All right. Thanks, Alan. I'm a little behind the eight ball, obviously, with open. Patrick, close your ears. He doesn't like to hear about this. All right. So, assumptions. I have four minutes. No hyperlapsity, on-track lesion. He needs stability in motion. He plays in high school. He wants to play in college. So, why did we start arthroscopic stabilization anyway? I was fortunate to train during the era of kind of transitioning from open to arthroscopic. So, I've seen and I've used all these devices, but we never had a significant failure rate of open shoulder stabilization. What are we treating? Detachment, stretching, proprioception. And I think these things can only be truly addressed with open surgery. So, this is the classic. I trained at Columbia, Neer and Foster, 97% excellent results with this method. And we'll go through some of the technical aspects of it as well. So, open stabilization has these simple, straightforward tasks that we have to achieve. And, you know, through a pretty small inferior axillary type-based incision, you can get to where you need to be, do what you need to do and get out with repairing your subscap. So, left shoulder, this is probably the hardest part of the procedure. We're detaching or incising the subscapularis tendon off the underlying capsule, which is what we will then shift and repair on the medial side. And especially in revision cases, this can be a little bit daunting, but if trained well, you can get to the glenoid from the anterior approach. Now we're titrating. Once again, left shoulder, we've left capsule on the lateral edge for later repair. And now we're incising the capsule. And we can titrate how much capsule we want to release. So, we really can't do that arthroscopically. Maybe how much do we take? How much do we placate? I can release exactly as much capsule as I can to remove the redundancy in the axillary pouch. And now we can visualize great visualization of the medial glenoid, putting our anchors exactly where we want, double-loaded, triple-loaded mattress. Now we do mattress repair. We're bringing the sutures out medially through the medial aspect of the capsule, inside out, and we'll tie down on the outside part of the capsule. Subscapularis is retracted medially. So, you can see we've gone from a bald glenoid to essentially a sheet of capsule from top down, all the way past 6 o'clock to 7 o'clock. It's indestructible. The shoulder can't come out anymore. On the lateral side, we do a balanced capsule shift titrating. For throwers, we want to have the arm in more abduction external rotation, so we do not restrict range of motion, which is one of the cons that are suggested for open stabilization surgery. And if you want to, you can add a little, through open procedure, a little long head biceps dynamic anterior stabilization as well. Mike wanted me to put that in there. He loves this stuff. All right. So, we can go through all the literature. You can find whatever literature you want to support. There's tons of literature that supports that open has a lower recurrence rate without any loss of range of motion. And you can read through all these papers as well, and you can find what you need. But there's plenty of literature to support open procedures for stability. We just got this published. My partner, Dr. Wright, about exposure. So, the biggest reason why probably is no familiarity with the procedure. You can go to a lot of institutions now, even academic, and residents will not even see an open procedure by the time they graduate and finish. And so, by reviewing the ABOS data, you know, we show that just because you don't see it doesn't mean you shouldn't teach it. So, issues with arthroscopic repair, perfect titration, no spot welds, yes, cost high, relatively lower success rate, and there's never been an issue with subscap published in the peer-reviewed literature. So, I'll finish with this. My esteemed colleague, Mary Mulcahy, if you look carefully at her paper on shoulder arthroscopy, return to sport, 66%. Sixty-six minus, 97 minus 66 means it's a third better. All right. So, obviously, I'm the winner. Winning, Dr. Near's the man, and please support shoulder week. Thank you very much.

open shoulder stabilization surgery

arthroscopic methods

recurrence rates

surgical techniques

medical training programs