Pull that through. Okay. And then if you can go ahead and pull these sutures and stop for a second, I'm going to take a probe or an ice tongue grasper, put the graft into position. Hold on. Okay. Hold on. One more time. Okay. Now go ahead and pull it up. Good. Good. Pull more. Bam. There it is. So the graft is in the tunnel. PCL is passed. The endobutton is flipped. I will delay the tibial fixation until after we're done with the rest of the procedure. Okay? Perfect. All right, next. So next up, we've already drilled our ACL tunnel. So we're now going to pass our ACL graft. Okay. We didn't really feel we needed to demonstrate ACL tunnel drilling. So I'm sure many of you are very familiar of that process. So we're just going to take our ACL graft. In this scenario, it's basically, it's a tibialis posterior allograft. And we're just going to, it's fixated, it's going to be fixated on the femoral side. Yep. Pull up. With a endobutton. Keep going. Keep pulling. Good. Okay. And then pull up on the white for me. And then we're just going to pull this into place. So it's a 20 millimeter endobutton. Up you go. Keep going. Keep going until the bottom side. Perfect. Now try and flip that. Can somebody come and hold that knee in place? Yay. Perfect. Okay. Is that dancing? Nope. I gotta be careful there. Yep. That's dancing now. So that's fixed. That's fixed on the, so we've now got PCL fixed on the femur. We've got ACL fixed on the femur. And then we could always then do our fixation of our tibia, but we're going to keep going with our collaterals. And then we'll just see how we're doing for time at the end. Okay. So now we're going to move to the lateral side. And so we're going to just swing this around a little bit. So we've got camera coming in from just behind us, if possible. We'll just, just repositioning our camera, David, and then we'll get a good view here. So again, we're on the lateral side and that's exactly the same approach that I've done on the lateral side as I did in the previous knee. And so what I've already done is I've passed my SEMI-T autograft. So I like to use SEMI-T autograft. I have great access to allograft, but I just love SEMI-T autograft for post-lateral corner reconstructions. And I'm going to do a full anatomic leprowd reconstruction using a single graft. And we'll just go through the process and how we actually do that. So can I have the pickups? Okay, so the first thing we've done is we've docked it in the popliteus tunnel and we fixed that with a screw. I've already passed my metzenbaum scissor down through the popliteal hiatus. Okay, so I can get all the way down to the post-lateral corner. So I'm just going to add, put a loop on the end of my snap. And we're just going to run down to that lateral side. Can I pick up this? That might be all right. And we're just going to pull that through. Now we're going to need our fixation devices. So we've got an adjustable loop fixation device. Is that package there for me? Yeah, the whole package would be great. And the first thing we want to do is it's an adjustable loop with a button that's already included on it. Okay. And so we're going to take this off. Just going to try to take it off. And what we need to do is feed this through. We can just cut that for me. Just cut that one. Perfect. All right, so first thing we're going to do is we're going to feed this. Hang on. So it's this one first. So we're going to take our suture where the end of the suture is on the anterior aspect of our tibial tunnel. I'm going to shuttle this through. Fixation device through to the back of the knee. So hopefully you can see that. Please tell me if you can't, if there's any issues with visualization. So this is now going to be pulled out on the lateral side. Okay. And then I'm going to pass my graft through that. Okay. And so then we're going to pull that loop. And now the graft is sitting on the posterior aspect, posterior aperture of the tibial tunnel. And then next we're going to pass the graft through the fibula tunnel from posterior lateral, so posterior medial to anterolateral. Okay. And that comes through. Now, what I can do at this position is I can start to shorten this loop down. And we're just basically pulling the loop so that we're going to get some tension across there. I'm not pulling any of the graft into the tunnel at this point. Volker, if you can grab those for me. What we're going to do is then take a ruler and the ruler, we're going to mark three centimeters, three or four centimeters. That's perfect. Okay. And now hopefully you can all see that. So the mark is now just outside of the fibular tunnel. Volker's now going to start to shorten that loop. So you've got to do this very, very gently because as you pull, as you shorten the loop, we're pulling a loop of the graft into the posterior tunnel. And once that mark goes away, so if you've done a three centimeter mark, you know you've got a 1.5 centimeter loop of graft into the posterior tibia. So we'll have a nitinol wire in it next, thanks. So once we've done that, now we've got a long, long graft here. So we can bring a little bit more in, pull it on in. Okay. We don't need all of that. keep going, keep going. Perfect there. Okay. We'll take the nitinol. And now we're going to fix, fix our, and we're going to use a peak screw. So it's basically a six by 20 peak screw, peak, peak, little one, there it is. Fantastic. I tend to, oh, here it is. This is the six. Oh, sorry. Same. Yeah. There you go. And we're going to place our peak screw. Now I'm going to do this at 70 degrees of flexion. Sorry, just watch the camera angle there. Can you see it? Okay. So, all right. So now we're fixated there. Okay. The next step, we're going to pass our graft superficial to the IT band. Open that up for me. Yep. And pull. Okay. And then we'll have the other ultra button, which is here. Now, both Volker and I like to fix our collaterals distally. So we fix on the tibia first and tension on the femur. And that way it allows us basically to pull. So it's biomechanically favorable because we can pull the knee into valgus for when we're doing the lateral side, when we're doing the PLC. So there we go. And we can also pull the knee into varus when we're doing the medial side. And so you're really not fighting against your fixation. So once I've done that, I can cut that off. And so I like to use adjustable loops for this fixation because it just makes us able to tension, retention, cycle the knee, try and get rid of any creep, and then really adjust your fixation as you go. Now, what we're going to do, so I've already measured the tunnel. It's about 80 millimeters. So we're going to pull on that. And that usually gets to the cradle. And then we just flip that. Which one are we on? Yeah. Okay. And we just pull back on it. So now I know that I'm in. Okay. So now I shorten it. Yeah. Keep going. And that's just going to dock our graft in. Now, I'm not going to tension that at this point in time. There we go. Done. Okay. So now our post-lateral corner is essentially grafted as past. We're going to go back to the medial side. Yeah. I mean, do we still have time? Or should we take questions? It's up to you guys. Yeah. We have some questions. I mean, the NCL just gets docked in here on the medial side. This is pretty simple. Yeah. We're going to take questions, guys. Thank you very much for what you have done. Very well done. First of all, there is one thing that we need is a picture of your paperboard planning. Everybody wants that. Okay. Then tell us about the first ligament that you fixed. We'll sign it for you. Yeah. Bring it back. Of course. And the last ligament that you will fix. So tell us the sequence for fixing all the different ligaments. Well, the first ligament we fixed is the PCL because the PCL will afford the knee not to sag. Once the PCL is fixed, usually the ACL gets fixed, lateral side, then medial side. The PCL at 90 degrees of flexion, maximum anterior drawer. And the ACL, whichever way you prefer in the extension. And then the collaterals each at 30 degrees. We have some questions for Buddy here. We've got a few for him. They were having trouble hearing us. There's your thing. Are you worried about, oh no, here you are. It says, they were worried about, do you always release the coracohumeral ligament even in small tears? Yes. Actually, that's not original to me. Dr. Mayer always releases it in every rotator cuff tear. Even with early PT, have you seen, oh shoot, there's all kind of stuff. Have you seen adhesive capsulitis? You speak about shoulder or knee? Sorry. We're talking about. We changed, we're on shoulder. We're on shoulder now, and then you're going back to the knee. Okay, okay, okay. Hang on, guys. We're getting there. So I don't do early PT. I do some passive motion. The patient does it at home. I save my PT visits for later. And I'm not really worried about capsulitis because you do a very good release of the capsule. Can you please mention graft types and sizes that you use more than one? So that's for those guys. That's for those guys. I think you're done. I'm done. This is for the knee. Now we're going back to the knee. For the PCL, 11 millimeter graft. Yeah. The Achilles tendon is the favorable graft because it's as long as you want and as big as you want. So 11 by 120 and a 20 millimeter bone block. ACL? ACL, I like to use autograft if possible. I like to use a quad tendon because then you don't have to worry about tunnel mismatch because often you have to make a shorter tibial tunnel so you don't get tunnel coalition with your PCL. But again, allograft's not a bad option depending on your patient. I use autograft exclusively for collateral. So MCL is a semi T autograft, lateral side single graft, semi tendinosis. Don't forget, you can always go to the contralateral side if you need it. So we've got lots and lots of options for autograft options. And obviously if you have availability of allograft, you've got it there if you need it. I go allograft on the collaterals. All right, so can you hear me? And then afterwards, this, very important. So can you hear me? Sure. Can you hear me? Yes. Can you go over the sequence slowly once again, starting with PCL? Can you go over the sequence slowly once again, starting with PCL? Okay, yes, absolutely. PCL, inside out tunnel using an additional low antilateral portal. Inside out, I use an enderbutton reamer, so 11 millimeter tunnel and a 4.5 enderbutton reamer. Then we go and do the ACL femoral tunnel next. Why do we do two different grafts first? Because of the extravasation. So once you've done that, we do an ACL tibial tunnel. And then lastly, and most importantly, and with fluoroscopy in my case, the PCL tibial tunnel, 11 millimeter tunnel. And then we pass the PCL graft. So if the sequence wasn't clear, we pass the graft with the soft tissue through the intermediate portal down the tibial tunnel. And then we have a draw suture in the femoral tunnel of the PCL. We take the bone block side, we take the sutures through the draw suture and pass it up into the femoral tunnel. Then we flip the enderbutton, and so the femoral side is fixed. If you wish to add an interference screw, you may. The same thing that happens with the ACL, both cruciate ligaments are now fixed on the femur. And now we're going on the lateral side, do all our work, and then start the fixation sequence. Yeah, and I think if you just, and if you really focus in on our chart here, this is what we do in reality, okay? We choreographed that demonstration for the purpose of a 30 minute demo. This is what we do in reality. Examination under anesthetic. I use a lot of local anesthetic infiltration initially with epinephrine to try and control bleeding. Lateral approach, medial approach. So graft harvest, depending on what grafts you can harvest a quad or a BTB through the same incision. Then we're going for the scope plus meniscal work. Then you go ACL femur, PCL femur. You can either do PCL tibia or ACL tibia. I tend to do PCL tibia first, then ACL tibia, then back to the lateral side where I do my femoral tunnels, because I've got to do a capsulotomy at this point. This is where you're going to get more fluid extravasation. We can then do our PLC or PCL fixation. We can go back to the medial side, do our femoral tunnels, and then it's a matter of graft passing, tensioning, PCL first, ACL, lateral side, medial side. David. Very good. We good? Yes, I think that we will finish the session. Thank you very much to all of you. It was great. So there, there, there.

ligament reconstruction

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surgical procedures

graft choices

tunnel drilling

graft fixation

surgical techniques