Wow. Well, that's pretty scary, Lori. Thanks for that. Well, I do appreciate both speakers really talking about risk stratification, because I do think that's the critical point here, and that not every case is the same. Dr. Figueroa, do you want to kick off with some questions? Yes, I would like to start with Corey. In this specific patient that we presented, what is your rate of dislocation based on your experience? So in repairs, I think they do extremely well. I'll be honest, in real practice, I tend to go right to a reconstruction, especially in a rugby or a football player, and I do a repair on top of that, to be quite honest. In my hands, I think it adds a little bit extra in someone that has a high risk of re-dislocation from the sport that they play. Could you tell us a little bit more about the surgical technique that you perform? So, yeah, I mean, I do MPFL the same way. I think the only difference is instead of not taking down the capsule and staying fully extra articular, in this case, take down the capsule, get that piece of bone back so you can do a capsule repair, as well as do an MPFL over the top of that. So, Lori, you know, 30% is still not 0%, and Corey showed a case which is kind of everybody's worst fear. Can you talk a little bit about how you discuss this with the patient if you are going to proceed with conservative management? Well, I think in all these athletes, your timing of the injury and surgery is paramount. So, you know, if they're five weeks before the Super Bowl, if you operate on, he's not in the Super Bowl, right? So I think the timing of their season is key. I think I look at even more risk factors that are labeled in those scores. So I think those would feed also into it. And looking at their neuromuscular control. So, again, if they redislocated and they have terrible neuromuscular control, that's not someone who's going to be back at four weeks because they probably shouldn't have been out there in the first place. So I think there's a whole bunch of other things outside of what we have on those scores and what we talked about that all go into the decision making. And I think patient, you know, the patient's own feelings about it, obviously, like some are nervous, some want surgery, some don't want surgery because they want to play. So I think all those things matter. You know, if they're at the end of season and they have the next four months off, I'd probably consider fixing them. So I think those things all matter. Great. I have a question for Lori also. Lori, does always the finding of a nostrochondral fragment change your mind in terms of non-conservative to surgical treatment? Yeah, 100%. I think that's the one thing we're all really clear on is if there's a fixable osteochondral fragment, they don't get much choice anymore. They get that fixed and then they get an NPFL reconstruction with it and their season will be next year. I think this is a really good point about the reconstruction. And so, Corey, you touched on this a little bit, even though your debate was for the repair. Can you talk a little bit about why you would in your practice lean towards a reconstruction over a repair? I don't think a repair is a terrible option, you know, but even though the data says that there's percentiles, I think that with the bony avulsion, even that, there's still going to be some injury to the tissue of the NPFL complex. So I think, yes, you can repair that, but if somebody that you're committing to going through a surgery and a rehab process, adding the extra tissue and stability in a, you know, proper way, I think, is just the better way to do it. If you're going to commit to go down that path. Great. Laurie, in the details of the non-aggressive treatment, as you state, could you tell us some details about the immobilization? Do you really use brace? Do you use gauze? What do you use? So, yeah, I hate the word conservative because that sounds like you're not doing anything. And actually, if you're treating them non-operatively, as in without an operation, you're still actually being very aggressive. So, you know, we go back to the principles of injury. So if you dislocate your patella and all your medial structures are stretched out and ripped and torn, and if you took an x-ray of that patient, they probably have a huge amount of tilt even because they've ripped apart their medial side. And their patella probably subluxes laterally in response to that. If you stick them into extension straight, all those tissues are going to heal in a lengthened position. So it's no wonder with all these studies of previous non-operative treatment, the patients did really crappy because we let them heal with that MPFL in a lengthened position. I don't actually think we know the answer of a natural history because we don't have studies actually putting the patella in the position where it should be in the groove and trying to let that MPFL and medial complex tissues heal where they're supposed to heal. So if those would heal in a good spot, which probably Patrick Mahomes did, that he might never need surgery again. But I don't think we treat people optimally with the bracing. So the one option is we brace them like 30 to 90 or 30 to full. So at 30 degrees, the patella should be in the trochlea and then if you keep them from going into extension where the patella will go laterally, then you can keep them in that reduced position while their tissue heals. Okay. Well, I think we're at time. So let's move on to the vote. Please vote. Magical vote. Of course, the chiefs had to win the war. Well, I think Lori scared everyone with her death comment. I think so. We trust to win. I know. Good. Let's rerun that if the chiefs were in the Super Bowl. Congratulations to Lori. OK. Thank you.

patellar dislocations

athletes

reconstruction surgery

immobilization techniques

patient preferences