All right, thanks for having me. Mike Lea from NYU. Obviously, I lack the height advantage. I also probably lack the attractiveness advantage as well, so I'm on an uphill battle here. All right, so I'm gonna argue that osteochondral allograft is the way to go here. I'm gonna pretend that MACE doesn't exist for this surface-based lesion, but I'm gonna pretend that osteochondral allograft is the only option that you have. These are my disclosures. So, articular cartilage needs no introduction, right? We all know it's a very highly specialized structure. It's got all the layers, the superficial zone, the transition zone, et cetera. Cartilage is great. It's a cushion. The body likes to have cushions, right? That's why I'm so fat, my wife tells me. She likes a cushion, right? So, it's good for the tibia, it's good for the femur. The contact pressures are restored. So, nothing beats articular cartilage. I tried to find a histology slide for a piece of metal, but I couldn't find one. And we all know that survivorship is key here. We got plenty of data to show that survivorship is excellent after an osteochondral allograft. This is from Brian's group over at Rush. It was a large systematic review that showed that at about five years of follow-up, only about a 20% failure rate. Better results are seen with trauma or osteochondritis testicans, as opposed to potentially this patient here, might be a little bit more degenerative in nature. This is data that just got presented at this meeting by Tim Wang, Bill Bugbee, Simon Gortz, showing a 15-year trial looking at the results of osteochondral allograft. And what they found, that there was a 75% success rate at 15 years. That's lack of revisions, lack of conversions, et cetera. By graft size also, there's a substantial advantage to a smaller graft, right? So, this is about two by two and a half, maybe four, five centimeters squared. Those patients do really well. 84% survivorship at 15 years. I like those odds. Same thing by age group. The older you get, the more difficult it is to maintain these. So, if you're over 40, over 50, those results are gonna perhaps go down. Although, from our own institution, we do have data showing excellent five to 10-year outcomes in patients that are even over 50 years old with osteochondral allograft. But if you're gonna do this, you have to do it right. Chris Jones has published a lot of stuff back from his time at HSS and now at UCLA, where if you put it in correct, you can restore the contact pressures to near normal. But if you don't put it in correct, then you're gonna drastically change the contact forces for the negative. Also, if you don't get the size correct and you're proud, you can also induce some changes in rotation where the bone plug can actually hit and bounce off the meniscus. Obviously, we're trying to avoid that. But the key is do it right and stay flush. Impaction also, right? Don't hit it a million times. With every tap, you're gonna destroy some cartilage viability and some chondrocyte viability. The other thing we have to talk about is revisions. Osteochondral allografts are easy to revise, right? How do you revise an O.C. graft? You either put another one in or it's a simple conversion to a uni or a total. When we're doing revisions with this metal implant, perhaps it might be a little bit more difficult to revise this. So in our patient, we've got a young patient with good biology, they're 35 years old. This is certainly not too old for a biologic procedure. If this was a 45-year-old or a 55-year-old, then you might be talking about something different. The metal resurfacing data is clearly good. There's definitely gonna be a place for that and I'm looking forward to hear what Clement has to say. But those patients in those studies are a little bit older with a little bit tighter standard deviations. This patient's also had no previous failures and no previous surgery. So actually, they did have an ACL, but no cartilage surgery. So again, this patient could do very well. Graft availability, we have to talk about as well. Some countries, you can't get osteochondralograft so the metal implant might be a very good solution for that. But for us, we're gonna assume that we have everything in our favor. If you do it well technically with a small lesion, no prior surgery on that cartilage, no varus, this is a home run. Thanks for your attention. Thank you.

osteochondral allograft

MACE

articular cartilage

survivorship rates

revision surgeries