All right, excellent. So now we have about 7-8 minutes, we're going to do the roundtable discussion. So if those, the attendees, if you guys wouldn't mind kind of clustering at tables, and then we'll have at least one faculty member per table. We're just going to be focusing on shoulder instability for these next several minutes and then we'll transition to biceps labral. Thank you. All right. I hope everybody has been enjoying the discussion at the tables. We're actually going to kind of pause for a minute if you guys don't mind. And we're going to go around to each of the tables and just if everybody, you know, just have a representative if one of the attendees or if the faculty wants to speak, just to share one or two points that you guys really took away from your discussion. So we're going to start with Sarah and Steve's table over here, however you guys would like to do it. »» We're having a great debate here over Latter-day Versus Rempliçage. The main focus is identifying the patient who is the right procedure. »» Right. So Latter-day Versus Rempliçage, identifying the appropriate patient. So excellent discussion. All right. Tiger and Brian back there. »» Sure. We were having a discussion about a couple of points on Rempliçage. A discussion about the safe zone. Make sure you get it ideally suited in the attendant capsule. Also whether you view subacromially versus doing a blind bag, or to just do some deferrals that facilitate more uniform compression and being able to see head down. »» Excellent. We have very important points related to the Rempliçage. John, thanks so much for picking up the mic over there. Go ahead. »» Yeah. This one actually works. We were talking a lot about the rehabilitation aspects of instability. I think we had some interesting discussions around that. One of the things is that first of all, we have some kind of very expert therapy and surgeons on this table. But one of the things that we were discussing is that the rehabilitation in terms of achieving full range of motion after instability, especially in our older patients or more complex instability is probably longer than we think, particularly getting in range of motion and kind of final full range of motion. And a critical portion of that was getting kind of the full perturbation and dynamic stability at in range of motion. And as we're gaining motion throughout the rehabilitation process, adding in some of that dynamic control with that as we go with range of motion was I think one of the take home points. Nick? »» Yeah. I just wanted to maybe address the controversy. I would just share my current algorithm that I've tried to simplify because we all see these different numbers that come in the literature. For me now, it's look at the glenoid side. If the glenoid has a critical defect, and how do we define that? low-demand patient, as low as 10% in a high-demand patient, then do a glenoid-based surgery. If they don't have a defect, then you're going to scope and repair them. And if you see a Hill-Sax, just fix it. I don't think we even need to do the track, on-track stuff. Because we know that Hill-Sax reduces the risk of instability. I don't think there's a penalty to doing a REM plissage. And so that's just been my current dumb it down algorithm of how to manage this. »» Thanks, Nick. And then Julie. Would you guys mind sharing the mic with Julie? Thank you so much. »» So we had a little bit of a different conversation because we have an international table. Because Toledo is a little bit like a foreign country in Ohio. We have Singapore and Germany. So we really just talked about grafts and graft availability and how where you are dictates what you do. And so for Germany, they don't really have the availability of grafts and are more apt to do Latergé for their cases. And then we were talking about in Singapore, different osteotomies and techniques, but they have readily available graft. And then we talked a lot about the difference between fresh and fresh-frozen and the cost and how the cost impacts the decision-making if you were to do distal tibia. So for me, kind of some fascinating information. »» Great. Thank you all so much.

shoulder instability

biceps labral

patient identification

rehab aspects of instability

graft availability