Good morning, everybody. Lou McIntyre, going to talk about bioinductive scaffolds, something I've really become interested in over the last five or six years. Disclosures are in the handout. So, you know, here's the problem, right? Tissue quality, right? Poor healing milieu, decreased vascularity, fibrosis, and then you've compounded that with tissue loss, trying to get this to heal, I think is a heavy lift. And if you look at the literature, certainly the literature reflects that in the high re-tears or failure to heal rates. I think it's rather the latter, not the former. I think really what we're trying to do is get these things to heal. They don't re-tear, they don't heal. And so that's really led to a great effort to try to increase the biologic effectiveness of our healing with, you know, whether it's bursal tissue or PRP or bone marrow aspirate. And lately, these biologic scaffolds, I don't think they're so much inductive as they are just collagen implants. It's putting collagen in where it's needed. It acts like a sponge. It soaks up all the blood and cellular elements and holds it where it's needed. So the perfect scaffold would be sort of off the shelf, right? Wouldn't be too expensive. It'd be easy to implant. It would be relatively inert. It wouldn't be so inert that it wouldn't cause healing, but it wouldn't be so inflammatory that it would cause an inflammatory reaction. It would accelerate healing, and it would result in tendon-like tissue, and then it would just go away, right? So we have a couple of these things on the market. Here's one that's a xenograft that's made from bovine Achilles tendon. And in the sheep model, it shows that it can really increase the tendon thickness and healing, and it goes away by three to six months. And then there's another scaffold that's made from electrospun collagen that's a composite with a PDLLA, and this in a rabbit model has shown increased alignment of collagen fibers. And in 1,600 cases, there's been no inflammatory responses in regards to bursitis or adhesive capsulitis. Then there are composites with other elements that actually can share a load. That's really interesting, right? I mean, these other devices that I've shown don't share any load. They're just meant to increase healing. This can actually share a load, which is really interesting, right, if you think about the ways we could use this. And then there are interpositional grafts that really don't have collagen in them, but are synthetic and are purported to actually recreate the footprint in a sheep model. And there is some evidence on this. We've published on this. We had a registry with 500 patients in regards to partial thickness tears. Certainly, this is level four evidence and really is more safety and efficacy than everything else. In the full thickness environment, the same, but we did an ad hoc analysis on this also and showed that there may be some value in this in regards to the large, massive, and revision tears. And Buddy has sort of proven that with a small study level four with really amazing healing rates, 100 percent in the primary condition and almost 90 percent in the revision condition. You know, level four, not a lot of patients, but something really intriguing. But if you're looking for evidence, it's emerging. These are two randomized clinical trials that have shown increased healing rates with the bioinductive, really collagen implants out of Spain. And there are currently six clinical trials underway. So this is an emerging technology that is only going to improve over time. It's going to help us take care of our patients. And I think it's something to pay attention to. We just published this economic analysis that shows that basically that 13,000 is per 100 patients. So the cost per patient per healed rotator cuff tear is about $130 for this. So if you're looking to hang your hat on a reason why you should do this economically, there is some evidence to that. And if you look at all the different comorbidities associated with rotator cuff tear, whether it's large, age, you know, hypertension, et cetera, it actually improves over time. And if you consider all of the costs associated with rotator cuff repair, you know, time out of work and things like that, it certainly, this comes out better. So when do I use this, which is what really everybody is interested in? You know, you really have to justify the cost because these things are costly. And really, they're mostly not for load sharing. They're really just to help healing, right? So impartial thickness tears that have failed conservative care. And conservative care in my hands is steroid injection and physical therapy for at least six weeks. Large tears, right, if you look at Buddy's work. Any kind of revision situation with rotator cuff tear I think is something that's you should consider this. And, you know, other comorbidities like hypertension, diabetes, smoking, things like that. So this is an emerging technology. It's one of the things that's really exciting, I think, about orthopedics right now and something we should pay attention to. Thank you very much. Thanks, Lou.

bioinductive scaffolds

tissue regeneration

healing

scaffolds

inflammation