So I just wanted to show four or five slides. So I've been doing knee ligament surgery for 28 years. I've seen all these metal devices. I've never put in any of these. Some of them I don't even know what their names are. But I would just like to make a plea for any knee ligament surgeon while you're at this meeting looking at gadgets and widgets and all new things to use. You should always plan on doing a revision. And how are you going to revise your own stuff that you put in, right? I think we should all be responsible. If we put something in, you should be responsible for getting it out, right? So all of these devices are problematic for me to get out because a lot of them create really large holes, particularly these ones here. And usually you've got to bone graft them. And now in general, if we're doing revision surgery and I can get around what's in there, I just leave it in. But some of these devices, because of their size and what they're made of, they almost dictate a stage procedure when you do the revision. So I have zero personal experience using these. I have a lot of experience taking them out. And usually every time I take one out, there are a lot of cuss words that day in the operating room because getting these things out is extremely difficult. So this device, now apparently, I think when you look at the book, I don't think it's supposed to be there. I think it was supposed to be pulled up on the femur. But as you can see on the arthroscopic view, it's right in the middle of the condyle. And then when you go to the poor company rep that got to come in my room that day that I don't even use this stuff, I say, well, can I have the extractor? He's like, well, we don't make an extractor for that. I'm like, excuse me, what did you say? There's no extractor to get that thing out. The only way you're going to have to get it out is you're going to have to core all the way around it and then dig it out with an osteotome or something. And I'm sitting there thinking, well, I'm going to take the whole, I mean, the whole condyle is going to be gone when I'm done, right? So we've already sort of talked about this, and Dr. Richmond talked about this, but what would you guys do? What are you going to do for this case? And he just, we only got a few minutes left, so just volunteer, because that thing's sitting right in the middle. Go ahead, John. I just go over the top. I just do an over-the-top reconstruction and forget about it. Yep. Yep. So that's why you have this device, right? So I trained with Chris 28 years ago. This was made by Acufex back then. I don't know if you can even find them. I guess somebody might make them still, I guess. Do they? We got them in Oro. Yeah, we do too. We have a set. We have a set. So you just go over the back, right? It's like doing our outside in, right? I'm an outside in ACL surgeon, and people say to me, Darren, it's so hard to get surgeons to make that little lateral incision on the femur. But it's really easy to do. We do it in kids, right? If you do skeletally immature kids that are tan or stage 0 or 1, you use the over-the-back. You can see here how we did this. And it makes it so easy to do. The other benefit is, you know, the talk about a long patellar tendon. So I'm a patellar tendon ACL surgeon. So before I started doing all two-incision ACL surgery, so I went back to the old days, if the patellar tendon measured longer than 45 millimeters, right, I always went outside in. So you can see on the top left slide there, by opening the guide on the femur, I'm dictating how long my tunnel is. Does that make sense to everyone? And that way, I can pull the patellar tendon graph up, which John mentioned, and then you can fix it. So I never have a problem with the graph tunnel mismatch anymore, right, because I'm making that extra incision. But you should get comfortable with this outside-in approach, if you're a knee ligament surgeon, because I don't know how many of you guys have seen these devices, but has everybody on the panel seen this wonderful slide with all these wonderful devices? Only from you. They can't only come to Lexington, Kentucky, there's no way. No, we send them all your way. Has anybody on the panel used these devices? Any experience as a primary knee surgeon? I don't know the design. Okay, well, I don't want to know. Don't tell me. My only experience with that, Darren, is taking out the washer lock screw on the tibia. That's god-awful. And that creates a cavity by the time you pull it out. Yeah, it took me 30 minutes last week to get that thing out, because getting those spikes out is impossible. And that same device on the femur, that huge screw there, that's a huge hole that you're left with when you take it out. So just, you know, my plea is, if you're a primary knee ligament surgeon, please put something in that's easy to revise, because some other person might have to do it, and then probably not saying great things about you. Any other? We've got to finish up here. Any questions for the panelists before we go? We've got room for a couple questions. Come on, now. You've got all these people in here. I realize it's 3.30, but... No? All right, guys. Thank you very much. Thank you for the panel, too. This was a great job.

knee ligament surgery

metal devices

revision surgery

device extraction

alternative techniques