Here's another way of doing this for Dr. Shambhala. Yeah. Thanks, Cassandra. I don't think I'll ever look so good up till now in my life, actually. So these are my disclosures. And probably that's what she thinks I am. You know, weak little boy sitting in the corner. And any representation is absolutely not coincidental here. OK, so what's my thought process? OK, we're looking at a 30-year-old female. She's a housemaker, as she's rightly put it. And she's not settled with non-surgical therapy. She's got an ACL tear. She's got a meniscus tear. So that's a no-brainer. We're going to do surgery on her. What about her other needs? She's a recreational athlete. She's not into collision sport. She's not doing any impact sport. So what am I going to do? A soft tissue graft. And why would I do it? Because 80% of the world is not wrong. I think if 80% of the world was wrong, then probably I think I wouldn't be standing here trying to defend my case. So ladies and gentlemen, I submit that 80% of you are right if you choose a hamstrings graft. So what does it really do? I mean, she gave some great data, which said that all hamstrings will fail eventually. And probably, yes, if you look at this group, which is hyperextension, then almost there would be a 14% failure if you do hamstrings alone. Well, obviously, if that's the case, and if you have more than 6 and 1 half degrees of knee hyperextension, yes, you will have almost a 15 times higher risk of a hamstring graft failure, which is something you do want to avoid. And you should not be doing an isolated hamstrings graft. So what are you going to do when you're using a hamstrings graft? You will modify your technique. You will try and push your graft about 2 millimeters posterior, leave the pin in, get your knee to an extension, and try and ensure that your graft does not impinge in the roof. And a BTB graft will fail if you do not respect good technique as well. And of course, you want to tension your graft near full extension, because this lady wants to get back her full range of motion all over again. So whether it's the BTB, or the hamstrings, or the quad, you have to respect the technique. And if you don't respect the technique, you're going to have an unhappy patient. So what is the risk factor that I need to mitigate? It's obviously hyperextension. And my solution for that is to add an extra articular tenodesis using a strip of the elutable band, if you may. Or if you're a follower of the ALL philosophy, you can use a free soft tissue graft. Does it help? Oh yes, it does. How does it help? Well, we've got good data that's going to show you that if you add an LED to your hamstrings, it's going to be a desirous effect, and you're going to be mitigating all the problems of early graft failure. Again, another good study which showed that if you combine it along with patients who have hyperextension or who have hyperlaxity, you're going to have a comparable outcome to a BTB, which is what you want to have. So do I want a scar in front of my knee? I would say no. But I think this is what we're going to end up doing. And Cassandra, I look much more like this, and not as beautiful as you showed me in your pictures. And I rest my case. I think hamstrings with an LED is the way to go. Thank you so much. Thank you.

ACL tears

soft tissue graft

hamstrings

surgical technique

patient satisfaction