Mellett, I got me Irish up now. I got me Irish up. Colonel Tokish has served our country with distinction. He was a linebacker for the Air Force and he was Academic All-American, 1990. He's a bright guy. And he served our country with distinction, 20 months of deployment. But you know, being a linebacker, Division One, takes its toll as we see this CT scan. He still can quote the literature, but the frontal lobe has got some issues. This is the ravages of tackling D1 football. This is the colonel's PET scan. Compare it to control. And you're noticing the atrophy in the frontal lobe. Because what we're saying is, judgment is an issue here. Now, I'm not going to sit here and sell snake oil. But if you want to restore native anatomy, increase effectiveness of labral seal, precisely tension the capsule, be kind to the subscap, address bone loss in holistic fashion, then an arthroscopic bankart is still your answer. If you want to nuke the subscap, nuke the labrum, denervate the joint, cause Arthur, imprecisely tension the capsule, subject your patients to needless pain and suffering, open bankart is in your belly wick. This is JT's extensile approach. And our job as arthroscopists is to restore native anatomy. Labral seal, tension the capsule. Hill sacks, we can address at remplissage. And now we can do bone grafting, which I'll show you to the glenoid defect. You see, with the arthroscope, folks, we can see everything. You know, we have poster laxity. Jim Bradley just gave a brilliant talk on poster and civility, Kim Legion's. The colonel can't see these things. You can't get there open. And labral height, and Buddy Salvo taught me this, horizontal mattress restores labral height. And the higher the labrum, the lower recurrence. Done. John Seidel showed us that capsule labral augmentation actually increases our stability. So when we do our tissue tucks, we increase the stability ratio of the labrum and the glenoid up to 50%. The labrum protects the joint from arthritis, as we say in Ireland. If you measure the contact pressure of the glenoid, and you take out the labrum, you increase the contact pressure 20%, you increase the peak pressure of the glenoid 28%. Notice how in glenoid, as we say in Ireland. The colonel would like us to take the labrum, in the words of Charlie Rockwood, the labrum is in the bed, bam. I thought I'd get one laugh out of that. Subscapularis atrophy, it happens. These are at least four authors talking about atrophy of the subscapularis. In fact, Scheibel had 92% atrophy of the subscapular revision surgery, 54% in all comers. Okay, I split the subscap. Well, Maynard showed that even if you split the subscap, you still get 8% loss of strength, and his latter Jay-Z had infrasubluxation of the humerus, because folks, the innervation is very delicate. You put a gelpy here, it is not fun. Not bad, but not fun. How about arthritis, as we say in Ireland? These are four or five papers showing that if you follow the open background long enough, look at divisor, five years, 34%. Look at Ogawa, increased OA, 32%. Look at Berendis, 30%. Pellet, 40%, as my brother lawyer would say, no further questions. This is J.T. Tokish, a two-year follow-up, open Bancart. Now, let's not ignore the obvious, and open Bancart works for one singular reason, scar. Scar. It prevents engagement, as Steve Burkhardt showed us, because it makes people tight. That's it, that's it. And if you want Arthur, go ahead, do an open Bancart. As we see, Colonel Tokish, this is a three-year follow-up. So, we can tension the capsule precisely with the arthroscope, and Johnny Sakia taught me, probably through Jim Bradley, I can take as many tucks as I want. I can be there all day, increase the labral depth, and tension the capsule precisely. Now, you say, sir, open Bancart is necessary in contact, and I say, no, no, no, no, no. If you do it right, Colonel, if you do a lateral cube, restore the bumper, horizontal mattress, tension the capsule, remplissage, and I've been adding graphs. We know that Mary Lorraine took rugby players, and I know he chose wisely, but these are still rugby players. And he showed, in 2006, only about 7% recurrence rate. Not bad. And Jimmy Andrews more recently said, you know, if you do it right, Bancart, and this is not remplissage, 6% recurrence in five years, no difference in recurrence observed in collision versus limited contact athletes. Now, remplissage does work, and all good things recruit come out of Korea. And Young Girl Re, just published last year, if you compare remplissage to Latergé, head up. You get a recurrence rate similar in both groups, but Latergé had a 14% complication, whereas remplissage, zero. Zero. So Sagaia shows us that glenobone loss, as Rick said this morning, if you tension the bone, it grows back. So what I've been doing of late, when I do my remplissage, Colonel, I take a plug of bone, and I lay it down. This is level 27, but I have some early data to show that this may be a new phenomenon. And this is a one-year picture, and the bone grafting, in my limited experience, does work. So the enlightened approach to antigen stability, and that's why we're here, to be enlightened, is restore the entire bumper, as Buddy taught me. Horizontal mattress gives you a better bumper. Tension the capsule precisely, do remplissage, bone graft the glenoid. Or we could do the medieval technique, as the Colonel is proposing here. This is Colonel Tokish preparing his instruments. And I love him to death. He's a lot smarter than I am, but he got issues with this one. This is the Colonel prepping his patient. And this is the Colonel, the young Colonel at work, doing his open banquart, subjecting his patient to needless pain and suffering. But the principle is sound, in theory. This is subscap, exposure. He's now splitting the subscap. Gelpy, please. Now, JT, we all love you and respect you, but the ravages of football have taken its toll. Right now, on this issue, your mind's in the wild blue yonder. Off we go into the wild blue yonder, finding hiding to the sun. Here they come, zooming to meet us. Thank you.

surgical techniques

shoulder injuries

arthroscopic bankart procedure

native anatomy restoration

open bankart surgery