Greetings from Argentina. We are still crazy celebrating our third World Cup with our GOAT, Lionel Messi. But my name is Guillermo Arce and my goal today is to share with you some concepts about lethargy and replisage for collision athletes with bipolar bone loss. My financial disclosures is in the Academy website. This is the challenge, collision athletes with bipolar bone loss. This is a huge challenge for all of us. So if we review the pronostic factors, we realize that we have 10 points in the CC score and at the GT scores as well. Lethargy enhances the glenoid phase and perhaps can revert the hit side lesion from off-track to on-track. But this is very controversial. There are some authors like the Lafosse group that say yes, the lethargy revert the hit side lesion to on-track. Renaleta from Argentina, but Emilio Calvo who is here says not always. At least 12% of the hit side lesions remains off-track after the lethargy. This paper for Patrick Denard and Matt Provencher points out that adding a replisage to any bone block procedure really enhances stability and restores better biomechanics. This is the challenge, a patient with glenoid bone loss more than 13.5% and a huge hit side lesion on the humerus side. We perform the replisage in the lateral decubitus position. The scope is on the anterior superior portal and I think it's very, very important to create this healing scenario with the birth. We don't remove a bone, but we remove the periosteum. To locate the anchors, as you know, the anchors must be located very, very close to the articular cartilage. So we use 4.75 millimeters anchors. After doing so, we put a second cannula inferior and distal and more humeral to the first one. And with a penetrator, we penetrate the capsule far from the glenoid. As I mentioned, the anchors should be very close to articular cartilage, but in order to avoid and prevent losing motion, you need to penetrate the capsule from the second cannula far from the glenoid, more laterally, in order to avoid shortening the posterior capsule. As you can see, the replisage action is reduction of the humeral head and a decreased translation. After doing so, we do not tie the sutures. We flip the patients to the beach chair position. I think that the beauty of the open latergé is how we prepare the graph. Giovanni Giacomo described how to prepare the graph and take all the measurements of the graph. But this part, we also measure the distance between the holes and the graph edge. After splitting the subscapularis and a glenoid side vertical capsulotomy, we totally focus on the glenoid neck. You don't need the Fukuda for that. You don't need to do any force with the Fukuda. You need to focus on the glenoid neck. We put first the distal screw and then the upper screw. I do it free-handed, trying to be very parallel. And I would like to see, because with many devices, you don't see what you are doing. I would like to see the holes on the graph in order to avoid breaking the graph. And I would like to see that my graph is totally flush with the glenoid face. So far, with doing this kind of open latergé and replisage, we really revert the off-track heel-satch to on-track heel-satch, and we have a better outcome. So for young collision athletes with bipolar bone loss, this kind of anatomic latergé and adding a replisage is a way to avoid early revisions and further damage to their joint. I think these techniques are very safe to ensure good results. All these things are discussed in the Icicle Shoulder Committee, which is an amazing group of surgeons all around the world that we approach these controversial topics. For sure, we wait for you in Boston next June. It will be a huge meeting, and we will enjoy and learn a lot. Thank you.

Guillermo Arce

collision athletes

bipolar bone loss

lethargy

replisage