Chapter 2123: Chapter 1785: Only Through Repeated Practice

He paused for a moment, turned around, and looked at the young doctor who asked the question.

"What I mean is that the millimeters are just for convenience in explanation. Every patient is different, and seven millimeters and two millimeters are averages, not absolutes. You need to find the ’Resident’s Ridge’ first and then use a probe to confirm. Within a one-millimeter range around the planned tunnel location, gently press with the probe. The bone texture of the original footprint is slightly denser than the surrounding area, providing different feedback when pressed. You need to find the hardest point, which is the real center."

In the meeting room, some people were taking notes, some were staring at the diagram on the whiteboard, and some were gesturing in the direction of "seven millimeters, two millimeters." The old professor sat in the corner, with his arms crossed over his chest and eyes slightly squinting, showing no expression, but his right hand was resting on his knee.

A middle-aged attending physician sat in the second row, leaning forward, with his hands crossed on the table.

"Doctor Gao, regarding the tibial tunnel positioning of the posterior cruciate ligaments. You use a bent guide directly from the posteromedial approach for positioning, which is highly risky. The popliteal artery is just a few millimeters behind. How do you ensure it won’t be damaged?"

Gao Yuan added the path of the popliteal artery to the knee anatomy diagram, a curve running downward from the back, close to the posterior edge of the tibial plateau.

"The risk exists, but it comes from uncertainty. If you’re unsure of the exact location of the popliteal artery, then it’s dangerous. If you’re certain, it’s no longer dangerous."

He picked up a red marker and drew a thick line at the location of the popliteal artery.

"The path of the popliteal artery behind the knee joint is regular. It’s located at about seven to ten millimeters behind the tibial plateau at joint line level, and about five millimeters medial to the tibial tunnel exit. When you use a guide to enter from the posteromedial approach, as long as you keep the guide tip directed towards the anteroinferior part of the tibial plateau and not deviating posteriorly, you won’t touch the popliteal artery. The key is..."

He tapped his fingers on the table three times, emphasizing the next words.

"The key is to be familiar with the popliteal artery’s path on the patient’s MRI images in advance. During surgery, you can’t rely solely on your eyes. You need to ’listen’ with your hands. As the guide passes through soft tissue, the resistance will indicate what tissue you are touching—fat has the least resistance, muscle has moderate resistance, fascia somewhat higher, the arterial wall has elastic resistance, and ligaments have tough resistance. The arterial wall’s texture is unique; it has a pulse. When you gently push the tissue open with a blunt dissector, if you feel a periodic, pulse-synchronized slight pulsation, it indicates you’re too close to the popliteal artery. Move back and adjust direction."

"A surgeon’s hand is the second pair of eyes, and the probe is an extension of the hand."

The meeting room fell silent for a moment as people processed these words and compared them to their own experiences, while the old professor seemed deep in thought.

The third question came from a female attending physician sitting in the first row, arms crossed and expression serious.

"Doctor Gao, yesterday you and Doctor Robert simultaneously adjusted the tension of two grafts without any communication, yet the tension seemed to match. How did you accomplish that?"

Gao Yuan glanced at Robert, who shrugged, indicating "answer it yourself."

"We use the same set of standards, studied under the same mentor," Gao Yuan said. "Professor Yang Ping, my teacher, has a theory on ligament tension matching. He believes that the tension of the anterior and posterior cruciate is not two independent parameters but two variables of a system. When the knee joint is in neutral position, the tension ratio between the anterior and posterior cruciate should be six to four. The anterior cruciate bears sixty percent of the load, and the posterior cruciate bears forty percent. This proportion isn’t fixed; it changes with the knee joint’s flexion-extension angle. But during this change, the tension curves of the two ligaments should be mirror-symmetrical—one rises while the other falls; one falls, the other rises. The axis of symmetry for these two curves is constant."

He picked up a marker and drew two curves on the whiteboard, one rising and one falling, crossing in the middle.

"This axis of symmetry is the signal for us to simultaneously stop the adjustment. When the slopes of the two curves are equal in absolute value, your tactile sense will tell you the force felt by your left hand and right hand pulling back is the same. The force felt by the left hand is exactly equal to that felt by the right hand. That’s when the tension matches."

He put down the marker and dusted off his hands.

"This process cannot be coordinated through language. Language is too slow. You might say ’tighten a bit more,’ and I tighten, you think it’s enough, but the process has already passed by tenths of seconds or even seconds, and the joint’s position may have changed. So, it’s all about tactile sense. You and your partner must share the same tactile sense, the same standards, the same judgments. This requires a high degree of tacit understanding."

Someone in the meeting room nodded gently. The female attending physician’s expression changed from seriousness to thoughtful, and she didn’t continue to question. It wasn’t because she had no more questions but because she realized Gao Yuan’s answer transcended technique—it was something beyond technique. You can replicate someone’s technique, but you can’t replicate the tacit understanding between him and his partner.

The questions continued; some asked about graft selection, postoperative recovery time points, handling bone tunnel expansion in revision cases, strategies for surgery associated with posterolateral complex injuries. Gao Yuan answered each question succinctly, accurately, and directly to the point. He didn’t beat around the bush, didn’t pile on jargon, didn’t mystify. Even complex questions, he explained the core in three sentences or less. This ability to express wasn’t innate; it was honed at the morning meetings in Sanbo, driven by Yang Ping, who wouldn’t allow him to speak for more than three minutes. If he exceeded three minutes, he would interrupt and say, "If you can’t condense it, it means you haven’t really understood it."

Two hours later, the questions gradually dwindled.

The old professor hadn’t spoken all along, maintaining the same posture, seeming like an observer. But everyone knew he wasn’t just an observer. He was the most seasoned individual in the room, his name appearing in every sports medicine textbook’s references. His papers on the biomechanics of the anterior cruciate ligament had been cited over ten thousand times. If he asked a question, it wouldn’t be about technique—technical questions he had asked himself countless times over the past forty years.

Now he spoke.

"Doctor Gao."

Every gaze turned to him. Gao Yuan turned as well, eyes calm, without tension or toadying, nor with the typical "neither humble nor arrogant" demeanor commonly shown before authority. He simply looked at the old professor, just as he would look at anyone asking a question.

"I’d like to know how long it takes your teacher to perform one cruciate ligament reconstruction surgery?" the old professor asked.

Gao Yuan hadn’t expected this: "Half an hour."

"I don’t doubt your word, but I want to know, how does he manage this? Half an hour means every step has no extraneous movement, every judgment has no hesitation, and the hands must be exceedingly quick. How is this efficiency and precision trained?"

This is not a technical question. It’s a question about ’becoming.’ The old professor isn’t asking about Yang Ping’s surgical methods; he’s asking about Yang Ping as a person—how he became such a surgeon? How did his technique evolve? How did he reach a state in surgery without hesitation, without reworking, without extra movement?

Gao Yuan thought for a moment and spoke.

"Actually, there’s no secret. I’ll use my teacher’s words to answer—’It’s all about practice!’"

He paused for a moment, looking into the old professor’s eyes, who looked surprised.

"Only through repeated practice"

Robert stood up to translate.

The old professor was again taken aback, furrowing his brows.