for questions. Again, we are in a cozy room. That's a euphemism. But we do have some open seats here in the middle and some over here. So please, don't be shy. Grab an open seat. We have two microphones here and here. Please come to the microphone to ask a question. Stay out of Matt Mluski's way. Great, great, great talks. Two questions, one for Dr. Webster. Long-term data like this is amazing. So you should be commended. It's really interesting that the contralateral rate gets much higher later in the process or later in the years. And any thoughts there? Because it doesn't really make sense with what we usually think, right? Yeah, absolutely. And maybe that's because we haven't followed up for long enough. But we have a fantastic sport in Australia, Australian rules football. And where I'm from, Victoria, we're the home of it. That's where we see a lot of injuries, particularly in our young males. I think it's probably exposure. Don't forget, these kids are still under 30 while they're playing. So if you're playing a high-risk sport week in and week out for an extended period of time, maybe it's just their numbers come up for their other needs. So I think exposure plays a big factor. What the actual mechanism of injury, need to look at that a little bit further, obviously. Great, and I have one more question for Dr. Drummond. Your rate of arthrofibrosis was higher in your bone block group, but you also had four fractures. And that's 11% of your group there. And you kind of glossed over what was done for those. So could you talk about how you treated those? And were they locked up in extension? Could that be a risk factor for? Yeah, those fractures were very small, like a fragment that's not amenable for fixation. It was a small fragment, like 3, 4 millimeters, when you're taking the graft. So it was documented. But just with sutures, that doesn't involve the whole patella. It doesn't change the rehabilitation. Yeah, I guess that's my question. Did you treat them the same way? Same way, same way. And did you look at where those folks, did those folks get stiff or not? That, I had to check the data. It didn't correlate. But I would say no, because I even had to check if those patella fracture was in. Yeah, but we didn't specifically look at, because it didn't change our rehabilitation protocol. It was very minimal. Thanks. So outstanding lectures across the board. My question is for Ben Hayworth. Ben, great presentation. So question for the IT band. Any thoughts for the future moving forward, the Hayworth 2.0 study? Would you alter anything to, or any theories as to why that number was a little lower for that group with the IT band? And anything you would do in the next phase, rehab-wise or surgical-wise, to make that improved? Yeah, thanks, Ted. Yeah, it's tough, because we do want to follow these folks for a few years to make sure that either they plateau, or if they rise, then it's a real deterrent to potentially utilizing this technique. But we do feel like early in the development of the technique, we had multiple labs and have done biomechanical studies and systematic reviews. And there's a big KSSTA 15-year follow-up, RCT, looking at an almost identical technique compared to BTB and had similar retail rates. So we sort of felt ethically justified in moving forward. But we did affix the ACL with the knee in full extension to sort of mirror the BTB. And I think we sort of, over time, developed a sense that these may be more like a hamstring. And maybe we wanted to affix them at 30 degrees instead. So they might have been a touch looser than. So if we had to do it again, we might do that. And the question is, can we really do it again without studying it better and further? So our group might shift into more of a level two study, larger study, looking at kind of some of the current techniques while we wait for the IT bands to sort of play out for longer before we. But we might go back to the lab and make some adjustments. Thank you. Yeah, we only have one minute to two quick questions. Frank, go ahead, and then Lee. This is more of a comment. I just wanted to congratulate the gentleman from Phoenix Children's in Mayo. I think it's interesting gait lab data regarding the hamstring. And I think, as we all know, if we think about hamstrings in an isolated fashion, we have to accept a higher failure rate in this high-risk cohort. What we've learned from our colleagues in Italy and France is that doing something, essentially a hamstring plus, whether it's Sonari-Cote's technique over the top or Zafognini's, they seem to have great clinical data. And I think we just have to understand that if we're going to use a hamstring, we should add something to it. Thank you. Thanks, Frank. Yeah. My question is for Dr. Webster. That's astounding data. I mean, it's unbelievable. Is there any opportunity to collect any information about their non-modifiable risk factors? Because that, to me, is like starts at this question that came up a little while ago. You get parents asking you, OK, my kid hyperextends. Do you want to add nitibantinadesis on? Well, what about the other knee? Do you treat that prophylactically? That needs to be studied. But I mean, can we identify if that's what these people looked like? Such as having a family history of ACL injuries and those sorts of things. Yeah, we do extensive demographic and background information on all our patients and follow them up over time. So we would absolutely be able to look at that. This is just our first step. I am actually also continuing to follow up these patients. My goal, as you could see, we had up to 14 years. So I'd love to have an 8 to 10 year mean. Then we can put some really robust numbers there. We also have to look. This really also raises probably an answer to the first question as well. We have some really good ACL injury prevention programs in Australia that are sport specific. There's obviously implementation problems we need to really focus on post-1 ACL injury and having that secondary prevention intervention programs really put to the forefront as well, I think. Thank you very much. Thank you to all the authors. Congratulations. Thanks for the questions. Thank you.

ACL injuries

contralateral rates

high-risk sports

fractures

IT band technique