Good. So this is a talk that Mark Philippon and Karen Briggs put together, and I threw my name on it just so you know I'm not Mark Philippon. Disclosures have not changed. So what this talk is about is basically addressing chondrolabral dysfunction, and the important thing to understand is there's a transition zone on the histology between the Highland cartilage and the labrum, and basically disruption is very common with patients with impingement as well as dysplasia. This dysfunction basically disrupts this fibrocartilaginous ring, and effectively there's been some studies, this is a finite element analysis from 2016 from Weiss et al., and basically they're looking at dysplastic hips and gait, but effectively the more damage you get, the more stress you can see across the cartilage, and that's why I think people become more and more proactive with making sure that this chondrolabral area is repaired and restored. So where do we see these problems? Primarily labral tears and chondral injury. They usually are hand in hand, so if you discuss with a patient that you have a labral tear, it's very good to also tell them they likely have chondral problems as well, because these zones are contiguous. There are debates as to whether preserving that chondral tissue makes sense. There's definitely some studies that have supported preserving the tissue, and there are other studies that sense that it's just necrotic, basically it's like an apoptosis. So I would come out and say that my personal opinion is to debride what you think is dysfunctional and preserve what you can. What do you often see? It's basically detachment of the labrum, disruption of this junction, and then you'll see this wave sign or chondral softening and delamination, and it's very good to be observant. This arthroscopic probe is definitely a must if you're going to be doing a diagnostic examination. What are the goals? Well, you want to try to preserve this seal. You want to stabilize this junction and try to preserve not only the labrum but the chondral surface. There are different procedures available, and more recently in the last few years, people have used biologic adjuvants to help. So in a labral repair, what you're trying to do is seal this area to try to unload the articular surface with the idea that the labrum is providing some protection. And then if you've got a flap, you may try to either use fibrin glue or repair down a flap, but it's not unusual to do what you see here, which is basically use a biter to get that down to a stable edge. So I'm not an advocate of this, but again, this was a talk prepared for this meeting, and some people do advocate judicial use, I should say judicious use of RF. This is a TAC-S probe, and you can actually go in and try to anneal or seal this area down to provide continuity across this space. The important thing is to try to limit the damage that's already occurring. So once you get something that's unstable in the joint, that mechanical stress continues, and you want to try to maintain this for fluid hydrostatics as well as gross stability. So in conclusion, this transition zone contributes to the proper functioning of the hip joint, specifically this labral seal mechanism. Disruption is co-existent with FAI-type pathology, which is often seen in athletes, which is the point of this session. And these lesions definitely vary. You want to be smart about preserving flaps when you can and debriding them when you think that they are going to be symptomatic. And then ultimately, you want to be able to alleviate the mechanical source of this. So if you do fix the chondrolabral area, if you've addressed dysplasia or impingement at the same time to protect that repair. I would please advise you, if you have not already, please join ISHA. If you can, I realize you're ANA members, but we have a lively society. The meeting this year is in Madrid in October, and we'd love to have you all present. Thank you.

chondrolabral dysfunction

transition zone

histology

labral tears

chondral injury