We don't have much time for questions, but I do have one question I want to ask Dr. Bird. You've been through all of this. Can you give us some perspective on where we've been and where we're going based on all your experience? Well, I think from my perspective, I think the panel sort of reflects where we are and there's so much we don't fully understand, but despite our best efforts to try to get these guys to contradict one another on management for certain types, the common theme seems to be that at least where we are today, there's sort of a spectrum of options available depending on what's available. That a repairable labrum should be repaired. If there's some portion of the labrum that's preservable in the frame of an augmentation, that probably makes sense, and if there's not, a reconstruction is a great option. I think what's lost is what is the role for debridement? I think clearly repairing the labrum makes more sense than debridement, but I think there are circumstances where if you can't repair it, that doesn't mean your only option is to then do a reconstruction. I think we see that reconstructions are uncommon in the primary setting, but not unheard of and growing as far as how common they are in the revision circumstance. I think what I was going to throw out for the panelists and let them kind of weigh in because the thing I see a lot of are these middle-aged females with some partially, and I would call it an ossified labrum, not calcified, but where the posterior labrum is almost completely ossified, and when you look in there, the labrum looks pretty normal, but you probe it and it's virtually petrified. It's the anterior part of the labrum where there's some partial ossification, a little bit of rim prominence, but enough labrum that's torn and there's just enough labrum to tear that's probably creating their symptoms, and what to do with that? Do you just clean out the damaged labrum? It's a little bit of a technical exercise, but you can free it up, trim back the bone and refix the labrum, but what do you do when you get back to the fully ossified part? Should you reinforce the small part of the labrum with an augmentation? Should you just take it all out and start over with the circumferential reconstruction? I would like it if our three guys might comment, especially trying to wear the hat for the topic that they've been assigned. So, I will weigh in on that. I mean, what you described to me is a patient who has a challenged hip, it's probably not an optimal, not going to be in our best outcome category for surgery of any kind, and I would favor being less aggressive than more aggressive in that, particularly when we don't have data to clearly support it, so putting somebody, middle-aged woman with some early cartilage wear and rim ossification or labral ossification, I think doing a minimal, as minimal a procedure as possible is probably in that patient's best interest, and the only other thing I would- Is that code for debridement? That's code for debridement, but I would also say, well, so I think that's my, of the three that I had, the first one is, you know, keep the stable labrum, you don't have to do refixation on that part, and then the other is to, oftentimes, there's two sides of impingement, there's the femoral side and the established side, can you get away with doing some decompression on the femoral side that would accommodate the hip and the joint, but do as little as possible on the labrum, debridement, debridement. Shane, reconstruction? Sure, I mean, I think this is an interesting group because, you know, for me, like, reconstructions in a primary setting for like a young patient with good, healthy tissue just doesn't seem to make sense, but this may be a group that it might be beneficial for. I would be interested to see, like, what the data looks like in this particular cohort because I think that if, I guess if we can prove that the labrum can be reconstructed in a way that is more like native labrum, that perhaps that might be advantageous for the patient, and maybe we can preserve them better, maybe we're just dismissing them, and that we can actually help them more than what we've kind of given them credit for. So I think it's still up for debate. Joe, we'll hit on you, you better get used to it, you got those broad shoulders now that you're weighing in with the Vail folks for good. Give us your thoughts. Yeah, so I think in this patient population as well that less is more, but, you know, if you do feel that the calcified labrum is a significant contributor to the symptoms, the approach you said I think makes sense to try to shell out, very carefully shell out the calcified portion while trying to maintain the circumferential fibers in the chondrolabral junction, and then an augmentation in that scenario I think is a good option. Great. Well, thank you, I think the point I would make is that the bony work is just so critical as to Dr. Kelly's point, you know, if you can do a great bony decompression, I think you can get away with a lot of things there, so, but yeah, certainly we're, you know, the jury's still out on some of this, but thank you very much, we're a little bit over time, so if you guys have further questions, please come and ask the panelists, but we're going to go ahead and adjourn this, so thank you very much for coming.

labrum tears

hip joint

management options

repairing the labrum

labrum reconstruction