Okay. Thank you, guys. We'll take any questions, and we have some polling questions, but I'll start with a couple. First, great papers, and thanks for being here. I'll start with the, to my right, Payam. You showed that there was surgically, in the surgically treated group, the space available in the sub-criminal space was greater than in the non-surgical group, indicating there's more risk of impingement in people not surgically treated. So how do you explain that anatomically? Is the, do you think it's superior migration of the clavicle creating a superior rise in the humeral head to the acromion, or how would you postulate that a decrease in sub-acromial space occurs in the non-surgically treated versus the surgically treated? It's really hard to postulate from the kinematics data alone, because it was, it is a complicated three-dimensional movement of a scapula with respect to clavicle, and when we were looking at it, the, if I want to just pull it up really quick, we see an increased internal rotation, which is usually that, that movement of scapula results in compromise of acromial space, but is negated by downward rotation and anterior tilting. So there was not a way to directly see it, because it's so three-dimensional, it's so complicated, and movements are coupled with one another. But the way that we finally was able to see it was to look at, by measuring the sub-acromial space during dynamic activity, by looking at undersurface of acromion and top surface of humerus, and seeing how this distance is minimized. So you think it's potentially rotational, where the acromion is rotating down more than it's the humeral head rotating up, is what you're saying? That's how we saw it. Next, Ajinkya. Am I saying that right? Ajinkya. Ajinkya, sorry. No, you're okay. And I recognize that you're a second-year medical student, and so I've, with that in mind, you did a study at a level one trauma center at the University of Pittsburgh, and being that this is sports medicine, do you think there's a difference, your age group was a little higher than what we typically see in the sports world, and so do you think that looking at the data in a sports medicine in an active population, I know you didn't do pediatrics, so you cut it off at 18, but do you think the patient population plays a role in the findings that you had at a level one trauma center versus, say, a sports medicine practice? And is that worth parroting out, or ferreting out in the data that you have? I think so. I think it's two separate populations, and I think for a younger, more athletic cohort, I think it would be nice to see something like return to sport data after a clavicle fracture. What I would say is, in theory, the athletic population maybe heals a little better, has less re-operates, because maybe they're more likely to adhere. Maybe there's a less proportion of smokers and less obese people, which are established as risk factors for re-operation. So I think it would be two different data sets, absolutely. Sure. Can I add one question to that? Do you think this is more of a technique, so a finding from dual plating, or because you're able to use smaller plates when you do dual plating, do you think it's an argument that we should be improving the technology, or the type of plates we're able to use, that we can do it with a single plate? I think it's the plating itself. And the reason I say that is because it's a multi-surgeon study. So we had, I think we collected data across six or seven of our surgeons. Some were shoulder and elbow specialized. Some were sports specialized. And some were trauma specialized. And I think there's probably a fair degree of variation in their techniques. So in my expert second-year medical student opinion, I'll say that it's probably the technology itself. It certainly helps. You have a bright future. All right. Moving on. John, the nanoscope, the office scope, obviously I think comparing apples to apples, you mentioned that there's no arthrogram. And I didn't see any evidence of a radiologist reading. You had fellowship-trained sports medicine docs reading them. But as I looked through the MRI you were scrolling through, it was pretty obvious to me that there was a rotator cuff there. So how would you cage that, and would you change anything going back? Because I think if you're going to compare to MRI, arthrogram certainly plays a role in a lot of people's lives. If we're going to compare it, we probably ought to compare all three. What's your thought? It's a really good point. So I guess just in addressing that, I should have mentioned this but didn't. We did have access to the radiologist read as well, which kind of played into it a little bit. I think as I was looking back through that MRI about to give it, I wished I had chosen a different one, to be honest with you. But no, I think that's a really good point. And from my personal practice, I don't use arthrogram very often, just because of sort of the pain experienced by the patient. So it doesn't play into my practice that much, but I think it's a really good point. And yeah, I think you do need it. Yeah, and I don't think you have to. I just think it's part of the consideration for some people. And so if we're going to make a statement about the utilization of nano-arthroscopy in the office, which I think there's certainly room for, we ought to make sure it may be different relative to people who use different techniques. So if you don't use arthrogram and it turns out that it's as good, but if you do use arthrogram and it's same, or it's better, then that would be valuable. I think it would just add a layer of value to the study. Oh, absolutely. And I think 3-Tesla would have been nice if you could have gotten that too. If you can get it. Talk to Hollis. You got one? Yeah. Andy, we're not going to let you off the hook. We're running out of time. So the question I like to ask at every single meeting about shoulder replacement, what do you tell your patients about weightlifting and how do you counsel them based on the results of your study and your general practice? How do you counsel patients on weightlifting after anatomic? Yeah. So initially, after fellowship, my trend was very much the same, 50 pounds, 30 pounds, or 25 pounds is kind of the party line that I now, that I had. After talking with many of my other mentors and seeing my own patients do okay in the last few years, admittedly, it's two-year followup, but I don't have restrictions for them postoperatively anymore. Once they heal their subscap, they're good to go. Would you consider in somebody you know is going to do or try to go back to heavy weightlifting, heavy pressing, would you consider altering your glenoid version to accommodate that by a degree or two? Is that a consideration in that patient population? I think that that's a really wise question. I think that there's a ton that goes into it, and the first paper highlighted that really well. I think short answer is yes. I think scapular version and the 3D scapular dynamics of the scapula as it relates to the thorax is something that's yet to be really figured out, but I do think that there's something to be said about that, yes. All right, no questions from the audience at all? We have some polling questions, I think, if we've got time for them, but if not, no big deal. We can do them after the next one. All right, thank you, guys.

orthopedic surgery

subacromial impingement syndrome

clavicle fractures

nano-arthroscopy

weightlifting