Thanks, Brian. First off, it's really great to see all you guys. I didn't realize how much I missed comparing notes and things until I was back. Second, I'd like to acknowledge David Maldonado, our former fellow and future attending, who took the lead on the data analysis in this study. My disclosures are listed with the AOS. So labor reconstructions indications have evolved both in the primary and revision settings. In the primary settings, in our practice, they currently include segmental loss or a calcified labrum, and in the revision setting, failed previous debridement or failed repair. We published the technique for circumferential labor reconstruction using the knotless pull-through technique, and this technique is actually applicable for a number of procedures. The technique allowed us to get rid of the need to measure the length of the defect and to be able to size the graft intraoperatively and intra-articularly to get it perfectly sized each time. And it's also applicable for segmental reconstruction, circumferential reconstruction, or labral augmentation. So we can do all three of these using essentially the same technique with very minor differences. This is the technique here in a nutshell. We see here a failed previous repair. So we remove the labral remnant, prepare the rim, place all the knotless anchors. They're all pre-placed before we introduce the graft. Then we insert the tendon graft, and this is the pull-through part. The tendon is pulled through the anterior portal and out the posterolateral portal. And after that, it becomes a very easy pass-and-cinch, pass-and-cinch technique to fixate with pre-placed anchors working from anterior to posterior. So this is a relatively rapid part of the procedure, is the actual fixation of the graft. Here we can see the completed fixation of the graft. We check the anastomosis of the graft anteriorly and posteriorly with the native TAL at the anterior and posterior extents, and then take traction off and evaluate the seal and make sure that the labrum has in fact sealed the ball in the socket as it should. There's the anastomosis viewed from extra-articularly. So the purpose of the present study was to look at the minimum two-year outcomes comparing segmental to circumferential labral reconstruction for irreparable labral tears using a propensity-matched methodology. We looked at our data registry retrospectively from 2010 to 2017, and the propensity score matching was in a one-to-one format. Power analysis showed the need for 45 patients in each group. After matching, we actually had 47 patients in each group. You can see that in the green here. The post hoc comparison of the groups to assess the matching showed that the groups were well-matched, in fact, according to all the criteria that were used for the matching. There was significant improvement in two-year patient-reported outcomes in all the outcomes for both segmental and circumferential reconstruction. Decreased pain and high patient satisfaction, again, for both circumferential and segmental reconstruction, and both had high rates of achieving MCID and PAS for all of the scores. So in summary, at minimum two-year follow-up, there was significant improvement in the PROs and high patient satisfaction and favorable rates of MCID and PAS achievement, but in fact these rates of improvement were comparable between the two groups, which is good. So there are a couple ways that we could assimilate that information. We could say, okay, it makes no difference if you do segmental or circumferential, but I think that's actually not the right conclusion, and I'll lead up to that in a moment. The strengths of the study were it was a propensity-matched study design with multiple PROs, and we used MCID and PAS. The limitations, it was obviously not a randomized study. I think propensity matching gets us probably as close as we can get to level one evidence without actually randomizing patients. It was a retrospective analysis, though the data was prospectively collected, and all the patients in this study were a single center, single surgeon. Obviously this was two-year follow-up, and we always look to extend our follow-up, and we'll continue to follow this group of patients, of course, at midterm and long-term. By way of a quick literature review, there's been a lot written now about labor reconstructions, so I won't be exhaustive, but just to point out a couple of the studies that we've published, this was the original technique for the circumferential reconstruction using the knotless pull-through, and following that, we published the comparison with a benchmarked labor repair group with minimum two-year follow-up, and then subsequently with minimum five-year follow-up, showing that this procedure benchmarked very well against the gold standard, if you will, of labor repair, and hence provides a good alternative when the labrum is not repairable. So the conclusions that I took from this data are, firstly, the knotless pull-through technique is one option that in my hands allows technical facility with both segmental reconstructions and circumferential reconstructions without having to change the technique. With correct indications and meticulous technique, both yielded favorable outcomes, and my takeaway from this is that the surgeon actually has the ability to choose based on the surgeon's judgment of the tissue viability. If the surgeon feels that there is only a segment where the tissue is non-viable, then a segmental reconstruction works well, and if the surgeon feels that the whole labrum has a viability problem, then a circumferential reconstruction works well. So both probably have a role in our field going forward. Thank you very much, and again, great to see you all again.

labor reconstructions

circumferential reconstruction

knotless pull-through technique

propensity-matched methodology

patient satisfaction