So, thanks, Lance, so we're going to talk a little bit about the last 35 years, I guess, so my, let's see this work, forward, there we go, so my disclosures are in the AOS database and thanks to John for giving me the old guy's talk. I'm not sure why he did that and so my real disclosures, I'm not dead yet, I'd like to think that I'm still being a little bit creative in trying to deal with some of this stuff, so when you ask about trying to learn new things, I started way back in 1972, I was a baseball player, did some track events and then suddenly couldn't throw and so before the internet, before all this stuff, I started researching and I found out about a guy named Mike Marshall and he was talking about how to rehab shoulder injuries and get back to playing and so it worked a little bit, I did some core and back work and but the big thing then was to work on your internal rotators and so ended up not being able to play so when I went to LSU and was trying to be on the baseball team, you know, basically the coach said you can't throw, you can't play center field anymore if you can't throw and so I had to think of something else to do so I decided to go to med school since pro baseball was now completely out of the picture. At the same time, typically I was at a bar, I went and a girl said, you know, if you grow a mustache, you'll look just like Robert Redford and the Sundance Kid and I went, that'd be cool, I'll get a lot of girls, this would be great and so there's the mustache, first couple years you couldn't see it because it was white and now I've come full circle so it's getting white again, still doesn't work for the girls, I actually look more like Ben Stiller in dodgeball so you can see that was not very effective so we had to move into other things so I was fortunate enough at the residency with Jim Hughes, went up to Richmond to interview and I got to thank Steve Weber and John Thomasine because they said you should go talk to this guy and I'd met Dr. Casperi and Dr. Andrews at a course and they were like, well, you got to go up there so I went to interview, unfortunately didn't get to meet anybody else in the group, Dick and I started talking, he said, well, come on, I need to get a bite to eat, it's like 10 o'clock and about three hours later he said, well, you're coming here, don't worry about anything else, I'll square it with the rest of the group so I canceled all the rest of my interviews and so that worked out really well. Probably, and I've watched a lot of people operate, I would tell you that he is by far and away and was the greatest shoulder arthroscopist in the world, he could do things that the rest of us can only imagine, an inventor, a speaker, a teacher and all the fellows who were laughing the other day because it's a two-handed sport so you got to be equally good with either hand and he's the one that really pushed that. Sometimes forgotten is the fact that Terry Whipple was also in that group along with Rick Myers and we'll talk a little bit more about that in a minute. Many of you don't know because you do arthroscopy and use a shaver, Whipple's the guy that invented the shaver, not Lanny Johnson, he did it, he invented the suction punch, the wrist traction tower, he was just a great guy and while Dick may have been our father, Whipple was like our crazy uncle and because he had all these weird ideas and he did talk about the Whipple test which we use all the time. Christian Gerber says it's the single best test for rotator cuffs ever and that's all credited to Terry Whipple and so when you're sitting here you have the world's best wrist arthroscopist, the world's best shoulder arthroscopist all in the same fellowship, kind of can't help but be creative as you move forward. So the thing about these guys and these are the three guys that had the fellowship is that there was no MRI, there was no anchors, these things didn't exist, Mitek had come up with a G1 anchor, probably none of you remember that, he had a Casperi suture punch that Dick designed, he had a place where he just made instruments and it was a six month to a year process to get one of these things out. Rotator cuff was an open surgery, many questioned whether it was necessary, big names questioned that, Charlie Rockwood, Jill Walsh just said you know they all get stiff, they all do bad, so that led to creativity. So I got my first prospective study out of that. I said well rotator cuff is unnecessary, it's a stupid operation, the shoulder gets stiff, people hurt all the time, why would you do this? At that time I was surveying my patients at one month, three months, six months and a year and when I did a cuff repair, my one month follow up after an open cuff repair was that you were the worst surgeon in the world, I would never see you again, I don't want to have this operation, I wish I'd never met you, so it really didn't make me feel very good. So I decided I was going to do something different. So we did randomized control trial, it was before IRBs really, so you could do whatever the hell you wanted, and so we did arthroscopic debridement in one group and open repair in the other. So at six months, my debridement group is doing great, Rockwood is happy, Casperia is happy, this is terrific, and so repair is not necessary. So I talked to Dick, he said yeah look at it a little bit longer, but this is great. I talked to Dr. Cofield because I had done some of my training at Mayo and he said I would be really careful about that and I talked to Hawk who said do me a personal favor and re-look at it. I went well that's just stupid because what do these old guys know, I know what I'm doing and they're wrong, but he said personal favor so you kind of have to do it. So I waited six months, I wrote the paper, all of a sudden at 12 months things started changing and I went uh-oh, maybe they're right. So I waited the two years out, my debridement group got much worse, my repair group kept getting better, so I found out that proving yourself wrong wins you awards. I won the Neera Award back in 92 for that paper and then we did a seven year follow-up in my debridement group and had a 98% failure rate. 98% failures, that really sucks, it's bad. So again back to Dr. Casperia, he designed equipment, holders, instruments, every time he looked at something he would design something to fix it. He's the most creative person I've ever met and he was worried in 1987 we would raise a generation of shoulder surgeons that forgot how to do open shoulder surgery, which is what's happened. So we're trying to rediscover open bank card and it just didn't work out. So innovation is all about teaching and learning surgery and if you're very fortunate you make a lot of friends around the world, that's me with Emilio Calvo who I actually taught when he was a resident, E.G. Toy and Japp Willems and you need to find people that share your passion in what you're doing and so it's, if you want to design new stuff and new equipment, you got to remember it's not about you, it's about helping out your profession and all the patients that you're going to see. So it's not about making money, it's not about anything else, it's about creativity and designing something that works better for a patient. So it needs to be reducible, reproducible and this is a fellows thing with Dr. Cofield who is still teaching and still does now. So I kind of divide my career into three phases, 88 to 95 are the busy years where we're doing just an incredible amount of cases, I have no idea how we were doing it. We had three good papers that came out right then, started in 88, Larry Field and I wrote about slap repair in 1993, Richard Duncan and I wrote about MDI and capsular shift and Scott Jones and I wrote about elbow caps releases, these are new creative procedures that happen. MDI paper was great because I presented it at an ANA meeting and everybody loved it and so I thought it would be great to go show it to the Shoulder and Elbow Society, my first year in and I got up to give the talk and there were 22 people, there were only 85 members in the society at the time, 22 people at the microphone so a fourth of the membership was there. First guy stood up and said, I think what you just said was an insult to Dr. Near and shoulder surgery in general. It got worse from there and the nicest thing anybody said was Russ Warren said, I think you just don't understand the shoulder or anything that you're doing and so you should probably go back and go back to school. Casperi was in there and he sat in the back and just laughed and laughed and said, they're all going to be doing this arthroscopically before too long and thanks to Steve Snyder we all did. Same thing happened with the elbow paper except Bernie said, I think it's a good idea and everybody sat down. So where do we do, how do we get these new techniques? Well the slap repair was great because we were doing transglenoids and I actually fixed the first few of those because I just saw them arthroscopically before I even knew what it was and then fortunately talked to Steve Snyder who said it's a slap tear and so then, oh, okay, so then we'll fix it. With the MDI it was cadavers and with the elbow it was multiple, multiple cadavers because the nerves were so close and I talked to Whipple a lot about this and trying to figure out how to do it and he was very gracious and helpful. The biggest thing was the late Doug Harriman, when we were talking about all these new things and trying to figure it out, gave me some five basic principles when you think you have something new. One, you have to have an injury mechanism that produces the injury. Number two, you have to have symptoms produced by that injury. You have to have an exam that you can do that will confirm the lesion, imaging to define it and then surgery to fix it that makes those symptoms and imaging back to normal. So the busy years, thanks to Steve Snyder, didn't just describe slap lesions. You guys probably don't know, but he designed an equipment for mini open cuff repair that was just fabulous. So we went from a big incision to a little incision, started an arthroscopic cuff repair interest group, consummate teacher, thought it was just fun to sit and visit about things and we had people in this group, Gene Wolfe, Steve Burkhart, Wes Nottage, many others. It was just flat out fun and we would stick around at cadaver labs and play with them after all the participants left. So he got us to our next level, which is that arthroscopic cuff repair might be possible. So I said, my mini opens are healing great, thanks to you, why would I change? He said, well, it would be fun. So I said, all right. So we did my tech G2 anchors, played with it, got back to it and that led to George Stolzheimer's report of arthroscopic cuff repair. We picked a whole bunch of them that would probably heal anyway and fix them and they did great. So all of you that are doing arthroscopic cuff repairs, thank Steve Snyder for it because he started it. Met Jill Walsh at the same time. Jill came over to DICC to learn how to do arthroscopic reconstruction. Didn't quite pick it all up. He did a couple of them, put two stitches in, it didn't work as you might imagine. So then he changed and switched back to the open Ladd-Arger, which he does very well, and changed that to make it a bigger procedure. So we kept going. I visited, I made a lot of mistakes. I was doing about 2,000 to 2,200 cases a year back then. And it was only operating on about one in 11 new patients that came in. We had the first cadaver lab. A bunch of guys that are here were there. That was back in 1989. And then the first OLC course. Met Maury and Hawkins and they started helping. Still had the mustache. Did not look like Sam Elliott. I actually looked like Sonny Bono. So didn't go over so well. And then it became creative. Anchors changed, applications to instability changed. A lot of guys were doing great stuff. And companies would bring equipment in and we would stay late on Monday night and test it for them for free and do all this stuff. And Kasperi used to fuss at me about this because he'd say, you should patent it. I'm like, you know, I'm just having a good time. I just want to have some fun. So we tried to do a patch study. That didn't work at all. Mike Metcalf wrote that up. It added nothing to our cuff repairs. And so we went back to Dr. Nier's principles and did a lot of releases, some convergent stitches, McLaughlin's old baseball stitch application, brought it all back to arthroscopy and then published this paper, which is the first one on massive cuff. Kept going. This is a drawing that I did in 1997. Sort of looks like a double row. I was not smart enough to call it a double row or a transoxys equivalent. I just said, look, we're doing an anatomic repair. It did great. And we kept developing more instrumentation, things that we still use today that really helped. So these are some of the stuff we've done over the years. It's a lot of shoulder and elbow things. It's been a lot of fun developing them. And it's always been someone helping and making it more creative. A lot of influential friends. Those of you that are interested in innovation equipment wise, I would look to Steve Burkhardt as the best example of how to do that. Steve patented things. Steve Burkhardt and Steve Snyder, the two Steves, they patent things, they make them available, they commercialize them, they teach you how to use them. And a very creative people to do that. And I think Steve Burkhardt set the model for corporate surgeon partnership and is a good example of that. Christian Gerber is a thought leader. He really has been a friend for a long time. We've challenged each other for about 30 years. And each of us keeps getting better. He just retired, but he's still keeping his hand in. So I've had a lot of helpful friends. I'd like to especially point out Larry Field to the top right. He was my partner for 25 years before I left Mississippi. We still collaborate. I don't think two guys could work together any better than we have with Larry. He certainly made me a better surgeon and a better person to have him as a partner. If you're really lucky, you have some special friends. You guys know all about this, thanks to Jeff Abrams. But Rick and Rick, Nick and Jeff have been just stalwarts over the years and easy to bounce ideas off of them and get better. So how do you innovate? In the busy years, it was from mistakes. We worked backwards. I brought everybody back at two years for a free follow-up and x-ray. We'd look at them, if they did good, great, what did I do right? If they didn't do well, what did I do wrong? Then we'd go back to the lab, always cadavers, always working on anatomy. Phase three is New Orleans. Hurricane Katrina hit, and thanks to Amy, we were able to move there and move into things. So we started a refining approach to teaching, education, and evaluation. Really try to get better one thing, one day at a time. I tell my residents and fellows, it's okay to make mistakes. John Wooden said, if you don't make mistakes, you're not doing anything. Just try not to make the same mistake twice. Make a new, more creative mistake. Don't do the same thing over and over again. The other thing is they would try to compete a little bit, and I'd say, look, the only person you've got to be better than is the one you were yesterday. If you can do that, you'll have a good life. So current research, thanks to Steve Arnosky, we're doing a lot of biology stuff. We've got the Shoulder and Elbow Society doing multi-center studies, but the Regeniton patch, and this is a conflict. I'm a little bit on help them with that. It's going to be published, but really it's a vascular patch, not a structural patch, and we're applying it to Achilles, to elbows, to different things, because it's all about biology and nutrition, and that's the newest focus of what we're doing, and as an example, we're following Lanny Johnson's lead in that area. Started looking like Jeff Foxworthy. I got stopped in Mississippi quite a bit, and it would go, you're him, and I go, no, I'm not him, and so we have to tell a joke. Okay, you might be a redneck if you stop a stranger at a gas station and tell him he's Jeff Foxworthy. So challenges are opportunities. Things are going fast. Man, computer-generated instrumentation, something that took us a year to put things together can be done in a matter of seconds. It's impressive, and then you 3D print the instrument that actually works. It's incredible. So this is such an exciting time to be an innovator. New ideas are changing what we do. You have the balloon. You have this SCR. You have patches. You have all these things, and our younger surgeons are learning different than we did, and we've got to encourage that. They do video. They do internet. They do podcasts, that we could never even conceive of 20 years ago. It's better. Teaching is better. Learning is better, and it's different. At the same time, we have a problem because the best way to learn surgery is actually to operate. If you don't do that, you have a problem, and the budget is less each year. So every surgery day, we do this. We go over all these things, models, cadavers, trying to get it right, and remember Malcolm Gladwell and the 10,000-hour rule. If you don't put in those 10,000 hours, you're probably not going to get better. So never take yourself too seriously. I was talking in Israel, and I went up, and they said, Mr. Funk, can we ask a question? And I didn't know what they were talking about, and I kind of looked and went, oh, I'm Leonard Funk today, so I'm from England. This is great. I certainly don't look like Matthew McConaughey. So my numbers are getting close to 50,000 shoulder and elbow cases in the past 32 years. Satisfaction is about 90%. Unless you think that's good, that means there's close to 5,000 people around that are not doing well because I didn't do my job right. And so I think that's a lot of failures. So you have to listen to them, put it back, and you'll do better, and I think the future is in biology. So challenges are that it's a small world. We have to encourage, not stifle creativity, and despite what everybody thinks, every generation thinks younger generations are not as good. I would submit to you they're smarter, better, and well-connected, and we need to encourage that and use that as a resource and develop new things. So think differently. Think outside the box. It's a phrase, but it really applies, and then every now and then grab a special moment with somebody you love like Amy. Thank you.

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