We've got about four minutes for questions. Anybody have any questions in the audience? Come up to the microphone, please. Hey. My question is for Dr. Looney with these graphs. It's kind of a technical question. My understanding, by the way, you're making the graphs is a quadrupled loop graft through two tight ropes, and you're using equal length of both gracilis since MIT. My experience is that you need at least 255 to 260 millimeters of graft in order to make that construct. I'm just wondering how often you're able to get a gracilis that long. So the amount of graft that they aim for to have in the socket with this technique is about 20 millimeters, and then the intra-articular length that they try to get is about 25. So I think fairly commonly, I mean, some grafts come out around maybe 15 in the socket when they're shorter, but we do know that most of the healing occurs around the aperture of the graft. So having more in the socket with bicortical fixation is not necessarily as important as long as there's enough in the aperture to have healing without significant windshield wipering. So I think with this technique, they fairly commonly are able to get at least like 15 or 20 in the tunnels. It hasn't really been an issue. So you think that you guys are able to do that 100% of the time with your gracilis grafts? Yes. How are you harvesting your gracilis? So just using a tendon stripper off of the, taking it down off near the PEZ insertion and then running the tendon stripper back up, essentially the same. So through an intermedial incision is what I mean, not through a posterior incision? Yes. Okay. Thanks. A question for Rachel. When you looked at the data, were you able to establish a maximum DCR or the biggest size where you could actually probably predict a failure rather than success? That's a great question. We were unable to do that because of the low overall rate of failure. So 8 out of the 66 patients had failure. So we could not make an absolute maximum where we say if you're above 5 centimeters squared, or not the absolute size but even the ratio, if you're above 2.25, meaning one-fourth of the condyle, you'd be more likely to fail due to the low numbers, which is I guess a positive for the overall procedure but would be helpful to have that number. Any other questions? Question for Dr. Aoki for the knee extension, tibial spine thing. I didn't understand. Did you aspirate knees at all or try to aspirate knees to try to get them to go to full extension or extend them more? No. So we didn't do any aspirations just because it's a little bit more challenging to do that in the pediatric world. Would you consider that? You think you would get better extension if you could aspirate? I think I could get more people to enroll, so I could probably get them more comfortable with extension. I'm not sure how that affects potentially getting a better reduction of the fragment. I don't know if that plays a role or not. Okay. Thank you. How about a question on the ACL paper? How much graft do you need in a tunnel? I thought Sharpies fibers, the union happened right at the bony interface, at the interface of the tunnel. How much do you think graft do you need in the tunnel? And if you had less in the tunnel, would you have a little bit longer graft or a thicker graft, more graft material? So regarding that last part, I think if you, yeah, the less you have in the tunnel in general, that's graft that you're able to flip back around and contribute to the diameter, to the girth of the graft. So we didn't really study, you know, biomechanically and I wasn't able to find anything about the, you know, a minimum length to have in the tunnel for this technique. But generally most people that describe it want to have around 15 to 20 in the tunnel. Yeah. Okay. Any other questions? All right. Thank you very much.

quadrupled loop graft

graft length

maximum condyle size

knee extension

ACL paper