For Macy, did you find that imaging correlates with the KUS score, and did you have any patients who had bad arthritis but good PROs? So for the most part, the MRI variables typically did correlate quite well with the clinical scores, so certainly the KUS subscale. So we did see a correlation there, obviously with some of the failures that we identified. So there were 14 that we'd found on MRI at that 10 to 16-year follow-up, and some of those patients felt fantastic, and some of those patients didn't. So that was an interesting finding. Sorry, what was the other question? There was a second part to that. I think you got it. Maybe there wasn't a second part. Yeah, no. Feel free to come up to the microphone if you have any other questions, and this is a question for our Missouri group. So great idea to have a health psychologist or psych eval. How did that work flow-wise? I mean, it's always interesting to have a creative idea like this, but how do you get them in the clinic and see the other health professional, and then did it make a difference in your decision-making to take that person to surgery? And just to add on to that, did you get it paid for, or is this just a charity that your hospital decided to support? So it's kind of all bundled in with the cartilage program that we have there, so I think it does get covered by their insurance. And the way that we do it, if we indicate someone for a cartilage transplantation procedure, we then refer them to our in-house psychiatrist. It's a separate visit with that provider. So kind of step one is, do they show up? If they don't show up, obviously that's going to be a red flag. And we have patients come from a distance, so some will be telehealth visits. And then she'll spend about 30 minutes with the patient, kind of evaluate their social situation, what they expect to get out of the surgery. They'll take their medical history, really get into things that we don't really have time to get into in the clinic and that us insurgents probably aren't that great at doing, and obviously recognize that. And then she'll kind of report back to us, and she'll basically give us, she doesn't clear them per se, but she'll basically give us a recommendation either, you know, green light go, yellow light proceed with caution, or red light, you know, this person probably isn't ready to handle this procedure emotionally. And then kind of what the surgeon decides to do with that is kind of, you know, their own decision. But I think this has really helped us to tighten our indications and choose the patients that are more likely to succeed, which I think has also probably helped, you know, make that a more successful procedure for us. As a follow-up question, what were the main barriers that were identified? As far as? In that consultation. So when they are evaluating as far as what may or may be a green, a yellow, or a red, what were some of those main findings? I think some of it can be, you know, kind of chronic pain, prior psych history was obviously one of the bigger ones. Then kind of socioeconomic status, we take care of a lot of farmers and maybe a population that just doesn't really have good access to physical therapy and good support system at home. So some of the things that you would expect were kind of correlating with those patients that may be a little bit higher risk for the procedure. Steve Avalo, I'm representing our clinic in Madrid, Spain. Your talk on MACI I think was wonderful. You showed that you have great durability at 10 years, that shows very well. Ours didn't correlate so well with the MRI. We know from ACI that if you have good results at two years, that you now have good results at 20 years. Our MACI, now we're coming up on 21 years of our MACIs in Madrid. And it's almost the same thing as the ACI. If you've had success at two years for the patients, our 20-year patients are equally successful so far. And I think we're going to present that in Barcelona next month in September. But I loved your study. I think it's great. Just keep going. Keep that cohort going because you're going to find and you're going to show that those people that grow cartilage, even though it's high in light, they're pain-free and a lot of our athletes have returned back to sport, different than the literature may show. Maybe our guys don't feel pain the same way in Spain. But anyway, just keep going. I think it was a wonderful study and thank you. Thanks. For Dr. Malewski, did you seek to correlate these factors with MRI findings? That is, did you find patients with high-risk factors for mobility but reassuring MRIs by rock criteria? So the question is in regards to how useful MRI is in looking at mobility? Exactly. Or how it correlated. So if you had a high, I mean, this was not my question, but if they had a high prediction rate but the MRI looked more stable, did you find that? It's a good question. So we did look at a number of radiographic and MRI characteristics to see if that would predict mobility and we found that they were not as predictive as some of the demographic and physical exam findings. We've previously reported on in our own group that while we have some great markers of instability on MRI, omen sign, breaks in articular cartilage, fluid behind lesions, inter- and intra-rater reliability for those findings are much poorer. And so it's still a challenge. We did not, I think their question is did we then go back and look at the MRI after we looked at these? And no, we haven't done that yet, but that's a good thought. And our next set of predictive models will be to try to distinguish or tease out some of the subgroups. For example, locked door versus trapped door, et cetera. Perfect. We want to thank all of our speakers here. We're going to move on to the next session. Thank you for all your papers. Thank you.

arthritis

MRI variables

patient-reported outcomes

psych evaluation

MACI procedure