Any question from the floor? Any question from the floor? OK. Emilio, there are many of these collision athletes that they have different Bayton scores. After your letter J, what do you do with the capsule? Do you fine-tune the capsule depending on the Bayton score, or you don't worry about that? That's a very good question, because initially, when I started doing open letter J, I used to repair the capsule. I started doing arthroscopic letter J without repairing the capsule, and now I'm repairing back the capsule. I think the capsule can be important just to keep the bone out of the joint and also to help with the stabilization process. So I try to repair the capsule. I try not to over-tighten it, even in hyperlaxed patients, because letter J is so safe that the stabilizing effect of the conging tendon prevents any anterior movement of the capsule, anterior subluxation, because of the conging tendon. So it isn't a matter of concern. Robert, what are your technical tips for re-emplissage? What do you do to avoid losing internal or external rotation? Do you have some tips to share with us? I think just choosing to not re-emplissage Hill-Sachs lesions that are very medial is the key, and if they extend medially, to try to be judicious about placing anchors that far over. Yeah, technical tips. I still do this in a way that I visualize in the subacomial space, and I tie sutures there. I've actually seen some complications referred. Re-emplissage is very low reported complication rate in the literature, but I've actually had a couple of patients referred that had some scarring in the subacomial space, or the internal deltoid fascia or the deltoid was included in the re-emplissage. And so for me, I like to visualize there and make sure that that repair is safe. But it is a relatively straightforward technique arthroscopically, if you're an experienced arthroscopic surgeon, I believe. Many times in this collision atlas, we see the Hill-Sachs lesion and a cartilage breach between the medial lesion and the calf insertion site. Do you remove all those cartilage, or you put your re-emplissage laterally? No, I prep the lesion as is, and try to inset that capsule of myotendinous tissue, whatever you're grabbing, into the lesion at the more medial aspect. OK, Emilio? I think this is a very interesting case, because there are cases where the Hill-Sachs defect is very medial. And if we do the re-emplissage at that position, the risk of restricted external rotation is higher. So it is a very good question. Should we remove the bony breach to put the anchor in that area? Should we leave it the way it is? Because we can take the risk of limiting external rotation. Alan, what would you do? Do you take your shaver and remove all the cartilage in order to get the re-emplissage far medial with your anchors? I worry about going too medial, because I think that with the re-emplissage, basically it works because it tethers. It creates a tether that prevents anterior subluxation. And so I worry about just what you guys were referring to, when it's not that common, but sometimes there's a significant cartilage bridge and then a medial indentation in the head. And in that situation, I'd almost do more with, Emilio said, and I'd bridge the glenoid, and I would leave that alone posteriorly. OK. No question from the floor. And return to sports, Emilio. Do you have a three-month CT scan to know the bone healing? And after the bone healing, you tell the patient that they can do whatever they want? Or you have some time, strength, a score to return to play collision sports? That's an excellent question, because one of the hypotheses could be that latter day is more efficient returning back to sports, because it is more solid, the construction. I used to do a CT scan of four months just to make sure that the graft has healed. But now we are undergoing a study trying to compare the isoconnective performance postoperative isoconnective performance of Bankart or Bankart per remplisage versus LatteJ. And it seems that the recovery is faster with LatteJ. Thank you. Connor? Yes. Rob, is there a number where you don't do remplisage and Bankart? What algorithm do you use where then you go to a bony procedure or something else? You're talking about glenoid bone loss? Yeah, 20%. Although, I think the range, Patrick may need to weigh in on this, the average glenoid bone loss in that study was around the number for this case. But the range was quite high that you reported, so there were clearly some patients who had more than 20% bone loss in that study. For me, I think 20%, 20%, 25%. Of course, it's hard, because the glenoid is so small that that's like a millimeter. Yeah, I know. And you prep it, and then it changes to. Right, exactly, yeah. But I think something like that, 20% to 25% for me, means bone. Thank you. Patrick, short question? It depends on the patient, I think. You can get away with it if it's somebody who's like 35 and they're lower demand. I've done remplisage, and we've published that in patients with 25% or more. I would navigate that across. Thank you. We are running out of time. Please vote. Vote for the two speakers, please. And also vote for best slides. Look at that. Very even, eh? Very even. Come on. Oh, come on, you came all the way from Spain. Kind of, California. We have to keep on going. You need to call some friends, Emilio, as we do in Argentina. Call friends to vote for us. Come on. There should be a sympathy vote here. Come on. Encouraging. All right, thanks, guys. That was great. Thank you so much. Thank you.

shoulder surgery

collision athletes

capsule repair

Hill-Sachs lesions

return to play