discussion, please also feel free to use the app. We should have time for a few questions. And so please come up to the microphone with your questions. While people are getting their thoughts together, I'd like to ask Dr. Cramer a question. So I think your data very nicely shows that the effect of age, and perhaps even a flexion point at age 22, I wonder if you can comment a bit more on why you might have seen the higher risk with increased medial tibial slope. Yeah, I think the risk factors shown for the Bayer repair procedure for re-tearing are very similar to the risk factors shown for reconstruction procedures. So in ACL reconstruction, the literature pretty clearly shows that the younger patients fail at a higher rate, and the tibial slope does seem to play a role. So I don't think there's anything independent about the Bayer repair that makes that medial tibial slope more concerning for re-tear as compared to reconstruction. I think it's a general risk factor for failure in these groups. It's anatomy that sets you up. I think the question is why the younger patients fail at a higher rate, and I think that's harder to know. Again, reconstruction, younger patients fail at a higher rate. It may just be that those patients are having more athletic exposure hours, or it may be something about their synovial fluid that interrupts the healing process with the sponge. Looks like Steve Svoboda has a question. Bob Arciero. I'm sorry. It's okay. The red shirt got me. I gained a lot of weight, I think, and many inches in height. No, I'm sorry. It's the red shirt. Overnight. I made a bad guess. I always wanted to be taller. Thank you, Connie. I have three questions for Dr. Saetna. So first one, could you comment on how the patellar tendon BTB technique was performed? That's my first question. Yes. The BTB technique was press fit fixation on the femoral side, interference screw on the tibial side. And where was the location of your femoral tunnel? You know, I don't know about 16 years ago. I wasn't really involved with Bertrand's cases back that long ago, and I have not kind of reviewed historical x-rays or images to understand that. But in contemporary practice, the femoral tunnel position is the same for BTB and other reconstructions, which is a mid-AM bundle position. I don't know if there's been an evolution in that position over the study period. Okay. I'm sorry I'm hogging the microphone here, but it just brings out so many questions. Are you advocating now that for every pivoting sport athlete that an LET of some variety should be added to every ACL reconstruction? It's a good question. We don't have the answer to that because nobody's done that specific study, but the way I look at it is that the complication rate, which we've published on in several studies, for an ALL reconstruction is actually extremely low. I know that our Get Good Stability study showed that there were some higher rates of complications, but I think some of those can easily be addressed by changing the type of fixation. In general terms, the rate of complications with LETs is very low, and the benefits are compelling. So I think that in every patient, we should at least be thinking whether an LET is indicated. I don't think that every single patient needs one. There's many patients for sure they don't. So I'm going to pin you down. Who do you think needs one? Primary ACL. We're not talking revision, but primary ACL. Who needs it? If we look at it strictly scientifically, based on available comparative studies, we have comparative studies showing significant advantages in young patients participating in pivoting contact sports, those with hyperlaxity, undergoing revision ACL reconstruction, and I would say you could even add in medial meniscus repair. One of the most common indications that we use, though, is high-grade pivot shift, and really that has not been well-studied in the literature, but obviously that's a very common indication. And increasingly, well, actually, Camilla Helito published last year that if patients have an imaging-proven injury to the anterolateral structures and they undergo isolated ACL reconstruction, their results are worse than if they have a combined reconstruction. So I think there's increasing evidence that imaging evidence of an extraticular or rather lateral, anterolateral injury is part of the emerging indications. Okay. Thank you. Thank you. And we'd like to thank our speakers for our first session. Thank you for your time and thanks for your presentations. We're going to welcome up our next group of speakers.

knee injuries

ACL reconstruction

re-tearing risk

medial tibial slope

BTB technique