Thank you, Chris, Vikas, Mike O'Brien for the invitation to follow Pascale Bellows. That's very humbling. I'm going to go ahead and argue for arthroscopy alone. This is going to be fairly a rapid fire, but we'll go ahead and advance the slide, please. I guess I can do it. Good. Disclosures as listed. So arthroscopy solution, three main reasons. Number one, we treat the patient, not the x-ray. Number two, we have over 20 years of literature support with arthroscopic outcomes. And number three, the arthroscopic solution addresses the pain generators and minimizes risk to this type of patient. So this is the first thing. Treat the patient, not the x-ray. This is Adam Ann's work with us. We basically went back and looked at all these acetabular metrics that we look at. So we consider borderline dysplasia to be a latter center edge angle or Weiberg angle of about 20 to 25. And what we found is if you actually look at coverage within the joint as well as volume, it's very a poor indicator of that, right? And so you can't necessarily trust what you're measuring. You have to have gut instinct on this. So poor correlation. Number two, we have over 20 year history of literature now supporting arthroscopic advancements in techniques in borderline dysplasia, starting with Dr. Bird's work in 2003 and most recently Lee did a meta-analysis of the literature showing greater than 75% long-term success. So you really have to focus on restoring the anatomy in these types of patients. Number three, the arthroscopic solution addresses what causes the pain we think in these patients and minimizes the risk. But to do that, you have to minimize your capsular exposure and avoid compromising the iliopsoas, preserve, reconstruct the three, what I call soft tissue rings, which are the chondrolateral junctions, zone orbicularis, and capsule ligaments complex. Avoid unnecessary resection of the acetabulum. Number four, avoiding labored abreatment when repair should be possible or reconstruction. And then being able to dynamically assess that hip to decompress any kind of CAM impingement or in this case, possible subspinal impingement. This is our basic technique. We use two portals. We've actually lateralized that or modified the anterior portal from the original description and we do that to avoid compromising the iliopsoas space. We've been able to use a lot of devices over time. Our anatomic footprint's very small now. We're actually using cannulas that are getting as small as a few millimeters and so the compromise across the capsule is limited. What's the difference between closing and a capsuloraphy? There's often debates about this. I consider a closure volume preserving and a capsuloraphy volume reducing. And when do we consider each? Well, typically if we're not doing a lot to the capsule, we'll leave it alone, especially if we've got good congruency, maybe some arthritic change, and we've been able to preserve those three soft tissue rings. However, if someone comes in and they do have some symptomatic hyperlaxity or complaining of some instability, we'll consider a volume reducing surgery. Postoperatively, we do brace. We do consider this to be a part of the rehab process. This is good for postural control as well as balanced kinetics. So in summary, I recommend choosing arthroscopy for these types of patients because we're treating the patient, not the x-ray. We have over 20 years of literature support and we think that arthroscopy in its modern form has really advanced the science of treating patients with borderline dysplasia. So thank you and thank you to my co-debater, Dr. Moran, who I'm honored to be up here on the stage with.

arthroscopy

borderline dysplasia

standalone treatment

individualized approaches

modern healthcare practices