Thank you very much. First of all, you did point out that meniscal experts, there was multiple people in there. It doesn't mean I'd agree. I can go down fighting. So disclosures on the Academy website. So meniscus anatomy, you have to remember the meniscus is not just one tiny spot that's attached. It's variable on both sides, as pointed out. So on the medial side, I will use, as I'll show you, bone plugs, lateral bridge. So this is actually from Tim Spalding. Verdunck was in that, but Spalding was the author. And if you look, this is pretty mediocre tissue for which you hold the meniscus. Dr. Shelbourne talked about that quite often. And anterior, same thing. So would you rather have this graft or this one? All secured. You have bone for which bone healing. It has a better understanding of the attachments, not just one spot. It's a broader attachment. So as I said, you have bone plugs on the inside, bridge on the outside due to the distance between the horn attachments. So let's go over this when we talked about fixation with soft tissue. So it's easier, less invasive, faster, and subjective results are the same. So is it easier? It may be a little bit, but you only have to have a two millimeter difference to get the bone plug in. You have to see the entire meniscus to be able to get the meniscus reduced. And you don't force the bone in. A lot of people try to yank it, pull it down into the tunnel. You should generally push it in, as I'll show you. And if it's difficult, get the graft reduced, and the meniscus bone plug can be much easier reduced as well, as I show you on a video. So less invasive? Not necessarily. If you read again, two of the better known people in Europe as far as meniscus allografts, in this article that they said two centimeter incision, you have a two centimeter incision proximal tibia that was shown. The way I do it, it's two to three centimeter arthrotomy, one to one half centimeter incision on the tibia. So they're pretty much the same as far as getting the graft. So is it faster? People talk about this being more difficult to prepare the graft. Well, it is, but if somebody's doing the graft on the back table, there's no difference in time. So this is a very brief video just to show you some things. You can have a device that makes sure that the bone plug with six millimeter gets through. You have to see the poster horn attachment regardless of whether it's a bone plug or not. And you have to see the meniscus to do this properly. So get into a tight knee. You have to be able to see posteriorly. So it doesn't matter if it's a bone plug or soft tissue, you have to see them back. The drill I use is only six millimeters. So it's not some massive hole that we talk about. It has robust blood supply, much better healing than a tiny little one. You can see the arthrotomies two to three. I'm pushing the meniscus in, not yanking it down into the tunnel. So as I said, you gently push it in and it reduces. Whether you use a bone plug or not, the hard part is doing the bucket handle tear reduction. That makes no difference either way. And you can see the height right where it should be. Now anteriorly, there's a lot of different methods. You can either do it open, you can do the drill hole. I just make a, through the arthrotomy, I drill down and go ahead and just put the plug in with my finger, have it tamp, and that's it. Now just as a word of precaution, if you're going to use something like a push lock or what have you, do it in the lab first. Because if you do it the technique that he showed you, it pulls the meniscus down and it pulls it away from the attachment. So be very careful the first time you do that because you may change your mind about the technique. Could you advance that for me? So when you talk about this, this is a meta-analysis. It talks about root tears versus bone and not. It says, of course, 42% soft tissue extrusion, says the clinical results are similar, but that extrusion, pay attention to what I just said, follow up 66 months. We're not talking about long term, 66 months in my mind is not long term, especially you young guys. So basic science, what do we have these people do all these basic science studies for? They're smarter than me when you see multiple ones that show bone plugs work better. This is a more recent one that shows under dynamic loading, interosseous fixation via bone plugs that the horns provide superior load distribution compared to suture only. So these smart guys are telling us to use bone plugs. The clinicians say don't. So we talked about mescal roots. I won't harp on this, but we all talked about these root losing hoop stresses when you're doing that. So we showed one slide, soft tissue 35.9, bone plugs 25. So which would you rather have, less extrusion, more extrusion? So this is a meta-analysis. Look at the soft tissue extrusion, 40%, why even bother? And this is not one author, this is a meta-analysis. This is a slide that's incredibly important to take home. Talks about meniscal transplant with and without extrusion, mean follow-up 12.3 years, not the 66 months. So if you look in the short-term, the extrusion, arthritis, the blue one, the gold one, look what happens after that 66 months, the arthritis occurs. So short-term, medium-term, sure, may be good results, but we're trying to prevent arthritis and the bone plugs, definite difference. The other thing too is rehab on these. As pointed out by Dr. Shelbourne, a meniscal roots, six weeks non-weight-bearing in a brace, start partial at seven, gradually increase. We're talking about a major effect on their life. On my rehab, zero to four weeks, I have partial weight-bearing, and people are much more compliant doing that. You have four weeks full weight-bearing, four months I let them, quote, run. I tell these patients they shouldn't be doing this for running, and hypothetically full activities in five to six months, which is significant difference in a rehab. So why do it with bone? Do it right. We showed you extrusion's less, arthritis is less. It's a no-brainer. We've got to listen to the smart people, the basic science that says it does better. Rehab's faster, and again, we're trying to prevent arthritis. Thank you.

bone plugs

meniscal transplants

variable anatomy

attachments

healing