So for the sake of time, I think what we're going to do is we actually are going to spend time talking about the rotator cuff pathology management, et cetera. We're going to forego the two AC joint talks. Dr. Brockbrier and I discussed that. The Hall of Fame induction immediately follows this, so we just really don't want to go over out of respect for everybody's time. So we'll spend just the next, you know, five or six minutes kind of talking about some of the rotator cuff related stuff and then just go around the room and share a couple of points. So thanks so much. Have at it. All right. Sorry to break up the great discussions that are happening, but I just wanted to take a couple of minutes so that we can give some highlights from each table before everybody heads off. So let's start actually with, actually Julie's still talking. Let's start with Sarah and Steve over here. So we actually spend most of the time talking about AC joint injuries, funny enough. Okay, perfect. The table asked me. That's perfect. So I don't know. We can talk about that a little bit, but basically just the discussion was centered on indications for surgery. Do you operate acutely versus chronically or, you know, give them a chance and then technique for fixation, which I think is a controversial area. Yeah, that's excellent. And sorry we weren't able to get to those cases in detail, but glad you guys spent some time discussing that. Julie. You know, we quote or spent most of the time just talking about what we all do internationally for the massive tears. Tendon transfers, do them, don't do them, what type of tendon transfers. Not everyone is doing trapezius transfers. They're still doing latissimus transfers if necessary. Not many transfers in Germany. So a lot about that and then about the different type of augmentation and the reasons why and how, you know, the collagen patches work and what impact they have. Excellent. Curious real quick. How many, so Julie, do you do tendon transfers for cough? How frequent is that in your practice? So we were just talking about this. So it's pretty infrequent for me. I mean, I really think it's the young, at least for me, it is the young patient with a significant ER lag. That is the patient that there's no SCR, there's no balloon, there's no partial repair that I think is going to work. So it's mostly, cause I, for me, I don't feel like a tendon transfer is going to reverse pseudo paralysis. I don't think there's something great for the supra, but for external rotation weakness or extreme lag in a young patient, that's when I think I've got to do something. Yeah. Supposed to your superior basically. Right. Yeah. Nick, I don't know. Do you do tendon transfer? Is that part of your algorithm anymore? Not really. Yeah. Uncommon patient, but you will see it every so often. Yeah. Yeah. John and Nick, from your table. So we spent a lot of time earlier just talking about rehab. About how you manage stiffness and how you not use a one size fits all post-op rehab program. And you can individualize it based on care size, age, goals, all those kinds of things. Perfect. Yeah. Very important points. And Brian and Tiger. Yeah. We just talked about how difficult it is to have a 45-year-old heavy laborer that comes in with a massive irreparable cuff tear. And what do you do in this patient to get them back to being heavy laborers? Tendon transfer is not great. Reverse is not great. There's not many great solutions in that population. You know, I think the tendon transfers, I probably do five, 10 a year, lat dorsi and trap, lower trap. And I think the only times it works is I've had the patients that have maybe pseudoparesis when they have 45 to 90 degrees of active motion and they can hold their arm up. If you let go, they can't hold it up that way. It doesn't work. So if you have somebody that can go 45 to 90 active and then it goes up and they can hold the arm there without dropping it, those are the patients that I can, you know, I think about doing it. Somebody super young, no arthritis, and I typically prefer a lat dorsi over a lower trap. The lower trap for me is somebody who has external rotation like. Those are the people that get lower trap because I think the vector is a little bit better for the ER like with the lower trap than it is for lat dorsi. But I think, you know, I tell the patients it's not a great operation. Also transfer is 50-50, you know, it's not great. It's a huge surgery and come back and I regret it sometimes. I'm like, why don't I just put a reverse in that patient after a year and it failed, you know? So. Excellent. Well, thank you all so much for being here. Thanks to the faculty for your excellent talks and great discussion. Hope you guys enjoy the rest of the day. And again, the Hall of Fame induction ceremony is right after this. So hopefully you guys will be able to attend that. So excellent. Enjoy. »» Great job, Mary.

rotator cuff pathology management

AC joint injuries

tendon transfers

rehab

individualized approaches