Well, good morning and thank you. It's clearly an honor for me to be up here with my orthopedic heroes. So for me, this is patient zero. This is what inspired me to begin my journey on meniscus root tears, 51 year old female presented to our clinic after a seemingly minor injury, relatively normal x-rays, but substantial pain and dysfunction. At the time an MRI was performed, they called some fluid in the bone, some fluid in the meniscus, but we didn't recognize the root tear. And unfortunately she was referred to as crazy because she had pain out of proportion. So she really inspired me to begin the meniscus root tear journey. We published on the existence of root tears, then how we diagnosed them on MRI. We defined the natural history, why debridement was not a good idea. Our technique innovations, which we'll share with you, our lab biomechanics data, our prospective clinical studies, finally recognizing extrusion and creating a solution with centralization. So initially we thought these tears were rare, but now we understand that one in three to one in four patients that present to our clinics have these root tears. And for this patient zero, you can see the problem, rapid deterioration over 12 months leading to bone on bone arthritis. We published the natural history with an 87% failure rate at five years. We just finished our 15 year follow-up published in AJSM this month. And you actually had a better chance of being deceased than you did successful management with non-operative treatment. So surgery, we looked to our friends in Seoul, the trans-tibial pull-out technique. But in 2008 and nine, this repair didn't make it to the recovery room, much less through rehabilitation. And in 2010, 11, we developed more complicated protocols and procedures with post-remedial portals. But at the end of the day, this was a difficult and dangerous procedure. So we had to do better. We had to be safer. We had to be more effective and more efficient for our patients. So we went back to anatomy. Mother nature always wins. So we created a trans-tibial root guide. We just released its second version last year. And surgeons are now benefiting from this safe and reproducible way to hit the target for the root. And we published our results. We then systematically looked at suture placement. We were looking at what our friends were doing in the shoulder with self-retreatment. We adapted the scorpion to the knee. We created the double cinch configuration for the sutures. We created the fiber link suture. And we created the ripstop technique for root repair and published on our results. We then created prospective multicenter studies with this technique. And overall, patients did very well, 90% improvement and 97% healing rate. And we compared it to traditional treatments of non-operative or debridement. These patients were doing substantially better. So we then got our prospective imaging. And unfortunately, we hadn't entirely solved the problem because what we were noticing is that there was still extrusion. So we had to challenge the dogma that root tear does not cause extrusion. But in fact, extrusion causes root tear by concentrating forces. And we defined the fundamental pathology as the meniscus tibial ligament and published our findings. So we conceptualized arthroscopic centralization where we're repairing the meniscus tibial ligament at the time of root repair. Our biomechanics data is in publication. We just published our two-year clinical results on 50 patients. So it's really been iterative improvements over time, taking an 87% failure rate to now 90% success with surgery. I would say in conclusion, it's been really a journey over the past 15 years going from a lack of recognition to reliable technique. We published 53 papers, several patents. We created a study group. And the bottom line is we've impacted tens of thousands of patients. And when that patient walks into your clinic, they'll benefit from what we've published and discovered in the literature. So with that, thank you very much. Awesome. Aaron, thank you very much. Great job. Questions? Dr. Miller. How do you take down the meniscus? Are you worried about impacting all types of people? Because then that becomes a lot of information about the whole medicine. So the anatomic preparation of the meniscus, taking down the tibial ligament, it's a tibial ligament, all the capsule stuff. How do you not create a worse problem? Yeah. So the analogy I would use to you, we look to our shoulder colleagues. So there's a Bankart, which is just a tear. An ALPS lesion is a tear with retraction. And a root tear with extrusion is that ALPS lesion. So you need to release, retention, and repair in order to restore Mother Nature. If we're not restoring anatomy, we're not restoring function. Christine. So the question is degenerative tissue, bad quality. What do you do in that situation? Yeah. Patient selection is very important. That's why we've innovated looking at different suture configurations, creating a ripstop construct. So with a ripstop construct, we actually show that it's comparable to healthy meniscus tissue with strength of repair, biomechanics data would support that. So Aaron, last question. Is this real or is this just part of natural history, natural process? Are you over treating? Good question. I would say it goes back to what the patient need is. And when that patient comes to you and they have substantial pain and dysfunction after an injury three weeks ago, we really try to restore to what their baseline state is. We're not giving them a new knee. We're not putting back new cartilage, but we're trying to get them back to where they were before that injury. Great. Great job, Aaron. Thank you very much. All right.

meniscus root tears

diagnosing root tears on MRI

natural history of root tears

treatment of root tears

trans-tibial root guide