So, we're going to spend about an hour while you eat, hearing about ultrasound. I'm dying to have one, like, five-minute window where we can talk about just what we do to manage, like, the arthritic patient, Jason, so I don't know how we're going to do it. This is the last time we're in the room together, you know? Maybe after this, see how the time goes, because, you know, still the most common question I'm getting is, what do you do, because I know, you know, we've talked about the confusion factor, and I think I would ask you just to frame this course a little different than you frame other things, because most of us are used to having a neat little box around what we learn and to be able to walk out and make decisions, and I think what you're clearly learning is that I know all of you have an interest in this. You just look around, you know, people are staying in the lab, they're doing the techniques, the room is always full. I mean, I do a lot of teaching, and this course is a little different flavor because people are really vested, and so you're, everyone's kind of hungry for knowledge, and a lot of this knowledge is new for many of the people in the room, so just be patient, and one of the greatest things about our profession is that we get to always be a student, right? I mean, think about the people who are not in medicine and how much passion they have versus what you have for what you do, so we always get to be a student, and this is one of those things that's just going to take a little bit of time to get your arms around, and the reason you don't know the answers is because we're also kind of feeling our way too, and I'll just, anecdotally, you know, the common question I'm getting is, okay, I get it that you in the office, you can use PRP and HA and amniotic, what about the OR, or how do you decide office or OR to use Adipose or BMAC, and I'm going to, I think it's safe to say there's no consensus of which one is better because it hasn't really been vetted in that way. I think it's been poorly vetted individually against some placebo, and they certainly haven't been compared to one another, so you're left with intuitive decision making, and you're going to hear one speaker say I'm compelled by this, you'll hear another speaker say I'm compelled by something else, and then there's the time factor, the economics of it, the hassle factor, how your hospital works, so there's a lot of tangibles and intangibles that go into making the decision, so you should assume that all this kind of fair game, you're probably not going to hurt your patient, you're hopefully going to help them, right, but this is really the art of medicine at this point, so I just urge you not to get frustrated, learn the techniques, and try to stay abreast of what's going on. I'll tell you that Anna, the ICRS, the AOSSM, and the AOS have a combined initiative that Jason has done a really nice job leading, but all of us in the leadership positions are coming up with a position statement to help guide thinking so that we can have, you know, better insight. The Ahn Foundation, same thing, we're all, that's one of the goals is to provide educational content so people can make more insightful decisions, but I just urge you not to get frustrated and just be a student because that's just the nature of what we're learning here. So when I do it, it's well, I haven't done an adipose procedure in some time, last couple of patients were doing great, let's do a few more of these, I mean, it's kind of, honestly, that's how I've been making my decisions, because we've done a fair number of BMACs as well, and a lot of it is what the patient's appetite is, and I personally don't do a lot of our degenerative arthroscopic knee scopes, so I try to do everything humanly possible to keep them out of the operating room, that's just my own bias. There's some really interesting work in how patients present with meniscus versus arthritic symptoms, and you would think that if they had mechanical symptoms that they would necessarily do better, even in the setting of OA, that's not necessarily true, when you look at the METEOR study, which is a multi-center study that was an NIH study that Bob Katz from partners at Harvard was the PI on, we looked at mechanical symptoms in those with OA, and that didn't serve as an independent variable to see who was going to do well, so it really has to do with what's driving their symptoms, is it meniscus or is it osteoarthritis, and if it's mostly meniscus, they're going to feel better, more completely, and for a longer period of time, if it's OA, it's kind of a crapshoot, they may feel better, but it'll be incomplete, and for less long, so all of us have to be, especially now that arthroscopy is being scrutinized, have to be really, again, transparent with our patients, we're not always ready, if you don't do arthroplasty, refer them directly to an arthroplasty surgeon, but just because you can do an arthroscopy doesn't mean it's going to solve the problem in some meaningful way, and by the way, temporary relief, I think, is acceptable, so I don't think we should throw the baby out with the bathwater, as they say, and say arthroscopy is bad, but it's all how we message it, because everything is temporary when you think about it, right, everything you and I do is temporary, you know, even up through arthroplasty, it's not temporary, it's how long they have to live with that implant inside of them, and then finally, in the end, if you want to choose to add something to it, whether it's PRP, amniotic, BMAC, or adipose, none of us are going to be able to tell you that this is what you should and have to do, because it's a clear winner, but they all may make a difference, so I think that's the general summation, and we haven't talked about cortisone, but that's still part of the algorithm, too, for some of us, so just to keep that in mind. So now, does everyone have it straight? All right, so what I'd like to do is introduce Doug Hoffman, he and I were just talking, he's the director of MSK Ultrasound in a very large group in Duluth, 600 plus physicians, and loves to teach, and you know, this is all, again, what I call academic philanthropy, right? None of us get paid to do this, but it's really the love of sharing knowledge, again, which is part of the privilege of being in the space that we are, whether you're an orthopedic surgeon, primary care sports, or other, right? So we're really privileged in that way. So Doug, to come here and share his knowledge with an hour lecture is just really a blessing, so we appreciate you being here, and take over, and see what knowledge you can disseminate.

ultrasound

arthritic patients

patient management

treatment methods

meniscus and osteoarthritis symptoms