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[Applause] [Music] [Applause] [Music] so this is a picture of london i took back in 1976 when the sun last shown here now two-stage revision acl is really unattractive to the patient its usually three to six months between the two stages and if youre a professional athlete that may actually mean that you lose another season for that for them that could be career ending its more expensive theres more morbidity and i suspect a lot of surgeons do two-stage procedures theres a reflex decision they dont really consider whether a one stage is possible now of course the truth is i do do two-stage procedures ive even published on it in this example on the right you can see a huge defect in the tibia the only answer here is a bone grafting first stage and a second stage revision but the truth is i do very very few two stage procedures if you look at my series of 204 patients in that um time period from 0 9 17 only three of them were two stage so youve got to realize my practice is reall
