Excellent talk. Thank you, Alan. Next up is not Dr. Philippon, but Karen Briggs, who is more than adequately filling in for him. Thank you for being here, Karen. Yeah, we'll see. So everybody knows I'm not a surgeon, but I know the data, so we'll go with that. Oh, there's Dr. Philippon's disclosures. They should be updated with the Academy. I got a list of details of what they wanted to say. So the first one was the definition of labral deficiency. So Dr. Philippon has a lot of different definitions, but the number one is, can the labrum maintain the seal? And it has to maintain the seal for the nutrients of the joint fluid, for the pressure, and also for stabilization. And we did several biomechanics studies to show that, yes, the seal can be recreated with a labral reconstruction, decreasing the loss of distraction force and decreasing the loss of stability. And therefore, he felt that the labral reconstruction could recreate the seal. And then Dr. Philippon has always used six millimeters as the height of the labrum. That's always been his cutoff, but we had to go through and prove that. So they did a biomechanics study, and they showed that less than six millimeters, you end up with decreased distraction force to suction seal rupture and decreased peak pressure. So from there, the study concluded that labral volume is critical to the hip joint health and stability. So from that, he came up with this labral treatment algorithm. And you can see that for the degenerative and absent, there's augmentation and segmental reconstruction. There's nothing for circumferential reconstruction. He doesn't really do that, so I don't have anything on that. So the labral reconstruction technique, he described it, first of all. Then we did biomechanics to support the use of it. And then finally, clinical outcomes at 10 years out. And then there was an idea to maintain some of the natural tissue that was there instead of debriding it down. And that became labral augmentation. And in a select group of patient, augmentation did result in superior outcomes. Although lots of times, they're for two different types of patient. So what are the indications? Well, if it's irreparable, it's degenerative. If it's ossified or hypertrophic. And then if there's just an absent piece. As you can see in the bottom, this one has a certain part of the labrum's there, and all of a sudden, it's just gone. So that one would be a segmental reconstruction. And the top, you can see the blood leaking out of the seal, showing that the labrum cannot maintain the seal and the pressure within the joint. So luckily, we have arthroscopic techniques now. We published a paper on the reconstruction using the iliotelio band, and then the augmentation. So you can see both of those techniques in arthroscopic techniques. Another thing about the labral augmentation, it not only increases the volume, but it also can create space between the labrum and the capsule to avoid adhesions. So sometimes, any kind of repair gets close to the capsule. That's a common place for adhesions to form. So the graft kind of pushes the capsule away from the repair, allowing it—we've seen less adhesions due to this. And then we did 10-year outcomes. These were early on, so a lot of them had the 2 millimeters or less of joint space. So we had to go back, because now that's a relative contraindication. You rarely does anybody with less than 2 millimeters. So we went back, and we did all the old ones, and the failure rate was 30 percent at 5 years, but that's with 2 millimeters. But then if you take all those 2 millimeters out, the failure rate at 10 years is 12 percent. So that's something that, again, shows that we are advancing the science through the research. There's pros and cons to both of these. Obviously, it's more complex. Some people talk about loss of innervation and also potential donor site morbidity, but a lot of times, he does use an allograft. So in conclusion, they can recreate a native-like state when labral tissue is gone. It can repair the seal and lead to less—stronger distraction. Successful clinical outcomes has been shown, and our further research is going to look into ways to prevent failures and early revisions. And this talk and our work is thankful to Dr. Richard Steadman, who started the foundation in the early 90s, and we'll miss him forever. Thank you.

Karen Briggs

labral deficiency

joint fluid nutrients

labral reconstruction

labral treatment algorithm