What do you think that's different between SCR dermal that we're doing down in North America compared to your fasciolata harvest? Yeah, please forget the dermal graft SCR. Actually, they're totally different animal than dermal and fasciolata SCR. Actually, the dermal graft SCR, of course, the poor healing response, and also the biomechanical less. So that's why the American doctors result is less, and now some doctors already stopped to do the SCR. But actually, fasciolata SCR in Asia is increasing because of very nice results. So I really recommend to switch to the fasciolata SCR. So very totally different. Can I ask a question to John? Yeah, go for it. My patients also complain about their portal sites. This isn't going to fly, Philly, okay? Yes. Can I ask a question? So just to make it slightly more spicy, if that patient has no teres minor and you have advanced fatty atrophy, would you try to still attempt to do postural repair? Yeah, because the fatty atrophy thing is very confusing because oftentimes the tendon is medialized, and you see the lateral aspect, and when you pull laterally, it looks better. I look at the patient. If they have any semblance of a forced couple, which this patient did, then I say to them, I can help you. And one of the things is really the subscap is the answer. We miss subscap tears. We forget about Steve Burkhardt's work on the forced couple. You get the lower infraspinatus and the upper subscap back, and you release the inferior capsule. I'm not selling snake oil. I've got a lot of happy patients. You can get some portals, or you can get filleted open, you guys. What's your choice? I don't know. That was a beautiful slide, awesome, of scapuloskinesis, by the way, you showed. So just to follow up to that, John. I don't call it the skinesis, by the way. It's a stem. Yeah, right. I got a bridge I want to show you in Brooklyn, too. In terms of the repair, right? So one of the biggest things with these massive tears is it doesn't seem to matter if we can get tissue down. It matters several years afterwards to get it to heal. I saw you had different options in there. I saw you had grafts, augments in there. What are the tricks to get this margin convergence to be able to heal? Well, I think the key, as I've learned the hard way, Ivan, is inferior caps release. And what I've learned through Alan, and I've learned through Joe Abood, the balloon, the biceps, if we can get the head down, and as you said, Basim, I think nature takes over. Getting the head down restores the fulcrum. And if you can do that in any way using the biceps, I've been using the biceps all the time whenever I can, and inferior caps release, and I get the infraspinatus up, then I just immobilize them through Steve Burkhardt very slow. I don't use biologics. They don't pay for my hospital. I do micro fracture. I burn the tuberosity, and I hold them very, very long. And I use grafts, too. So one more thing after that is how do you know when the head's down? Because when you put them up, especially in a lateral recubitus position without traction, they always seem down right away. Even a high-riding head and even a lateral recubitus, I use 15 pounds of traction, and after I do an extensive release, and I call Father Tokish, then I know I'm down. And I've got to see it. If I don't see it down, I'm like, we've got a problem. Then it's like Southwest Airlines, when I get away. Then you do lower trapezius. Okay, JT. When that nerve goes to that, that head falls down a little bit, too, there, John, for you. First, I'd just like to say what a terrific debate. Thanks, JT, for that wonderful affirmation. Classic. Everything I said about you, I take back. A classic and a debate. Really awesome. Here's a question that I don't know the answer to, and I'd love to. I've never understood. We can't get a rotator cuff to heal, which is autograft essentially at your own thing, right? We're still looking at 25%, 50% failure rates in these chronic retracted tears. They just fail. We've all seen it. And yet, you guys show allograft in both situations, right? Because you've got to take the Achilles, you've got to take the tensor fascial autograft, but it's still dead tissue. What's the secret? Why is it that we can get those grafts to heal on the humerus and we can't get the cuff to heal even when it's not under tension? What are your current thoughts in that regard? And then just as a follow-up, are you considering, because augmentation is becoming such a big role in rotator cuff as an augment, and I'd just like to hear both of your, all three of your thoughts on augmentation. Thanks. Thank you very much. Actually, healing autograft fasciolata, it's excellent. Actually, the biological study using rabbit, actually it shows the regeneration of the cartridge insertion. And also, I have second look many times, and actually we could see the remodeling. Even though the dermagrafts show it's not the remodeling, you cannot expect the remodeling. Autograft auto is actually a complete difference for autograft. So that's why, actually, I recommend autograft fasciolata. And also, again, the auto, we can expect the healing, very nice healing and remodeling. So, yeah, that's my answer. Good. Sorry, just before Bassam talks, can we just switch over to the voting, and then please, Bassam, last answer. JT, I thought about this one as well. And, in fact, there's a paper right now from Korea showing 85% to 90% healing rate at even one year. But I think this is, you show the case with an allograft, tibial plafond. It heals. Why does it heal? It's an allograft. I know this is bone. But the difference is we all talk about the degenerated rotator cuff. The quality of the cuff is different. It's degenerated. It could be pathologic. When you get the healthy Achilles tendon allograft, it's healthy. You put it on healthy bone, you debride it, it can heal. This is my theory about it. Well, the numbers show themselves, folks. No further questions. And is it really tension-free? That's in most of the cases. It's mostly dead, mostly tension-free. Anyway, thank you very much. Fantastic faculty, fantastic panel. Appreciate it.

dermal graft SCR

fascia lata SCR

North America

Asia

rotator cuff tears