I'll get you up here on time. Anyone have any questions? I got a couple if the audience doesn't have any, but if you do, please step up to the microphone. I'll be happy to be quiet and let you ask your question. Dr. Comini, I do quite a bit of elbow arthroscopy, so I commend you on your work. I have no problem not being anonymous. I had a nerve palsy on one of my patients. It happens. You do enough of them, it's gonna happen. Do you have any recommendations on portal placement? The standard teaching is two finger breaths proximal to the epicondyle, one finger breath anterior, then you're supposed to be safer, and the more proximal you are, the more safer you are. Any recommendations on your portal placement based on your research? I think not based on this, but just generally, any portal is a centimeter for medial and lateral, anteromedial and trilateral, a centimeter in both directions, inferior and anterior. But I also spread directly down to capsule in both perpendicular directions. So if there is an aberrant or a subluxing nerve in any direction, you can sometimes not injure them just by passing past them, having dissected them out first. I also do capsular releases arthroscopically. Has this changed your technique for doing capsular releases arthroscopically, to get completely across that anterior capsule? I was gonna show you a video, but it was running longer. So the question is, do you have to find a nerve to do a good capsular release? And the answer is no, as long as you're cognizant of where the nerve is. So now what I teach the residents is that we actually published a manuscript called the extra capsular capsulectomy, and that's based for very high-grade contractures. But the principle is that you're freeing up the capsule before you cut it. So in fact, what I do is I take a periosteal elevator, a very thin arthroscopic periosteal elevator by MyTech. You're on the blind side of the capsule. You're then freeing. up the capsule before you start cutting. So the muscle and the capsule of plane has been freed before you cut it and you never get muscle in your capsulectomy scissors. Thank you that's good work. Mr. Barron, I'm a big believer in that the reason the the gold standard is not the UCL reconstructions are done in young it's that the the gold standard is the UCL reconstruction be done in the throwing athlete in a repair. In my opinion probably shouldn't be done but that's a topic for another day. My question is do you think and I know you've got a bachelor's I know so I commend you on your work congratulations it's very good for you to be up here. Do you think the rise in repairs has come with the rise of industry pushing their implants for repairs? Can you hear me? Okay so a lot of the recent research has indicated in this patient population that the patients themselves and their family members are actually asking for the procedure based on perceived return to play being able to return faster specifically in the throwing athlete population as you mentioned. So I think it's not only industry I think it's also patient perceptions and that immense pressure and these young collegiate athletes who maybe are vying for scholarships for college and for their careers to really return to play faster and in this population they perceive that ulnar collateral ligament reconstructions is the way to get them there faster. No I don't disagree that just be my final comment I'll get down. We did a study in fellowship where we surveyed all the coaches and parents over 50% of parents thought if their son got a ulnar collateral ligament reconstruction that they would have a stronger arm and have a better chance to get into college and over 30% of baseball coaches believed in prophylactic ulnar collateral ligament reconstruction so it's not only the parents it's the coaches pushing these parents to have their kid get these elbows operated on them and I hear people talk about good outcomes with ulnar collateral ligament repairs my usual response is they may have had a good outcome if you had operated on them anyways so but no it's something we've got to be cognizant of as a group moving forward I think. Anyways great job you guys any questions from the audience?

nerve palsy

portal placement

capsular releases

UCL procedures

industry influence