Thank you, David. All right. Thank you so much for inviting me to go up on stage here. I already talked trash a little bit to Harris over there, and so here we go. So disclosures are there. So first of all, I just want to tell you, this is not for all audiences, OK? So you've got to be a little bit careful, and especially, and I haven't seen Harris's talk yet, but there may be some crude and inappropriate tunnel drilling right across the physis, and I believe there might be some BS going on with citing literature. So just so everybody's aware, now, we have two graft choices, ladies and gentlemen. We have quadriceps and hamstring. There's nothing else. Allograft is out. BTB is out, unless you want to create a bar. These are the four techniques. The lower left was given to me, but I don't do that technique. I go the upper right. So I'm going to show you why going over the top on the femur and going through the physis on the tibia is the way to go in these young athletes. So this technique was first developed in Bologna in Italy in 1998. It's a combined intra- and extra-articular augmentation. The graft is passed over the lateral femur condyle, fixed on its cortex, and the advantages are that you avoid the physis. It's easy to use, and it's also quite inexpensive. There's some really good outcome data. Small groups, of course, but very low revision rate and return to professional sports all possible at average eight months. Here are my arguments. So Harris, pay attention. Physio sparing. No femoral tunnel misplacement. It helps prevent early failure with the addition of LAT. It's faster, and it's cost effective. This is the case. So far, the alignment is neutral, and the plan is to go over the top. And you can see by placing the staple far away from the physis and obviously not reaming over the top position, you're going to be golden. Now, you often encounter these really tight notches, and it's very difficult to get an anatomic and appropriate tunnel placement in there. So my point is, if you don't drill a tunnel, you will not misplace it. It's faster. You really have much less fluoroscopy use compared to the all epiphyseal technique. There's no back table needed because you leave the pests attached, the tendons, you strip them, prepare them right there with a quick suture. And also, therefore, there is no tibial fixation needed. So it's a very sort of anatomic and very mild type of procedure. So here you can see, this is about an eight millimeter graft. An additional factor is the preservation of the stump. Here's a small postilateral accessory incision to expose the over-the-top position. The suture gets passed, the stump gets preserved, and you're done. This is a nice and quick procedure, and nicely anatomic. It helps prevent early failure by adding the lateral addition. So this hamstring tendon, if you manage to keep it at least 20 centimeters long, which you should, then you can go over-the-top and route it back at GERDES too because there's abundant data from Isacos, Al-Gadgud, Stability One. Again, not AOSM, this is Isacos. Also, Sonnery-Cote has, of course, a lot of good data and many good articles. And finally, it's a very cost-effective procedure. So for the young people in the room, you should be aware of this. You want to be sustainable, you want to be green, and you want to save money and be effective in the operating room. So here's my final slide. Fisial sparing avoids the femoral fices. No femoral tunnel misplacement. You help prevent early failure. It's faster and very sustainable. Thank you very much. All right. Thank you. Thanks, Volker.

ACL reconstruction

young athletes

over the top technique

Italy 1998

quadriceps hamstring grafts