and use the microphone. And I know Rachel and I have a couple of questions as well. We have about four minutes. Do you want to start, Rachel? Yes. And it looks like there's currently no questions on the poll, so don't be shy. This is a friendly space. Ask your questions. I have a question for the room that's going to relate to a question for Dean. How many in the room treat patients with knee osteoarthritis or cartilage problems and use a steroid injection every now and again? Dean, tell us. What are we doing wrong? I still use steroids. It's a powerful anti-inflammatory. However, I don't use methylpenicillin just because it seems to be more chondrotoxic. And then in the young patient, especially the young athlete with intact cartilage, I'm a little more sensitive to steroid injections. I may want to use a hyaluronic acid injection or PRP instead of steroid. Let me ask you one further question. So a patient gets an osteochondralograft or some sort of cartilage procedure, comes in within the first year with an effusion, not quite sure what's going on, imaging's a little unclear. Do you use one-time steroid or no? I don't in that scenario. Dr. Cole? Because of this? Because of the chondrotoxic. Usually, you're injecting the steroid with also the pipivacaine, which we have also shown to be very chondrotoxic and has an effect on mechanical properties as well. I'm more inclined to address that with something like meloxicam or Voltaren oral. Yeah. You know, I think the single-shot studies are different than the prolonged exposure studies with local anesthetics. So I guess I don't necessarily extrapolate in the same direction. But I think it's interesting and we have to be thoughtful about it. One challenge is when you look at some of the work that you quoted about progression of disease over time with repeated injections and they stopped the study, I think one of them was an injection every three months over two years and they saw like a 0.05 to 0.1 millimeter difference. And someone who had, they were Kelgorn-Lawrence threes and fours to begin with. So I think we don't know yet, but there clearly seems to be a movement against the use of routine steroids or repeat steroids. I wanted to ask a question of Dr. Langen's mark. I would just wonder if you would think about this paradigm differently. What if we said that the best graph was living cartilage and dead bone? So is it aspirational and desirable to have living bone? How do we know that that's the right thing? Because these graphs, when you compare them to freeze-dry graphs, don't incorporate, if you look at retrieval studies and so forth, it's not the same type of creeping substitution that you get with the anhydrous or demineralized bone and things of that nature. It's a different biology. So I'm wondering while we probably agree to agree that maximizing chondrocyte viability is a good thing, why do we, do we necessarily know that maximizing bone viability is a good thing? Yeah, I think that's a great question. I think the big thing, the reason, the impetus for the study is it hasn't really been studied yet and we haven't really even looked at it. So it's just kind of assumed the bone's all dead and there's at least a small component that may still be alive. And if it is alive and doing bad things for incorporation, then it's something we wouldn't consider maybe our strategies to minimize that or limit the effect. Okay. Yeah, please, Scott. Yeah, please, Scott. Yeah, I think our detection methods were pretty elementary. They only measured quantity and organization with histology. With compressive mechanical properties, the gags, you know, the fixed charge density is what really matters in terms of providing that compressive mechanical property. I think we need to start looking at that more, something more, more nuanced. Dr. Lucey, final question. Is 12 months long enough? Because they cited six months with having these abnormal arthritic PROs, which may not be the... I don't know. When you think about recovery, I'm not sure that it's... You've got to tie clinical progress with those scores. But is 12 months long enough to pick up these differences with the serum biomarkers? Yeah, that's a great question. And I like to think of this especially in relation to like the symptoms at the 12-month time point. And we've had this discussion multiple times of like when do we start thinking of symptoms being related to the surgery as opposed to like the development of osteoarthritis. And I don't think we have the answer yet. But I did see a paradigm being discussed at ORSI where the idea was instead of thinking about individuals who start to develop symptoms, maybe we need to start thinking about the people that don't get better with their symptoms over time. So I think that would be an interesting thing to look at moving forward. Thank you. Great job. Thank you to all of our speakers. We'll have you guys step down. And I'd love to invite our case presenters to come up if they're able to. And we'll start with Dr. Adam Yanke who's going to start off this case presentation section where we're looking at incorporating biologics into surgeries that we do. So first he'll talk about osteochondroallograft with biologic augmentation. We will have time again for questions at the end. So please send them into the app if you have any questions or come up to the microphone at the end. Hi, everyone. Thanks for having me. It's an honor to be able to talk. No. Can you turn the mic on, please? Can you hear me? Yeah. Okay, great. We have the talk pulling up. My name's Adam Yanke from Rush University in Chicago. Thanks for allowing me to present, hopefully, on osteochondroallograft biologics. Do you guys have the talk? Mueller. I'm seeing a head shake. No. Okay. Does somebody else want to go first? Do we have any talks for this session that you can pull up? Do you see another one? Okay. All right. I know what's going on. So I'll come back. Okay. No problem. Dr. Koiner? Yeah. Okay. Case presentation on meniscus repair with biologic augmentation. Can we pull up Dr. Koiner's slides? While we're pulling them up, poll for the panel. Who uses biologics routinely for meniscus repair? No one else? Dr. Kohl? No biologics? On occasion. Dr. Koiner? You're going to talk about it. I am, on occasion. On occasion. Dr. Mazzocca? I don't know what a meniscus is, so. How about in the audience? It's true. It's that thing you do in the shoulder when they get chondolysis. You put it in there. While we're trying to pull up Dr. Koiner's slides, if we can in the back, get a little All in the audience, who uses biologics with meniscus repair? On occasion. Who uses biologics with ACL reconstruction? Not on the agenda for today. On occasion. On occasion. Who uses biologics for rotator cuff repair? Who uses them 100% of the time for rotator cuff repair? I'm going to keep going until we get the slides. If there was no outside cost, no out-of-pocket cost for the patient, would you use a biologic on every soft tissue sports medicine surgery that you do? Yes. Yes. I love it. What about for OA grafts? Who routinely does or wishes to do it for osteochondralografts? Although I realize not everyone in the room is doing OA grafts, but... I'm just going to give a plug to the people...

biologics

surgical procedures

knee osteoarthritis

cartilage problems

meniscus repair