Cathy, how did you get this to, there we go, all right. So recent articles really talked about subacromial bursa being really kind of in a good position for rotator cuff repairs. There are multiple animal studies that have shown tendon healing cells do not really originate from the bone or the tendon but the peritoneum. We hypothesize that the bursa is the peritoneum of the rotator cuff. So we started looking at those cells. This is a 55-year-old right-hand dominant female farmer with a right rotator cuff tear. It's important for everybody to realize that we never really recreate the enthesis when we're doing a rotator cuff repair. When we say it's healed, it's really a mixture of disorganized collagen and scar. You never get this highly organized calcified fibrocollage, uncalcified fibrocollage or a tendon. What patients are indicated this? Really anybody that you're kind of worried about I think in a primary repair. Russ Warren when I first started looking at this had told me stop looking at the revisions and just go to try to prevent the failures in primaries. Finally after 20 years I've come around and listened to him now. Biologic activity of bursa readily available, inexpensive and fast. These are head-to-head studies of bursa and concentrated bone marrow in the same patient. Proliferative ability, bursa over the rotator cuff versus bone marrow. And then here you can see how it can, as we show that they're pluripotential, they can differentiate into cartilage, bone and fat and you can see that the bursa is more proliferative than the bone marrow. There's two areas of bursa that we looked at. Bursa over the tendon and then bursa over the muscle. We thought that originally the bursa over the muscle would be more cells because it was more vascular. That ended up not being true. We also found that you need to break down the bursa into a slurry. Unprepared bursa will not release its cells. You have to be able to get the cells released. More cells in the bursa over the tendon than over the muscle. The cellular composition of bursa is dominated by progenitor cells and fibroblasts. So this is kind of how we go about it. We take blood with ACDA, not using heparin as an anticoagulant. We then centrifuge this just to try to create a fibrin clot. This has nothing to do with the bursa and the pluripotential nature of the bursa. You can take the bursa out with a shaver and a filter or you can just use a Blakesley or pituitary ronjor to pull the bursa out. We then release it on the back table with tomatomy scissors. We then have a 3 to 1 ratio of autologous PRP, PPP and thrombin. You can make a large volume or a small volume, whatever you want. Really the goofiest part of this right now is the application of it afterwards. There's still some variability in this all autologous fibrin clot. Sometimes it's very robust and I'm only showing you the good videos. Sometimes it's not and it's a little disappointing after kind of doing all that. But I say that only because I think there are people out here that may have a better way to apply this. Human outcomes. We've done this in a number of people. We've had six failures. It doesn't seem that the colony forming units have an effect on failure rate. You can see the red are the failures. You can have low and high, but it doesn't really matter. We compared this retrospectively to another group of double row rotator cuff repairs. Really we think the bursa, since it's right there, is a good way to go. That's it. »» Okay. Great guys.

subacromial bursa

rotator cuff repairs

tendon healing cells

peritoneum hypothesis

proliferative ability