Great, thank you. And thank you to Dr. O'Brien, thank you Dr. Tapasvi for inviting me. It's a pleasure to be here. You know, with all due respect to Dr. Toro, who's really an outstanding surgeon, there really is a better way. So here's my disclosure. So why don't these tendons heal on the articular side? Well, we know about the anatomy, the hypovascularity, but what about the mechanical effect? Studies show that there's strain adjacent to a tear, and that strain turns off a healing response. Is there a possibility of adding tissue, and essentially decreasing the stress in the adjacent tissue, and reigniting a natural healing response? And that's really the disruptive technology associated with this implant. We know it's a bovine type 1 collagen, and minimally cross-linked. Does it work? It certainly can in the right population, and in this case scenario, I think so. My very first case was a 49-year-old right-hand dominant gentleman with left shoulder pain. I'd done a complete and release on the right side, and now it's his left side, and he said, you know, anything but a complete and repair. So he was a perfect candidate, and you can see the findings on the imaging at the bottom. This is what it looks like arthroscopically. For the first 25 cases, we didn't debride anything. No confounding factors. Just laid this implant on, and you'll see here, again, the implant, our first implant. And this is what it looks like here, pre-op, 6 weeks, 4 months, and 2 1⁄2 years post-op. That's a pretty good-looking x-ray, when you think about what we did for this particular case. This is a pediatrician, 15-month history of chronic shoulder pain, recalcitrant, high-grade, partial articular-sided cuff tear, as you can see. This is what it looks like at the time of surgery. At this stage, we're debriding, so we get a better idea of the depth of the tear. We debride, and this is probably 40 or 50 percent, and very similar to the cases presented here. You can see a high-grade tear. We place, and now we look here. This is pre-op, and you see post-op, filling into that footprint. Again, very impressive imaging, at least I think so. Then here we are. This is a second look. This is a patient who did get stiff. This is what it looked like pre-op. Again, we're debriding to get an idea. This is about a 30 or 40 percent tear. We come back because of stiffness, and here you see the footprint fully filled in, essentially, at 4 1⁄2 months after the implant's been placed. This is an interstitial tear. You'll see pre-op and post-op, essentially a nearly 60 or 70 percent intersubstance tear, place of scaffold, and significant improvement within a two-month period. And here, this is a baseball player, got an early paint lesion you see on your left. We basically place this membrane, and here, 10 weeks post-op, that's completely filled in, and this is, I think, something we may want to consider in some of our throwers. We did a quick review of our intertendonous tears with at least a minimum 18-month follow-up, and the pros were definitely better in terms of VAS, and same in terms of imaging. Most had improved, if not completely healed. So what about clinical results? Well, Camacho-Chaconne has shown that this implant results in tendon-like tissue. There's complete implant integration without an inflammatory reaction. And then clinically, we'll look at Schlegel's study, Boker's study, all showing significant improvements after the use of the implant, and the degree of patient satisfaction in Schlegel's study was 100%. So if you look at transtendon, you look at the scaffold, this is pretty easy. Surgery is challenging. Joe's a very good surgeon, but it's challenging. Immobilized for six weeks. Pain is 11 on a scale of 1 to 10. Return to sports, six or seven months. The results are pretty good. Complication's pretty good in terms of low, and it's not that costly. You look at the implant, guess what, five or 10 minutes, and I don't think it takes that long. In one week, pain level, three on a scale of 10. Return to sports, faster. Complications and results are very similar, and it is more costly, but at the end of the day, I've got to tell you, if it's my shoulder, it's definitely worth it. So my recommendations for the implant are the younger, less than 50%, articulated sided tear, hopefully not retracted. I do believe that for the intrasubstance tears, it will be used more often, and for some of the throwers, this may be a solution in this very tough population. So with that, I have the great honor of introducing my very good friend, the best of the best from Buenos Aires, Professor Arce. Thank you, Reef.

implant technology

tendon healing

bovine collagen

shoulder injuries

clinical studies