Well, thank you very much, it is a great honor for our association, Argentinian Association, to be a guest nation, so thank you again, Luis and John. I'm going to talk with this topic, I don't have a config for this topic. When we talk about the ACL reconstruction, our goal is to recreate in the best way the ACL function, so for that we have different techniques. You can use the old-fashioned trans-tibial, anterior portal, outside-in, or the modified trans-tibial. It still remains a debate focus on that, but we don't want to talk about the trans-tibial technique in that shape, that it has isometric channels, vertical reconstructions, and no control of the rotational stability. Those are non-anatomics. We want to talk about, can you run the video, please? With the modified technique, trans-tibial technique, that we can move with the pronation of our brace of rotation of the over-the-top guide to achieve a good point entry for the femoral tunnel, and like you see below, you got a good femoral tunnel and good ACL reconstruction. For that, in 2000s, we used devices that are suspensory, and instead we want to use an anatomic reconstruction. We start with the guide closer to the joint line, proximal and medial, to have a good angle and to perform this trans-tibial using this device, and as you see below, we can achieve good results on that. Basis on Berners-Bach studies that we can achieve with the pronation of the femoral guide, and also important to have the tibial tunnel more than nine, so it's easier when you perform a BTV, it's around 10 millimeters, because you have freedom on the tibial tunnel to perform a better position on the femoral side. So we start doing that in calabaric models with some friends, and then we write a prospective randomized control trial that we presented in 2017 in Isaacos, Shanghai, that the objective was to evaluate our femoral position of the tunnel with both technique, with modified trans-tibial and anteromedial portal, using randomized rubs with BTV graft in all cases, and we evaluate them with CT imaging. We have inclusion and exclusion criteria. We choose 34 patients, 32 for any group, and we randomize them, and we study the femoral tunnel center, large diameter of the femoral tunnel, femoral tunnel depth, and coronal and sagittal inclination of the tunnel. And we have in the CT imaging similar femoral tunnel position in both techniques, greater diameter coronal inclination in the group of the group two, the anteromedial portal, and in the diameter of the femoral orifice in the modified trans-tibial technique, the shape is more oval. And we found no statistically significant difference in the tunnel position. And also in the sagittal plane, we don't have statistically significant difference, but we found statistically difference in the coronal plane, so that it is important. When we choose a modified trans-tibial technique, we know that we have some risk, some short tibial tunnels, anteromedial tibial fracture, we are very close to the joint line, and of course the location of the femoral tunnel is dictated by our tibial tunnel. And when we perform an anteromedial portal, we have risk of short femoral tunnel, posterior vulvar valve, sometimes you can use another accessory portal, and if you work very medial, you can make a heterogenic medial condolation. After this paper of the Danish register that shows increased risk of revision rate in anteromedial portal, some authors, they were comparing anteromedial and trans-tibial modified. And talking about outcomes and results, in both we have excellent results, so it is important to know those. In conclusion, we can say with the modified trans-tibial technique with the femoral entry is similar to achieve with anteromedial portal for single bundle in ACL reconstruction. Looking for the data, in 2018, this group of Egyptian and Arabians published a similar that we studied, angle, outcomes, and results are similar in both cases. In 2020, next year, we have our meeting in Buenos Aires, and we are going to organize with the ANA board, so it is going to be a great pleasure to receive you there. We have soccer, we have rugby, we have wine, we have, as you see, mountains, you can ski, you have mountains with seven colors, we have the falls, and we have the glacier, and it's going to be a great pleasure for us to receive you there. Thank you very much.

ACL reconstruction techniques

anatomical reconstruction

femoral tunnel position

studies

Buenos Aires