Okay, I'll start off asking a question from the audience. The first one we'll go ahead and ask to JT. JT, the question is, how do you debride the HillSax deformity during a remplisage? Sometimes it's difficult to get an appropriate angle for the shaver into the defect. Yeah, I think it can be. And I think one of the lessons is that not all HillSax are amenable to a remplisage. So DiGiacomo had published a study that you can divide them into AB-ducted and AD-ducted HillSax depending on when the patient came out. And a patient that had an AD-ducted HillSax, which is a higher percentage than we realize, are not amenable to all. So you can't do it every time based upon that MRI scan. In terms of tricks for debriding, I think that that percutaneous approach that you saw with that spinal needle alleviates that problem completely because I'm coming directly at it, and so that helps. If you do this in the lateral position, one other trick is that you can bring the arm and vary the arm in abduction and AD-duction, and that will help the shoulder come to you a little bit with the HillSax lesion. And of course, if you do this in the beach chair position, you're already in an AD-ducted position, and it's actually much easier to move it in a beach chair for that. So I think that if you're just a little creative about how you get to it, you can usually bring that, lightly debride it, don't make it any deeper, but it's important to prepare that biologically. Albert, we had a question from the audience. What's your preferred method for measuring percentage of glenoid bone loss? That's a great question. There's a lot of ways to measure. We know that 2Ds overestimate than 3Ds, and we also know unilaterals overestimate compared to bilaterals. If I were to have time, I would pick the PICO method. I think that's sort of the method that's been demonstrated to most accurately, I think, assess bone loss. The truth is, when you have a busy clinic, you're not doing that. And so I do the 2D method on the sagittal image, do the perfect circle, and understand that that can definitely overestimate because it's 2D and it's unilateral. Great. Thank you. I might say, remember, this is one tool, right? So bone loss is important, and we're measuring a little bit with a micrometer and then cutting with a chainsaw a little bit on our sort of algorithms. But remember that sometimes this is a contact athlete or a collision athlete, a younger athlete, et cetera. I think that even the difference between 13.5% and 20% is 2 to 3 millimeters. So I wouldn't use it as gospel. I would use it as a guideline like we do in the rest of our clinical decision-making process. Great. Very helpful. Thank you. Okay. And one question. So for you guys, what are you doing currently in your practice? So if you have a patient that is 5% glenoid bone loss, no Hill-Sachs lesion, and is a collision athlete, what's your approach? So with 5%, and are we talking about... So it might depend on some things, too. A first-time dislocator, a sort of multi-dislocator. But assuming it's not a multi-dislocator, I'm probably doing an arthroscopic band card. I'm probably going to incorporate the PIGL, as JT just mentioned, understanding that that might actually do exactly what a REMPLISAGE might do. And I think this is a scenario in which the thought of maybe putting... I don't know about creating a Hill-Sachs lesion, but maybe putting it into the bare spot. Maybe that would be a good indication to also add that. Because these contact athletes, they're problematic. I struggle with this a lot because the arthroscopic band card is right there. It's a... For most of you in the audience, it's a fast procedure. You're very good at it. You can make it perfect, and then it will fail in a contact athlete. And we continue to have to learn this lesson over and over again if you're not following. And everybody out here, all of us, me too, we look and we go, no, I just don't see the rates that everybody talks about. But it's because they don't fail until 12 to 18 months, and they're gone from your practice. It's just the truth. So the studies show us over and over and over again that a collision athlete, you're accepting... Even in the absence of bone loss, you're accepting a double the failure rate with a simple arthroscopic band card. I know that's a real controversial statement, but show me a study that would deny that. At the end of the day, though, it's one factor in many, but I would tell you that I think you should add something else. You need something else in that contact athlete. They're going back to, let's say, American football or rugby or Australian rules football, and those require more than a normal shoulder to be successful sometimes. So I would say that I think it's really important that you add something else, whether that something else is a latter J, or it's a remplissage, or a posterior augmentation, or even aggressive bone blocks. I think that's fine. There's no data on that yet to tell us, but a simple arthroscopic band card in that contact athlete that's asking for trouble. I think we could stay here for probably another hour asking great questions and getting amazing answers and insight. But I think in the interest of time, we'll probably have to move on. We do have one announcement, logistical announcement. So for tonight's event, the family event, there are shuttles that will be leaving Broadmoor at West or South Tower starting at 5 p.m. Other AOSSM hotels starting at 5 p.m. as well. Thanks everybody for coming out. Great session.

shoulder surgery techniques

HillSax deformities

debridement tricks

glenoid bone loss

contact athletes