Come on up to the mic, any questions? Don't be shy. Brian Kelly, thank you very much for asking a question, that way I didn't have to get a text from you. Those are all great talks, and it is great to hear people in person, not look at them on the Hollywood Square as things, but this question, I guess it's kind of maybe for Ben, and anybody else who has any ideas on this. In the primary setting, I just, in my practice, I haven't seen circumferentially deficient labral tissue, and so what, do you see that commonly, and how do you, how would you explain posterior labral deficiency when most of the pathology we see is anterior from the impingement? Yeah, I wouldn't call it common by any means. Does that not work? No, no, no. The setting in which I see it most commonly in the primary situation is basically a calcified labrum, or a barely existent labrum in like a coxa profunda type of situation. So in that case, if you think that you've got a captured hip with global overcoverage, for example, whether it was always that way, or whether it calcified and became that way, you basically wind up resecting bone, and you don't really have labrum to repair. So what we did in, once you're done correcting the bone deformity, so in years past, we would leave that with basically no labrum, and a lot of those patients did okay. Probably some didn't, and there were some studies on labral reformation, and I think there was even an animal model that showed the labrum can reform, so maybe it can. I think that in that setting where there's no labrum to repair, I think the literature leans us toward the conclusion that a labral reconstruction might provide improved outcomes or more consistent outcomes. But I do recognize that an alternative, and something we've done a lot in years past, is leave it. Great, thanks. Great, thanks. Dr. Carrera, a quick question for you. You used that word old during your presentation in terms of having a high-grade cartilage lesion. From what you've learned and what you've seen from this, if you have a 35-year-old male that has, radiographically, tonus is still under two, but inter-articulately, a lot of exposed articular surfaces, from your study, what are you taking away in terms of telling your patient how they're going to do afterwards? I think that the high-grade cartilage injury definitely portends a negative prognosis. I think that's been shown, I think, well in what we've studied. I think one of the problems has been that prior data has shown that there wasn't a difference, but exposed bone is definitely a negative prognosticator. All these minds in here are wondering what you tell your patient after the surgery. Did your decompression, labrum was fixed, high loss of cartilage, what are you telling your patient based upon your data? I always tell the patient before surgery, I'll give you an updated prognosis after surgery. If there's grade four damage, I do decrease the efficacy, I might say, anywhere from six to eighty percent. I never really have huge cartilage defects that are grade three or four, and that's been the experience of the group, but the size of the defect, I think, definitely matters. I frequently tell them, we don't have enough good data related to the size of the lesion, so if it's a smaller lesion versus a larger grade four lesion, I think we really lack data on that. Mike, another question? Yeah, I was going to ask Dom a similar question in that, based on the parameters that you have, maybe even in the preoperative setting, is this something that you prepare them for and then does it change your management intraoperatively? So if you know that they have a lower ability to achieve the symptomatic score, does that change to doing a debridement and staging them for a total, or do you plow forward with your decompression and labor repair? I definitely go forward with the procedure because I think the majority of them still do well. So the question is, if we really knew, ultimately, statistically, how well they will do, then I would potentially abandon, or I think more importantly, adjust microfracture versus chondroplasty because the recovery is so different. But we really don't know and the larger defects, I think the majority of us would still microfracture, but there's still data missing and I think that we need more data, basically, to really answer that well. Perfect. Well, we're going to move on because the next panel, oh, we've got another question. Thanks. You weren't supposed to let him up, Winston. You just tackled right there. I snuck around him. Go ahead. Quick. Yeah, Alan Zhang from UCSF. I know you guys saw that the severity of the acetabular cartilage injury is associated with, I think, male sex and BMI, but did you guys also look at severity of impingement, like a larger CAM lesion, alpha angle, or a pincer lesion? No, we didn't. Okay. So I'm excited to introduce, is Tom Byrd here?

Q&A session

hip injuries

circumferentially deficient labral tissue

labral reconstruction

prognosis for high-grade cartilage injury