Well done, Argentinian beef, it's simple to eat. And answer this question, is there any place for an endoscopic soft tissue revision? When I was a young fellow in Argentina, my dream was to be as deep work I was as a surgeon, so I always tried to scope all. This is the case of 1999, a fly fishing instructor, friend of mine, multiple episode of instability. As you see there, engaging heel satch. This is a overhead worker. You can see there an engaging heel satch with a large bone defect. I tried to move the capsule in the labrum and fix it with four anchors with simple sutures from two o'clock to six o'clock using the Kaspari technique. 20 years later, no recurrence, and we are still fishing in Patagonia in Argentina. And if you ask me why, I don't know why don't recurrence. So, the arthroscopic bunker repair is the first and most common surgery in United States. 96% in primary and revision surgery. And if we assume that the recurrence rate is still too high, I think that we have a problem here. Pascal Boileau in a recent commentary, in editorial commentary, talk about levels of competence of the surgeon. And I agree with him that strategy is the main level of competence, but perhaps the least used. So, if you use strategy, we have to look up risk factors, age, instability, epilepsy, numbers of dislocation, bone loss, contact or collision outlet or poor surgical surgeries. My friend and colleague, Mario Larine, wrote this paper in 2006. All rugby players, collision outlets, a long follow-up, excellent results with a low recurrence rate in primary and revision surgery. Why? Because he had a good selection criteria. So, surgical decision-making, first of all, ask you why the primary surgery failed, and then always taking care of risk factor, epidemiologic risk factors, age, epilepsy, contact or collision outlets. The not recognized bone loss is the main risk factor. We talked about that. But in revision case, always, always, thinking the pathologic capsule, the loose capsule, because we can't fix a long bone loss lesion with a pathologic capsule with a soft tissue operation. We talk about this, the book had talked about this, 2000. The number is 20 to 25% in primary surgery, but how much glenal bone loss could we tolerate in revision surgery? 21%, 15%, 13.5%, maybe 10%. We don't know, really. The concept of bipolar bone loss, the on-track concept, I think that is a very novel concept. We have to take care about that. But I like very much this paper with a clinical validation of the glenotrach, and the positive predict value of recurrence in an off-track lesion is near 75%. And even in patient with recurrence after an arthroscopic pancreatic repair in an off-track lesion, the WASI score is going to be very, very bad, similar to a recurrence. So recurrence is not only the way to measure it, the results. Capsular deformity, take care about this. It's very important. So my approach, my limit in glenal bone loss is 10 to 15% in revision case. In these cases, I don't take care of all risk factors, and I go through a later jet and bunker. If I have no bone loss, with a healed such lesion, I like to do remplissage. It's a very nice surgery. But if I have a collision atlas of 20 years, perhaps I go through later jet to bunker. In recurrent traumatic episode, take care with this bone loss, with this fragment near the glenoid. In a primary surgery, I like the bunker bridge. It's a very nice surgery. But in revision surgery, perhaps I go through later jet and bunker. Finally, prosurgical techniques. I have my one ankle technique also in a revision case. I think that these cases with a modern arthroscopic bunker technique, considering risk factors, you are going to be okay. Is there a place for arthroscopic sub-tissue revision? It's not a battle between arthroscopic bunker versus later jet. I think that it's a battle trying to see what happened with the primary surgery and always taking care of risk factors. Thank you very much.

endoscopic soft tissue revision

shoulder surgery

Kaspari technique

glenohumeral bone loss

lateral jet and bunker techniques