We've gotten a lot of good comments on the app. First I want to say, based on one of them that I got, that there's not a Pittsburgh bias since four of us did the fellowship and Sharon and I I think share a Pittsburgh chairman. The first comment that if we can just do a yes-no right down the panel on a couple quick questions that came. Who soaks the graft and with what? That's come from a lot of people. Jeff, do you soak the graft yes or no and then with what? Yes, thank you Myson. Thank you. I don't soak mine. And then the next question is, all of you use multiple grafts. One of the questions is regarding Robin's comment that I think a lot of people have caught on to, that there may be some extension loss in quads. So could each of you comment, Jeff, I don't know if you're seeing that or if you're using any quads, but how would you compare your, the question specifically is, your post-op rehab based on the graft, does it change? So I do probably about 25% quad right now. I do mine with bone, which I think may change things. My quad grafts, and I compare those, probably the groups are probably most similar with my patellar tendon group. The quad I think I have to get on earlier on trying to get motion back than the patellar tendon. I think they do struggle with that. I think the quad tendons from a, how does the patient look when you see them in clinic at three months, five months, seven months? The quad patients look better than the patellar tendon group, but their testing, I think in my group at least, looks a little bit worse. The hamstrings tend to rehab pretty quickly. I think with the hamstrings, you don't have to push them quite as quickly. The bigger grafts, you do have to work on that extension early. I would just say with either its quad or patellar tendon, you're injuring the extensor mechanism. That's important regardless, so I don't think it's specifically to the quad tendon. I think gaining that full extension and that active, as Robin stated, that slight hyperextension is really important. Yeah, the rehab protocol is the same. I think I just focus on that extension with everyone. Yeah, same with me. I think really focusing on extension in all your patients is extremely important no matter what graft that you're using. And I just have one follow-up question, I think probably primarily for Robin. Robin really articulated well when they like to use different grafts or when they don't. When would you not use a quad? Is there an indication for not using it? I don't really have an indication for not using a quad. Even though somebody had a quad injury, a quad tendon injury in the past, I don't have a reason not to use it. Anyone else want to answer that question? Not to use a quad? Yeah, when would you not use a quad and what athlete population or in what circumstances? If there's some previous injury to the quad or issue with tendonitis or tendonosis, if you see that on MRI, then I wouldn't use it at that time. Steve, there's a specific question for you regarding which plug you use in which location. Yeah, so I typically, whatever my smaller plug is, I typically will use in the patella because that way I have a little bit more room for mobilization. So I typically will use the patella in the femoral side and the tibia in the tibial side. The reason for that for me is that if you have that, I don't like that little overhang of the bone on the tibial side and I don't want the plug to go up and then have an angle and risk injury to the bone tendon interface. Okay, great. Thank you to all of our speakers and for our excellent questions from the audience.

grafts in knee surgery

rehab for different graft types

quad and patellar tendon grafts

full extension and active motion

individualized treatment