Thanks, Chris. And thanks to John Kelly and Anna for having me do this. John wanted me to spice it up, so I'll spice it up here and give a strong advocacy of labor reconstruction is the only way, my disclosures. So over the past decade plus, decade and a half, we've learned to appreciate the labor from biomechanically as well as clinically in terms of being able to manage joint fluid, decrease compression on articular cartilage, decrease the friction on articular cartilage, and overall have concluded that it's probably better to have a well-functioning labrum than to not have one. Histologically, it's a fibrocartilaginous structure akin to the meniscus, as we know, and widely cited clinical studies show superior results with repair over debridement. So problem number one. So I really want to repair the labrum, because I know that it's better, but it looks like this. I would say that every labral tear, as we know, is a chronic injury, and there aren't a lot of places in the body where we repair chronic injuries of the fibrocartilage in an effective manner. So would we repair this type of meniscal tear? Probably not. Problem two. The labrum is a pain generator, as shown in this study by Haversath from CORE in 2013. Particularly situated in the anterior superior aspect of the labrum, there are quite a bit of pain-associated free nerve-ending fibers. So what we have in the hip arthritis world is a standardized procedure. Regardless of the degree of arthritis, et cetera, we can get a standardized procedure with a more or less standardized result. So in hip arthroscopy, if we have a labrum that looks like this, and we can convert it to a labrum that looks like this, where we're reconstructing it in a circumferential manner from the transverse acetabular ligament in the front to the back, and able to get a solid structure on there that is not painful, does not have free nerve-ending expression, and then restores the suction seal in a reproducible way, I would argue that that is a standardized solution to a problem. So this also obviates the need to repair tissue with limited healing potential. Obviously by taking it out, you're eliminating pain-generating tissue, and then I would say that with practice, you can develop a very reliable and reproducible result that is less reliant on the healing of patients' chronically damaged tissue. These are my results we published last year in AJSM. We had 162 hips undergoing primary treatment, 99 had repair, and 63 had primary circumferential reconstructions. We looked at two-year follow-up and found big differences between the groups from the standpoint of what we started with. So the group that underwent reconstruction was older, had higher BMI, higher tonus grade, higher pain scores, more severe labral pathology, and yet ended up with about the same failure rates of 5% in the repairs and 8% in the reconstructions, as defined by reoperation. And so both groups improved statistically in distinguishable degrees, about 30 on the IHOT-12 score in both groups, and this is despite much tougher patient characteristics in our reconstruction group. Lest the Donnybrook get out of control and you guys rip my face off, this is my algorithm that we used for, that we published a couple years ago in Clinics and Sports Medicine, for how to decide in terms of repair versus reconstruction. Other folks, Dr. Philippon was the first one to present his results on arthroscopic reconstruction and found, and most of these, half of these were, these were all segmental reconstructions and half of them were revisions, and at 18 months, mean satisfaction was 8 out of 10 and had Harris-Hippock's improvement of 23 with a 9% failure rate. Brian White, also in the revision setting, found that his re-repairs were failing at a 50% rate and the reconstructions were failing at a 12% rate, and more controversially, in his direct comparison of primary repair and primary reconstruction, found a 31% failure rate in his repair group and no, a 0% failure rate in his reconstruction group. So on to more of the Donnybrook, I know Dr. Dohm's supposed to present here, also I'm going to throw in a gratuitous picture of the Washington Capitals and Alex Ovechkin because we're chanced for like another month, so we got that going for us. So Dr. Dohm's going to come up here and tell us we should never reconstruct labrums, but it's just a quick little Google search. He's a very prolific guy, you know, he's only published 10, only 10 articles I could find on labral reconstruction, so don't listen to anything he says. So take-home messages, the labrum is important for hip health in most patients, the labrum can also be a pain generator, we don't typically repair chronically damaged fibrocartilage tissue elsewhere in the body, and I would say that circumferential labor reconstruction offers a standardized solution to a common problem with reproducible results. Thank you.

labor reconstruction

joint fluid management

articular cartilage compression

labrum repair

labral reconstruction