in. If anybody has any burning questions, feel free to come up to the mic as well if you guys want to put a mic out. So I guess we'll start with Dr. Browning on the study on gluteus repairs. Maybe if you can comment on, it appears that it's harder for these patients to reach PASS than MCID, so maybe they get better but not as good. And a related question from the audience, what's a realistic expectation for strength gains and time to adequate strength and those things after the surgery? This is working? Okay, so there's two questions there. So one was, why are patients achieving MCID at a higher rate than achieving PASS? And then the other one is, what is a reasonable expectation for improvement in strength? Yeah. Okay, so I can start with the MCID and PASS. It's fairly consistent with the rest of the literature in these patient populations that the patients are more likely to achieve MCID than PASS, as it seems that the threshold is a little bit lower for achievement of MCID by definition. As far as the improvement in strength, you know, whether it's grading strength based off, you know, out of five scale or by the gate, we do document for each patient the strength out of five, and it seems that the patients do improve. Our study did not look at hip abduction strength improvement. And I think from your paper, a lot of these are partial thickness tears, I think is right. That's a good thing, yeah. Yeah, so I don't want to speak for the senior authors sitting here, but partial thickness tears are much more likely to undergo endoscopic repair in his hands than full thickness tears. All right, this next question is for Dr. Maldonado. In terms of looking at your label reconstructions, did you separate the partial or the segmental repairs or reconstructions compared to the complete reconstructions, and do those patients still have the similar outcome to those undergoing primary repair? For this study, we didn't do that, but that's a topic that we have studied in the past, comparing the reconstruction segmental and circumferential, and we found that you can customize the reconstruction to the size of the defect, so either way is fine. And then one more one more question there. So it looked like it with Labor Recon, about 25% of patients still fail to reach MCID or pass. I think Labor Recon sometimes is the holy grail of hip arthroscopy, that we think everything's fine. What were the issues in those patients, or why do you think so many patients still had pain even after the labrums excised in Recon? Well, for me, labor reconstruction is a great tool, but I'm the first one to say that it's not the holy grail, especially in revision surgery. You have so many reasons that a hip arthroscopy can fail, and you cannot fix all those patients doing labor reconstruction. That's one thing. Usually, what I've seen is a progression of arthritis is usually the problem with these patients. Okay, great. And then a few questions coming in for Dr. Safran. So in market scan, do you have availability to look at NSAID prescriptions? Certainly, NSAIDs have been a major role in decreasing the rate of HO with our typical hip arthroscopy. Do you have that data at all, or it's not something we can access? So you actually have access to the pharmaceutical claims, but it's just what we don't have is the timing relative to the surgery. So we didn't include that because we couldn't tell if they got it pre-op or post-op or when they got it post-op. And then another related question on HO, do you think capsular management plays a role? And this certainly isn't from your data, but closing the capsule versus leaving the capsule open, do you think that plays a role in HO? Well, a lot of people have talked about that. In reality, Udi Rath had looked at that and did not find that that affected heterotopic ossification. So the only study out there that I'm aware of that has looked at that specifically didn't show a difference. And then of those with HO, were those a diagnosis of HO, or went on to surgery, or a mix? Were they symptomatic or potentially asymptomatic, just labeled as a diagnosis? So it was just labeled in the post-operative billing form, if you will. So it's unclear. You know, as you know, in practice we see a lot of patients that will have some calcifications. Rarely does it cause symptoms. Occasionally, though, we do get patients with large HO and do need to take it out. They are symptomatic. But that's much less common than those that just have it notable on post-operative radiographs. Okay, perfect. Thanks, guys, for three great papers. And we'll transition to the second part of our program here. So if we can have the speakers for the second part all come up here, it'll speed our transition. So we're going to spend the rest of the hour on a mini...

gluteus repairs

heterotopic ossification

hip arthroscopy

Patient Acceptable Symptom State

Minimum Clinically Important Difference