Thanks, guys, and thanks, John Kelly, for a great meeting. We now have seven-year follow-up, so I'll just give you that information. My disclosures are in the program and there. This is an update on our prior results of looking at focal excision versus labor repair. So initially, we presented at the academy at 10-month follow-up that there are really no significant differences between the groups. And then at 19 months, we saw significantly better good to excellent results in our refixation group compared to the debridement group. And then we followed this up with mean three-and-a-half-year follow-up, and really the results were maintained in both groups, being better in the refixation group. Our hypothesis all along was that labor refixation would result in improved outcomes compared to labor debridement when performed as part of an arthroscopic joint preservation procedure. So beginning in 2004, we began arthroscopic room resections for pincer-type FAI with a focal labral debridement or excision. And in 2006, we began labral takedown and refixation. We had a detailed evaluation of all patients undergoing labral debridement prior to performing refixations, and then compared these to a consecutive group of labral refixations. So in Group 1, the inclusion criteria, they had FAI, labral pathology that after review was deemed repairable with our current techniques, performed prior to our first refixation and minimum two-year follow-up. And in the refixation group, they had FAI, a labral refixation, and again, minimum two-year follow-up. So we had a total of 100 HIPs that we've had throughout this study. All 100 met the inclusion criteria and achieved minimum two-year follow-up, and our mean follow-up now is seven years. In Group 1, there were 46 HIPs, mean age 33 years, and a mean follow-up of 7.22 years. And in Group 2, there were 54 HIPs with a mean age of 28 years and mean follow-up of 7.06 years. We did perform a power analysis, and in order to see a clinically significant difference, needed 29 patients in each group, which we did achieve. For our management of pincer-type FAI, we performed a labral debridement versus takedown. A rim resection is seen here, and labral refixation if there was good tissue. For management of CAM-type FAI, we performed a femorosection osteoplasty as seen in these pre- and post-operative radiographs, intraoperative floral assessment, and then a typical dynamic assessment which we've described previously. Pre- and post-operatively, we had VAS pain scoring, SF-12 scoring, and modified Harris HIP scoring. And we looked at the alpha angle on the AP and lateral pre- and post-operatively. There were no significant differences between groups for gender, age, tonus grading, FAI classification, or outcome scoring. There were no statistically significant differences in the overall femorosection between groups on both the AP radiograph and lateral radiograph before and after. Modified Harris HIP scoring was significantly better in the refixation group at mean follow-up seven years, with the latest score being 90.5 in the refixation group and 81.4 in the debridement group. And we also had significantly better results in the refixation group for SF-12 scoring as well as VAS scoring. So our mean update seven-year follow-up, good to excellent results, 47.7% in the debridement group versus 86.3% in the refixation group. Failure rates were 29.6% in the debridement group versus 13.7% in the refixation group. So initially this was described out of burn. They had two consecutive groups of labral excision versus labral refixation utilizing a surgical hip dislocation. At two-year follow-up, better results in the refixation group. And recently, impressively, at mean 13-year follow-up, they looked at survivorship, which again was much better in the refixation versus the excision group. So we simply copied this type of technique using an arthroscopic approach. We had consecutive patients, again, labral debridement versus refixation. At three-and-a-half-year follow-up, again, our results were better in the refixation group for good to excellent results. And now at our current study at mean seven-year follow-up, the failure rate was higher in the debridement group. Good to excellent results are better in the refixation group. And really, our results dropped in both groups, but the disparity has increased between groups favoring labral preservation. The strengths, we compared debridement to refixation. The debridement group, we only included labral pathology. Those felt to be repairable prior to the refixations. Prospective data collection, single surgeon, and all had a pincer component. Certainly there's use of a historical control group and a better understanding of FAI over time. In conclusion, longer-term mean seven-year follow-up revealed a drop in patient-related outcome measures for both groups. But the longer follow-up, there was increasing disparity in outcome measures between groups favoring labral preservation. These are consecutive groups with slightly different management as our technique has evolved. And the question is really whether the differences over time relate to labral preservation or overall improved technique in managing FAI. Thank you.

long-term outcomes

labral excision

labral refixation

femoroacetabular impingement

FAI