Thank you. My co-authors and I appreciate the opportunity to present this series. Our disclosures are available and not relevant to this particular project. So we know that preservation of articular cartilage, whether it be osteochondral lesions or osteochondritis dissecans, can be a challenging problem. Those challenges, including achieving union of the fragment, getting compressive fixation and sometimes tenuous fragments, and minimizing implant-related injury can be important aspects to consider. So we considered suture bridge in our practice because while these cartilage procedures are getting much better, as we're hearing today, preservation of the fragment, particularly in our young patients, seemed to be the best option. We looked at the technique history for patellar lesion suture bridge, as well as for femoral condyle, and we've had some evolution over time in these techniques, along with our anchor and product evolution. But really we felt that the union rates that are achieved, the patient-reported outcomes, and certainly what the applications are for OCDs was a little bit unclear. So as we started forward on our series, our purpose was to evaluate the osteosynchondral integration following a suture bridge construct utilizing MRI, and to assess the outcomes and short-term complications of this technique for osteochondral fractures and OCD in the knee. So we looked at our consecutive patients since initiation of the technique. This was our first 16 months of patients. We screened them then for a minimum of six months required to assess bony union, and that left 40 knees and 38 patients to make up this series. So we looked at the preoperative imaging. All of them had MRIs to look at lesion type, the presence of bone within the fragment, the size and the location of the fragment, and then we assessed healing by radiographs and MRI with MRI obtained on all OCDs and any lesions that were chondral only. Our grading system that we used for our methods included cancellous or cancellous-chondral union when 100% bridging was a full union. Stable union was defined as greater than 50% continuity. Some fibrous tissue may be present, but bone union throughout the majority of the fragment or un-united, less than 50% continuity and extensive fibrous or fluid interposed. We looked at complications, rates in return to sport, and COOS outcome scores in our OCD cohort. So the technique that we utilized, we used 2.5 or 2.9 bioabsorbable knotless anchors. In this series, the average number of anchors was 4. We used multiple bridging suture strands. These were hand-tensioned. Just under 90% of the lesions in this series were treated with vipral suture with a small number treated with polyester tape. We used both open and arthroscopic techniques for all the OCDs. We treated them with elevation, debridement of the fibrous tissue, cancellous autograft interposition prior to fixation. So this is an example of the technique. On the left there is an osteochondral, an alchondral fragment, and on the right side is a medial femoral condylar OCD. So our follow-up was average 18 months, 12 to 30 months. Our average age patient was just at 15 years of age, and the lesions were relatively large, the main major length of the lesions being just under 20 millimeters. In looking at the osteochondral fractures, these were evenly distributed between patellar and chondral lesions. Just at 20% were chondral only lesions. The chronicity was from 3 to 4 weeks on average, but some much greater than that in terms of the chronicity prior to treatment. When looking at the osteochondral fracture results, just under 90% achieved full union and we had none that we graded as ununited. Again, this is our case example, a large chondral shear fracture in a 12-year-old occurring with a patellar dislocation, a suture bridge technique with concurrent medial patellofemoral ligament reconstruction, and a six-month MRI there on the right side. For our OCDs, these were distributed between chondral, trochlear, and patellar lesions. Just over 70% of the OCDs had bone in the progeny. Sorry, can we go back there a bit? Sorry about that. Two-thirds of the OCDs achieved full union and none were ununited. Again, this is our OCD case example. This was elevated, we had interposition debridement and cancellous autograft, and this is a six-month MRI on the right side. So our return to sport rate was 75% for the series at an average of six and a half months. Our COOS scores all improved at six months and one year in the OCD group. We had three reoperations, two for marginal chondroplasty on otherwise stable lesions. We did have one medial femoral chondral OCD that was originally graded as stable lesion, which required revision to an OCA at 24 months. In discussion, we feel that this may have some benefits in comparison to other constructs, but we certainly feel that the evaluation of our long-term chondral viability will be required, and the physical suture effects certainly require critical evaluation. So again, 82.5% of our entire series had radiographic full union, good early PRO and return to sport, and minimal short-term complications. Thank you. I'll remind the audience...

suture bridge technique

preservation of articular cartilage

osteochondral lesions

osteochondritis dissecans

knee