Technological Advances in Sports Medicine Knee and Shoulder Surgery

Technological Advances in Sports Medicine Knee and Shoulder Surgery

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Welcome to this edition of Facebook Live here at OrthoVirginia. Uh my name is Keith Lawhorn. I'm one of the orthopedic surgeons here in the northern region. Um I specialize in in sports medicine as well as provide general orthopedic care in addition.

But I want to start off by defining, you know, what is sports medicine? Many of us and many patients really see sports medicine as a specialty to take care of of athletes and athletic induced injury. But to become a little more granular from the scientific side, really we as sports medicine surgeons, see us, see ourselves as soft tissue surgeons involved in injury to the soft tissue aspects of the musculoskeletal system. And so patients that have ligament tears, ligament injuries, tendon injuries, cartilage injuries. These are really the vein

of the the sports medicine surgeon and the challenges and skill sets that they bring to this specialty. And so as a result over the years and over the decades sports medicine has evolved in large part to a lot of minimally invasive procedures. Procedures where the arthroscope, or a special,  a camera and specialized  techniques through little poke holes called portals are utilized to allow us to fix many of these soft tissue injuries that occur within the joint without having to make large incisions and do extensive exposure. This is advantageous because we don't need to disrupt normal anatomy to fix abnormal anatomy. However, the challenges that that that those techniques pose to us is that when we are operating in a patient's joint, these spaces are very tight. They're very small. And so, we're limited with regards to access to of these areas. Uh in large part, just inherent by the lack of space available

when trying to operate through these small poke holes. And so, really challenges that we're faced with in that regard are such that how do we in effect make a patient's joint bigger to allow us better access and to allow us to do more complex types of procedures within someone's joint, particularly using the arthroscope. And one way to do it is by making the instrumentation smaller. And by making the instrument smaller and the implants themselves smaller, we in essence can relatively increase the size of the joint. Having these smaller implants allow us a greater degree of flexibility to access the joint in a safer way. Such that we don't damage the articular cartilage and we can get to areas of the joint that we need to to fix many of these soft tissue injuries and so things that I've been involved in my career. I've been a consultant to an orthopedic implant company, full disclosure

here. Uh I've been doing this consulting work for 24 years now and I've had an opportunity to innovate and to try to help create implants and devices and techniques that enable us to better access some of these injuries within the the joints of patients. And much of this has evolved by using or converting screw in type implants, metal implants, that then evolve to plastic implants that evolved to absorbable implants with the idea that we would put an implant in and it would resorb and go away and get replaced by bone. Unfortunately, that hasn't necessarily panned out for a lot of the resorbable devices. There are some newer

devices that look more promising these days but the process by which that occurs appear to take many years. And so the alternative has to has been to come up with soft anchors that are very small, that are deform, that are deformable, and it allow us to use very small instruments to introduce these devices into the joint. And by have, in to having these smaller instruments and using these deformable implants, the disruption of the formal anatomy in an effort to these implants to fix the or injury is enhanced. And what we don't want to do again, we want to preserve normal anatomy and only fix the abnormal anatomy or the abnormal pathology. So, I'm going to show you some anchors here. So, this anchor and it may be a little bit difficult to see but to put it in perspective, this is a soft anchor that fixes in the bone and basically you drill a hole, and I'll show some video sides later that demonstrate this, and what we do is we place this anchor into a drill hole and we tension these sutures to deform the anchor and it's the deformation of the anchor in the drill hole that achieves fixation. There are a whole host of them that we use. This is one that we can use arthroscopically in the shoulder. It's a much longer inserter

because we have to work through cannulas and portals for that to occur. And we have a larger one that we use for rotator cuff surgery that again, this is all suture. To put this into perspective I have two anchors here. The diameter of this anchor, the drill hole required to put the large white anchor in is 2. 9 millimeters. The drill hole to put the small anchor in, the blue one, is 1.4 millimeters. And so these drill holes that we make are very, very small.

When you compare it to conventional anchor fixation that we use in the joint, whether it's plastic, or you know much of us have gotten away from metallic implants, but those those implants typically run on the order of two and a half to three and a half millimeters in size. Uh nearly twice the size drill hole necessary to place those more rigid anchors as opposed to the soft anchors. Now, oftentimes, even in orthopedics when surgeons were introduced to these soft anchors, many of them were skeptical that the biomechanical properties, that is the strength, the pull out strength, and the fixation of these anchors, would be inferior compared to the more conventional rigid polymer anchors. However, biomechanical studies have proven that not to be the case. In fact, these anchors are comparable, if not better, with regards to pull-out strength and when you  look at the biomechanical  studies in the literature, the anchor itself does not pull out of the bone but the suture breaks and so, the weak link isn't the fixation of this small anchor in the bone. It's actually the sutrure material

itself and so, that's a great innovation to allow us to use these small anchors and these small instruments in the joints and I'll show you with some video just the relative size. Even though this is 1.4 millimeters, you'll see in the arthroscopic video to gain some even in the joint. Now, another technology that that I've been involved with and that I've used for many years is adjustable loop fixation. Adjustable loop fix is a way to achieve fixation in a knotless manner. And in this particular setting, I have this device called a Ziploop and again, I'll show you in in a video how we use this in a representative case but there are multitude of uses for this particular technology and what we can do is, if we tension this, we can shorten the loop, and as I make this loop smaller and smaller and smaller, you can see that it locks. And so you can pull on it and we can make this

loop any size that we want. It will actually shorten down to within five millimeters. And if the two loops are equally tension, the way this is designed is the sutures are woven back on itself so that when you pull on both sutures, one suture is pulling in one direction, another suture is pulling in the opposite direction, and therefore, it won't elongate. And so the value of this technology is that when you use knotless fixation, you don't have a stack of knots sitting on soft tissue that could be analogous to having a pebble in your shoe. Imagine having a little pebble in your joint because this suture knot can

engage with the articular cartilage. Now, most patients won't feel it because the articular cartilage in the surface of the joint, there are no nerve endings. However, certainly, the last thing we want to do is have any implant that will silently create any kind of damage to the joint because after all, we're in the joint for a reason and that's to actually fix the damage that's in the joint but not necessarily inadvertently promote any additional damage in the future. Lastly, what I want to show you is a device and this is a meniscal repair device that that I spent many years trying to develop with the company and fortunately with a number of very brilliant engineers who helped to put this together and actually take some of this innovative thought and create this invention. Um this is actually a device that puts both of these technologies together to allow us to repair the torn meniscus in the knee. And this device was designed not so much to replace the plastic implants and plastic anchors that many other devices still commonly use today. But it was a device to

try to develop an arthroscopic version of the inside out suture repair technique. Now, basically, that's a technique where we pass needles through the joint that exit the side of the joint that we capture and then, we make another another incision to capture those needles and then tie the sutures over the capsule. Well, now, this version can afford you an all suture your type repair without having to make accessory incisions and to do it purely arthroscopically and I can tell you this has been out now, got FDA approved in 2019, and it really has changed how many of us can do meniscal repair surgery in a much simpler fashion without compromising the quality of the repairs that we can achieve. So Margaret if you don't mind you could pull up the the slides. So, the first slide and where we'll start is we'll start with with shoulder arthroscopy because this is really been the big platform by which we've used these very small deformable anchors to repair the torn labrum, to repair the rotator cuff. Uh this is where this anchor first got its start as an anchor for bony fixation. Next slide. And I do want to mention that we will be showing some video of arthroscopic surgery. There's

not any blood but there is some surgical video that will be shown in this presentation, if you would prefer to just listen. Though this is a slide and what I'm basically demonstrating, this is patient with instability. And while the patient is asleep, I'm demonstrating how the shoulder can be readily dislocated and the and these anchors are used to repair a the torn labrum and reestablish the function of of one of the ligaments in the shoulder that make the shoulder stable. Now let's go back to the other side. You went you went to next slide now. So, this is the size of

the needle, right? This is 1.4 millimeters and so, imagine using this small a needle or it actually it looks like a needle but it's actually the drill bit and using this small of a drill bit through a guide and you can see this guide just basically goes through one of these small cannulas that we have placed in a portal and we're going to drill a little hole in the bone and then through this cannula, we're going to impact the anchor and you can see through the window, the drill bit goes in and we'll drill the hole.   Next slide. and then we'll advance the anchor again. I mean, we maintain this device over our drill hole

and you can see that little blue soft anchor and this was the earliest version of the device, the handles that I showed today are a little more lower profile, little easier to use, and so, this is basically pounded into the bone and then, once it's seeded in the bone, we can go to the next slide. Then, we simply going to pull on the sutures and that's going to set the anchor. So, what happens is, is that this anchor goes to this very, very small hole and then by pulling on the sutures, the anchor deforms, kind of balls up within the tunnel and gets trapped under the hard cortical bone And that's why these anchors don't pull out. The suture will break before the anchors pull out. But you can see how small that is. When we use suture anchors to fix soft tissues, it's what we call point fixation. And when you have these small anchors, it affords you the opportunity to increase the number of fixation points. And this is an example of what a completed labral repair looks like

using the small anchors and this number one suture to do a capsule labor repair and capsular shift. Next slide. So, the next example that I'm going to use using this technology is rotator cuff repair. And in this particular case, many of you are familiar with what the rotator cuff is. So, I have a shoulder model here and I, you can see in the picture and the picture, the rotator cuff lives here. I was working In the first set of videos, we were working in this very tight space right here between the two bones. This is representative

of the subscapularis tendon and we go right above that right in this little window where my finger is. That's the little window we're working through. We make these small portals and pass a couple of cannulas through here and through these cannulas with in the front and the scope in the back, we can actually utilize, again, this small instrumentation to place these anchors in the joint and to fix the pathology of the labrum and the ligaments and the in the shoulder and we  can do it circumferentially,  not just in the front but we can fix it in in 360 degrees. Now, the rotator cuff exists here. So, these little red bands, the blue portion here that you see, that's the actual, the ball of the shoulder and this is the rotator cuff tendon. So, now, we're going to be working in this space here. So, we're going to be

working between this bone, the bone called the acromion on the top, and then this tendon here. So, if we can go back to the slides, next slide, and so, this is just a simple example of a of a patient with a rotator cuffed tear. I've introduced the cannula and then, you pull out the little opterator and then, I put these anchors in perpendicular to the bone because that gives it the best fixation. You'll see I drill a hole and then, the drill hole will or the cannula remains in place and then, I pull the drill bit out and we simply insert, there's that white anchor and we basically just gently pounded in place. Technically, it's very simple and easy to do. You'll see what, you know, my son once said to me when he was looking at these videos when he was younger, he asked me, he said dad why is it so windy in there? Well it's not actually wind. It's it's water or fluid

flowing through that space. Cuz we do this arthroscopy in a fluid medium. And you can see I'm pulling on the anchor. I can pull the entire humeral head up without worrying about the anchor coming out. I use special instruments to pass suture. And then once

I passed the sutures, we'll use special tying instruments and I tie these sutures down and that's a completed rotator cuff repair. The nice thing about using these small anchors for rotator cuff repairs, most tears occur because the tendon peels off or tears away from the bone. Well, the way that we fix these tendons is that we have to restore the position of the tendon against the bone and over time, scar tissue will form that helps to stabilize the tendon and form the reparative site between the tendon and bone. Think about it. With these small anchors, we're disrupting less of that normal bony anatomy that is necessary for the tendon to heal to the bone. So, the smaller anchors allow greater fixation points with less volumetric damage to the surface area of that tuberosity which is where these tendons heal and therefore, we're going to optimize the tendon to bone interface because we're able to use smaller anchors and preserve the native bone. Next next slides. Now, we're

going to move. Actually, Margaret, let's, let me pull up a knee model. So, this is a knee model and we're all kind of familiar with the basic anatomy of the knee and so, this is the kneecap, okay? And one of the things we commonly see in orthopedics and in sports is we see patients who dislocate their kneecaps. So, the kneecap will pop out of the groove. And it happens in a subset of patients and who are largely at risk based on their anatomy and how their knees developed and so, the most common instability pattern of the knee joint is a patella dislocation. And so, one of the things that we do in that particular setting, or the way we treat it is we build the ligament and we reconstruct the torn ligament. When you dislocate your kneecap, you tear the medial patellofemoral ligament over here 100% of the time. and in most cases, what what we do in the patients

who have recurrent instability is that we create a ligament that attaches to the tendon and attaches to the bone in their native sites and by reconstructing that ligament, we can stabilize the patella to  prevent it from continuing  to dislocate. And so the next example that I'm going to show you is how we do an MPFL reconstruction and why is it so important. The reason it's important, particularly on the kneecap side, in the human body, the greatest compressive forces and loads are applied to the surface of the kneecap. The thickest cartilage of any surface of the of the human body in any joint is under the kneecap. And that's

because the compressive forces are the highest. When you run, it's roughly 10 times body weight of compressive load under the kneecap and between this groove called the trochlea in the femur. The entire kneecap bone, not just the cartilage, but the entire bone itself is responsible for dissipating those compressive forces. And if we use surgical techniques where we make large sockets in the kneecap and we disrupt the native anatomy of the kneecap, we run the risk of potentially altering that architecture to the point that it affects force dissipation and then the question is, what impact does that have on load distribution underneath the surface of the patella. It certainly can't be good and so once again,

the use of these small implants, particularly with the in the patella, helps us to keep from disrupting the native anatomy but yet affords us the ability to fix the torn ligament. So, if we can go to the slide,   and this is a video of a female that had recurrent patella instability. She's asleep and this is before I've started to do any surgery and you can see how the kneecap readily dislocates and I pop it back into place and this confirms the instability. We're going to correct that by doing an operation that reconstructs that ligament. And this operation has proven to be highly successful in these patients. Next

slide. And so it's called an MPFL reconstruction. I usually use a donor graft. I used to use the patient's, one of the patient's hamstring tendons but study show that a donor graft works equally as well and what we do at, next slide, is this is the kneecap and in fact, I used to put three three of these small anchors in the side of the kneecap. Now, I only put two because studies show that two is more than adequate. When you look at the pullout

strength of these, these are 1.45 millimeter anchors, and you look at the out strength of these anchors, they exceed the strength of the native MPFL itself. So the strength is more than adequate. And when we put in a graft and we put it in the appropriate location and it functions the way it's intended. Again the success rate for this operation is very high. Next slide. And this just shows that you make the, there's a, I use X-ray to identify the point on the on the femur side or the thigh bone side. And then the next slide and

then we go in and assess it arthroscopically because we can assess the behavior of the kneecap as we flex and extend the knee and we can visualize, we can then visualize our graft which is seated in the appropriate location on the surface of the synovial lining of the joint in the appropriate layer. And so arthroscopy helps us to confirm that. Okay, next slide. Now, these are different adjustable loops and again, the one thing I'll mention, you know, this company, Zimmer Biomet, was the first company that that really embraced this soft anchor technology and the adjustable loop technology. In fact, they developed the adjustable loop technology and then, licensed the soft anchor technology but they were the first group to really take this technology and actually create implants and surgical techniques. I can tell you today, every sports medicine company that is active in in producing

implants for for surgeons to to perform these sports procedures all now have soft anchors and adjustable loop technique technology. They all have their version of this original Ziploop device which is a testimonial to how good the technology is. You know, they say, imitation is the highest form of flattery and and I can tell you that without a doubt, this technology has really proven to be very helpful for us as surgeons caring for patients.

Next slide.   So, again, I kind of demonstrated pulling on this loop. I wish I had a larger version but basically, this is just a schematic of how these two loops are woven in opposite direction. It's a suture within a suture and it really does function quite well. I've done

quite a bit of research  and done some biomechanical  studies looking at the performance of these devices both in vivo, I'm sorry, in vitro, in in living models as well as on the benchtop in vitro. Next slide.   So, this is a a surgical technique and you will see some drilling. This is an ACL procedure and what's being done at this point in time is the femoral tunnel is being drilled. This is where we we have to connect the tendon graft. One, there's a tunnel in the shin bone and there's a tunnel in the thigh bone and this is drilling that tunnel into the in the into the notch where the ACL's going to be fixated. If you want Margaret, you can speed that up and we measure that. You can just keep, you can speed

it up some more and this is that Ziploop device. And so we'll mark it appropriately. And this helps us to to know when to to pull on the graph to flip the button. You can speed it up again. Yep, some more.  Some more. Yep, we're going to go to the point where we mark the graph and then we're going to pull it in the joint. Yup, you can speed that up and you can see there's the device. There you go. This is a good spot. So, we pull it up. You see the marks. You pull back on the

graph. It flips the button. The button then hooks on the bone. And then what we do is we go in and you can keep tension on the graft which tensions the the the looping strands that the graft is looped around. And what we'll do and we're just seeding the button here ensuring that it's fixated. And then what we do is we retrieve the tensioning sutures. Cuz remember we have pull on the 2 sutures  to make the loop smaller.  And so in this particular case, we're pulling out the tensioning sutures. and then, using kind of a seesaw type motion on the sutures by pulling it, the loops will loosen or I'm sorry, will tighten and as those loops tighten, and it will pull the graft up into the tunnel. And we'll keep doing that

until those markings get close to the to the entrance of that thigh bone. All the all the meanwhile this this loop is getting shorter and shorter. And when you pull on it it won't elongate. So it allows us to use one implant, one device for varying tunnel lengths that might exist between patients based on their anatomy. So we don't have them take and make

calculations. And then have a multitude of different devices and implants with with different loop sizes and lengths to to perform this procedure. Next slide. So the last device we're going to talk about is meniscus repair. So, I'm going to pull up the knee model what I showed there in this one, the ACL is sitting right here in the front. So, it may be hard to see but that's what that last video was  demonstrating. Now, what  we're going to demonstrate

is these pads in here called the meniscus. And so these, these pads can become torn, and patients can have injury to those pads. Most of the injuries to those pads that require repair or that we do repair are the ones that occur in in conjunction with the ligament tear like an ACL tear. Only about 10 to 20 percent of tears are repairable. About 80 to 90 percent of tears are such that they're not able to be repaired and we trim those.

So there is a distinct difference between the two. But nonetheless, the, well the next, the videos will show is how we combine the adjustable loop technology to the soft anchor technology to create an all inside arthroscopic menosco repair system. So, if it's okay with you, Margaret, can we return to the to the videos? Next slide.   So, this is a young patient that was 17 at the time that had this very large tear of her medial meniscus and you can see this is an arthroscopic view. So, we've got a camera and we're probing that

meniscus and this patient also had a concommonant tear of her ACL. Next side. And so what we do is we have this little sled device and we'll introduce this device that that I have here that I showed earlier And this is what it appears in the joint. And you can see how little space, I mean that needle, to put it in perspective, that needle is 1.9 millimeters. So, it's less than two millimeters. And so, we need to, in essence, be able to do this

in a very tight space and you can see, it's a very technique to basically advance the needle through the tissue and then, what we do is we're deploying one of the soft anchors and then, we're going to tease it out of the meniscus and then, we're going to find a second location and then we're going to do the same thing and then, we're going to tension it and cut it off and that creates this low-profile knotless suture, no pebble in the shoe. You can see where the patient already had some wear of the cartilage from walking on her meniscus tear and so, we want to preserve those surface, that surface cartilage. It's so important. The reason we repair these menisci is because saving those cartilage pads actually preserve and protect the surface cartilage of the joint. Next slide and so this is what it looks like when a big tear like that has been repaired and this is a completed repair and we can go in and see  how well we've approximated  that back to the rim back to its, where it was torn and give this patient the best chance of healing that tear and I can tell you, I saw her at 26 months post-op and she's back doing everything and she's actually getting ready to she's graduating from UVA and getting ready to to go to officer candidate school and join the Air Force. Next slide. So, in addition to to all of these or just a few

of these examples that I've shown today with regards to this technology, again, this this technology has has been used to create a whole platform of devices specific to different anatomical areas of the body with unique injuries to the elbow, other injuries to the shoulder, the foot and ankle, and so, it really has been you know, certainly a game changer on many levels, particularly for those of us who really want to use really small implants, lessen the burden of foreign material in a patient's body, in an effort to correct abnormal pathology and injury while simultaneously preserving their native anatomy. So, that's all I have. Hopefully, it's been informative. If there are any questions that anybody might have, you know, feel free to to ask.

Thank you so much, Dr. Lawhorn. Please feel free to ask your questions in the comments. We do have a few questions already. So, when did this soft loop technology develop? So, I was actually, a marketing guy actually from this company showed me this little anchor in 2004 and asked me if I had any ideas or thoughts where I might use this soft anchor technology in a sports medicine application. And as soon as I saw that, I knew exactly what I was going to do with it because for years, I've been trying to figure out ways to develop an all-inside all suture arthroscopic, meniscal repair system. It was really a an

unmet need as far as I was concerned and when I was introduced to this in 2004, I went to work putting together some ideas and actually convincing some of the engineers at the the company that had licensed this technology that we try to implant some of these into the meniscus and determine what the pull out strength would be and low and behold, it proved to be quite successful and you know, that journey began in two thousand late 2005, 2006 when I actually developed the implant with the engineer for meniscal repair and we've tweaked it along the way but this current version which is what we had intended all all along but had to work around some intellectual property along the way which is another challenge for those of us who like to innovate. Um that's why in 2000, it took until 2019 to actually get this implant out but 2004 is when we really started working with this and the first implant thousand six and went to that. Some engineers said let's this this works in bone and actually implanting these in cataveric glenoids and we determined that the fixation was tremendous and so then, that led to the engineers then designing a number of these different soft-anchor implants.

Thank you very much. Do using the soft anchor implants changed the recovery time after surgery? No. No, because the recovery time is dictated by the rate of healing and so, you know, our goal, you know, when we do surgery and there's a reason why no surgical procedure is 100% successful. So, you know, as a surgeon, when you embrace new technology and when you're looking at innovative technology, you also, you always have to be cognizant of the fact that no operation is 100% successful and you have to ask the question, what am I going to be confronted with? What is the patient going to be confronted with? Should their procedure fail and they require revision surgery. What kinds of of of failures occur? What kinds

of potential problems will exist as a result of the use of this new technology and these implants? And fortunately with these soft implants, again, the amount of bone and native anatomy affected is very small. Um the rate of healing, again, is not determined by the implant itself but by, you know, in essence, determined by God and this is how, you know, what we do is we technically can repair these injuries. We create an optimal environment for healing that consists of restrictions and the rest has to occur and the healing has to occur over a period of time. And that's usually, you know, what happens within the human body and we as surgeons don't have control over that. So, we do a good job technically. We create an optimal environment and I think that's the best we can do and most studies show that in that particular setting, success rates are are quite high.

Thank you. What is the recovery time for an arthroscopic repair of a torn meniscus? In my hands, it's 6 months. Um patients typically, if it's an isolated tear of the meniscus versus a tear that's repaired with an ACL. Those are two different patients and the healing

rates are affected differently. Isolated repairs and it also depends on whether it's a medial meniscus or the lateral meniscus, Healing rates of the lateral meniscus occur more readily than menial. Why? We're not exactly sure. We know that healing rates occur more readily when the meniscus repair is performed with a concombinant ligament reconstruction like an ACL. We know that when we look at and there was a big metanalysis published recently   demonstrating after looking at numbers, a large number of studies that only 75% of these meniscus tear repairs heal. And that's that's based on second look arthroscopy which is kind of the gold

standard evaluation for healing. But that includes patients that had incomplete and complete healing. And most of the healing, when it was complete, occurred in patients who had ACL surgery. So, it's a six-month recovery. Healing rates are about 75% across

the board and I tell patients, even though they may be healed, I don't think we're ever out of the woods after a meniscus repair. I've had patients come in six, seven, eight years later and were doing great and then had a recurrent tear of their meniscus. Thank you. Do you receive any compensation from the implant technology you worked on?

I don't receive one penny of compensation for any implant that I put in any patient. Secondly, I don't receive one penny from any surgeon who puts in any of these implants that I've helped design in any facility that I work in that they also work in. That includes anyone of my partners in my group or anybody that I could have a local influence upon. I don't take one penny of compensation. Because I'm not compelled to use any of these implants

or devices in a in an effort just to simply make money. Um this, all of my decisions are made for the good of the patient. And that will never be compromised. Now if I do have a royalty stream on my meniscus repair system. And if somebody in Europe, South America,

Canada, other parts of the US happened to use it. Then yeah, I do receive a small royalty for that. But I don't take  one penny of compensation  for any of these devices that I use. Thank you. Are there BMI limitations for patients who are using this technology? I'm sorry, repeat that.

Are there BMI limitations for patients using this technology? There are not specific BMI limitations, not for this technology, no. Um most of the the limitations with regards to BMI, deal with the treatment of the condition and the condition itself rather than the implant. So, the implant has no role in terms of of of of the impact of BMI. It's the pathology to be treated in is is going to be performed and own potential

complications associated with patients who have elevated BMIs. Alright. Our final question for today is can this technology be used in revision surgeries? Revision surgeries for people who do not know or surgeries that are basically updating a previous surgery. Yeah, this technology is very very helpful and useful in revision surgery, especially you know, ACL surgery where I've used different implants for ACL surgery or someone has had an ACL procedure done and there are various techniques, tunnel drilling techniques, tissues, fixation devices, and in many cases, in the revision setting, you know, I recently did a a patient who had a   four ligament knee dislocation who had had a prior ACL, ACL revision, and a prior medial, medial collateral ligament  repair and so I used quite  a bit of this technology to revise the medial side, revise the ACL, fix the PCL, and also reconstruct the lateral side as well. Alright, thank you so much, Dr. Lawhorn. If we were unable to get to your question tonight,

we will answer it in the comments on Facebook. Dr. Lawhorn, would you like to close? Yes, well, I want to thank everyone for for tuning in. Uh hopefully, it was enlightening and that I provided some really neat stuff. I mean, it's something that I've been passionate about with regards to my career. I think a couple of take home points. One, you have

to be a contrarian to innovate. If you just follow the masses, we'll develop nothing new. And that's always kind of a scary thing. Um, but when it works out, boy, it's, it's, it's very rewarding. And so, hopefully, this has been helpful and I'm certain that, that over the years to come, a lot of this technology, who knows, maybe this will be archaic someday and they'll be, you know, even biologics and other treatments that will render a lot of this stuff that we have currently today somewhat irrelevant. But in the in the meantime I I find this technology very helpful and it's been very good for the for the outcomes of my patients that I've cared for over the years.

2022-07-21 19:10

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