I'd like to invite all the participants out here to go ahead and ask questions through the app, which we will start right now. First question is, Phil, when you do your technique, are you using one continuous suture from anchor to anchor, or are you using separate sutures? No, generally we use separate sutures. You know, from each anchor, we'll use both strands. Occasionally that strand will then be, you know, taken to another anchor, but generally I would say each primary anchor has two strands that are then taken across. Yeah, just a follow-up question on your technique as well. Have you noticed any cyst formation from, you know, drilling that deep with the anchors over time with this technique? No, we haven't seen any cysts to this point. I would say occasionally we'll try to preserve a piece of cartilage, particularly patellar lesions where there'll be a lot of comminution, and so on the margin of the preserved cartilage fragment and the transition into some exposed cancellous bone, we've seen some, and the people that had chondroplasty, the two that had chondroplasty were patellar lesions that kind of made a little bit of a fibrous or a hypertrophic spot there, but the anchors themselves have been, you know, relatively quiet on MRI, and we haven't seen any cysts around the implants. Another follow-up question, sorry. So, you know, a lot of times even with bioabsorbable implants, we'll see that you'll get some effusions and everything else while they break down, so you have the majority of these with vicral sutures. Have you noticed any effusion reaction with that as those are dissolving, and again, have you seen any, like, long-term symptoms with those that have the tape? Not to this point. You know, we, the series is not large enough, and we don't have enough follow-up yet on, you know, to know the chondro, you know, viability long-term, but in the early going, the hemarthrosis seems to resolve from surgery in a reasonable time frame, and the knee remains pretty quiet. You know, we've tried to go back on most of the suture tape and remove those. At the time that we removed that tape, the chondral surface and the opposing chondral surface looked pretty similar to other, you know, cartilage salvage techniques, really. So we haven't, to this point, seen either on the 3T MRI a lot of cartilage change or edema, and certainly the knees clinically have done well, but we need further follow-up. Brian, do you have a question there? Yeah, thank you. Well, Phil, continuing with the Phil Wilson show, another question for you. The suture bridge technique, I think, was initially popularized when we were dealing with mostly cartilage lesion, and I know in your series you had a number of those as well. When you compare it to, and there's some reasonable results published with, say, metallic screw fixation, Herbert type, AcuFlex, AcuMed, things of that nature, right, which can be done arthroscopically as economically actually pretty efficient, and then you compare this technique when you have an osteochondral fragment, may require open technique. I think it's a little more challenging arthroscopically, but it can be done, but the angles have to be right. What would you say the advantages are over traditional compression screw fixation, everything else being equal? Sure. Great question. I think when there is bone on the lesion, if there's a significant depth of bone where you could get screw fixation and leave that way into the subchondral bone, I think that's an excellent option. I think many of these are osteochondral but pretty thin bony fragments on the acute lesions, and so in that case, our preference has been to often go back and get screws if they're really close to the articular surface, and certainly the bioabsorbable healing rates have been good, but we know that there are some reports of continued effusions or second body wear with the durable implants, so the thought was a vipral suture on some of these, even if they have an osseous component, when it's shallow, may allow us one surgery and no follow-up to do implant removal. Great. Great job. Thank you. Question for both of our osteochondral papers for Dr. Leidy and Dr. Standard. Anything that you've noticed as far as the mechanism of mode of failure? Were they mostly cystic formation? I think you've delineated a little bit, Dr. Leidy, in your paper as the different modes of failure. Did you notice any difference as far as the sex mismatch? Sometimes cystic changes of the bone are not uncommon when they're going to failure, for sure, and then collapse. I don't know that we noticed any more or less of that in the ones that, when we went back and did the histology and immunohistochemistry, had a pretty significant immune response and those that did not, so I'm not sure if that's related to the immune response or not, but I suspect that a subclinical component plays some role and that if we could delineate this better, and maybe it is the sex and maybe other factors as well, that we could hopefully get a decrease in our failure rate. I don't think we'd delineate it by any means, but maybe decrease it in some. Yeah, I would say the same, actually. So we are actually planning to look further to this patient and see if you can find any change in the MRI regarding to bone cyst formation or bone edema or something like that, but for now we don't know that yet. Thank you for all those great papers, and next up will be Tom DiBardino, Patella-formal joint...

surgical techniques

osteochondral lesions

continuous sutures

separate sutures

anchors