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uh thank you so much for having me um itamp;#39;s a very much an honor to be joining this morning it is very early in the united states but i am happy to be with you all um so again i my name is connor ziegler and iamp;#39;m an orthopedic surgeon in uh in massachusetts i live about two hours west of boston so just some background so we know there are many risk factors for acl graph failure in the literature the graph failure rate after primary acl reconstruction ranges from six to nine percent this can be due to technical errors graft factors malalignment as we discussed recurve autumn deformity knee hyper laxity or global hyperboxy unaddressed injuries at the time of the primary acl reconstruction tibial slope particularly posterior tibial slope the age of the patient at the time of their acl tear certainly psychosocial factors in our influence as well and then inadequate rehabilitation so why does it matter well first and foremost patient well-being outcomes as we know are typicall