I'm going to ask a few questions to the first two and Michelle will ask questions to the next two. We have gotten some questions from the audience. Please send them in if you'd like. Dr. Lee, we've always talked about the importance of the meniscus in terms of the articular cartilage and there seems to be almost a discounting of that within what you did. How would you, were you, was the authorship surprised that the meniscus wasn't involved? And then is there a correlation between any prior meniscus surgery and the articular cartilage? I want to congratulate you. I think that this could be a baseline study for all future studies that we're looking at on MRI and cartilage. It's already on. Okay. Thank you. Sure. Thank you for the very important question. Yeah. We absolutely that the meniscus play a significant role in this PTOA development, especially because of concomitant injury during the ACL tear. And for this cross-sectional analysis, when we say there is no significant difference between operative versus contralateral knee, I think it surprised us a little bit, but it's not in a way that meniscus is not involved. Especially when we look at the data, it's, there's no significant difference between these two side, but both of the side are higher than the controls. And when we look at the cartilage data, in some cartilage compartment, you can have operating knee higher than contralateral and then higher than controls. So we think it's really rather indicating the timing is different. And in a way, potentially, maybe meniscus even degenerated earlier than cartilage degeneration on the contralateral side. I mean, that's already on the same level to the operative side, and both are higher than control. So I think that indicates also importance, because some studies in the literature try to use the contralateral knee as a control. But with this observation, we know the contralateral knee is not necessarily healthy control-control. It can be because of the adaption of the biomechanics and other things also introducing the degeneration. And to your second part, yeah, that's the baseline meniscus injury is also very important. And that's the next step. We are now going to analyze the data and to see how the baseline measurement predicting were associated with cartilage and meniscus degeneration in 10 years. Thank you. Thank you. Cassis, you are the recipient of multiple questions. I think that you're the recipient of multiple questions. I think the quad is, you know, and you made a very good point in your talk about the actual size of the graph versus the patella tenon. Several people in the audience have asked similar questions around what you would attribute the earlier return to play in the quad autograph to be, and then could you describe your criteria or protocols for return to play? Sure. And actually, the findings were pretty surprising to us. We didn't expect to find that. And we kind of sat down and thought about why it would happen. And our major theory is the fact that the biomechanics, the biomechanical properties of the quad does seem to be stiffer. And the idea behind that is that with a stiffer graft, maybe there's a huge component of patients feeling more comfortable with it. Maybe there's a, with return to play, there's a major component of the psychological aspects of feeling comfortable with that knee. And maybe with a stiffer graft, which I do believe the quad tenon is, that they have that confidence in that knee to return to play a little bit sooner. Could you address your actual criteria to determine their return to play? Yeah. So we go through several things. Typically, I work with a small set of physical therapists in town, whether through Mayo or outside of Mayo, and we have specific criteria. And we use different tests, such as the hop test. The hop test is probably the most important one. Single leg squat is also important. And we try to have them be within 90% of the non-operated leg to return to play. And once they have that, that's the objective data we use. Then we have got to, we follow it with the trainers. Typically, we have got trainers involved with this. And we see how they're feeling and such. And the final decision is mine. But I take into account the objective data we get from the hop test and other tests we get from there, along with the feelings from the trainers and the physical therapists. Great. Thank you. Great. Thank you. I have a question for you, Laura, about the PASS score. Eighty-seven percent is a great number. I think we're all really happy that our patients are satisfied at 10 years with that. But given the MOON data closed in 2008, we're coming up on maybe 15 or 20-year data. Do you intend to also track that out a little bit further? Yeah, absolutely. So right now, yeah, we are, MOON is not enrolling anymore, active rolling. But we are attempting to do 20-year follow-up on this cohort that we started in 2002. And our goal is to actually incorporate this question in with our new patient-reported outcome measures. Because we feel it's a much more pointed question for today's environment, especially with the insurance and the payer models that are going out. So we absolutely will include this in our next cohort. Okay. And I have a follow-up question to that. Given that you identified subsequent surgery as being the primary risk factor for patient dissatisfaction, did you go into a little bit more detail, or do you have more data about which subsequent surgery specifically? Yeah, we actually, the things that affect patient dissatisfaction most, we did a first level of subsequent surgery. We dug down and did a subsequent analysis. And it's primarily meniscal repairs or meniscectomies, as well as repeat ACL revisions. Those were the big ones. We did not have enough total knee arthroplasties in this cohort to figure out if it's significant. But meniscal repairs and meniscectomies and ACL revisions were the big ones. Great. So maybe Mars will help us with the past question next. All right. Well, my next question is for our last paper, for Emma, if you could address. I think we're all very well aware of the concerns about opioid addiction, and particularly in younger patients, as you point out, where ACLs are much more common. One of the risk factors you looked at was substance abuse. Did you look at marijuana as any of, you know, this is Colorado, but this is something that a lot of our patients are self-medicating with, and did that play a role in the number of pills people were taking? Yeah. At the moment, we didn't specifically ask about marijuana use. So I can't speak to that. Okay. I was just curious. That may be something to include. And I don't think, it doesn't look like we have other questions from the audience. We're going to go to the next session. Thank you all for coming.

meniscus

PTOA development

return to play

patient satisfaction

opioid addiction