{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.14,"body":"Chuck, welcome"},{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.14,"body":"to the upper hand podcast where"},{"speaker":"Charles Goldfarb","startTime":7.14,"endTime":8.88,"body":"Chuck and Chris talk hand"},{"speaker":"Charles Goldfarb","startTime":7.14,"endTime":8.88,"body":"surgery."},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"University in St Louis, here to"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"surgery related, from technical"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"subscribe wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.14,"endTime":20.84,"body":"podcasts, and thank"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"you in advance for"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"leaving a review and rating that"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.0,"body":"helps us get the word out. You"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.0,"body":"can email us at"},{"speaker":"Chris Dy","startTime":26.0,"endTime":31.34,"body":"handpodcast@gmail.com so let's"},{"speaker":"Chris Dy","startTime":26.0,"endTime":31.34,"body":"get to the episode. Oh, hey,"},{"speaker":"Chris Dy","startTime":31.34,"endTime":33.86,"body":"Chris, hey, Chuck, how are you?"},{"speaker":"Chris Dy","startTime":31.34,"endTime":33.86,"body":"I'm"},{"speaker":"Charles Goldfarb","startTime":33.86,"endTime":35.06,"body":"really good"},{"speaker":"Charles Goldfarb","startTime":33.86,"endTime":35.06,"body":"today."},{"speaker":"Chris Dy","startTime":35.66,"endTime":38.12,"body":"Excellent. It looks"},{"speaker":"Chris Dy","startTime":35.66,"endTime":38.12,"body":"like you are in the office, as"},{"speaker":"Chris Dy","startTime":38.12,"endTime":40.84,"body":"is our special guest, also in"},{"speaker":"Chris Dy","startTime":38.12,"endTime":40.84,"body":"the office. Our"},{"speaker":"Charles Goldfarb","startTime":40.78,"endTime":43.84,"body":"special guest,"},{"speaker":"Charles Goldfarb","startTime":40.78,"endTime":43.84,"body":"Sanj Kakaar, is rejoining us by"},{"speaker":"Charles Goldfarb","startTime":43.84,"endTime":48.55,"body":"popular demand, because everyone"},{"speaker":"Charles Goldfarb","startTime":43.84,"endTime":48.55,"body":"loved the first episode on"},{"speaker":"Charles Goldfarb","startTime":48.58,"endTime":52.12,"body":"skatefa Luna, we wanted to take"},{"speaker":"Charles Goldfarb","startTime":48.58,"endTime":52.12,"body":"a deeper dive and talk a lot"},{"speaker":"Charles Goldfarb","startTime":52.12,"endTime":57.04,"body":"about technique, because Sanj is"},{"speaker":"Charles Goldfarb","startTime":52.12,"endTime":57.04,"body":"a luminary. He's going to teach"},{"speaker":"Charles Goldfarb","startTime":57.04,"endTime":57.79,"body":"us all today."},{"speaker":"Chris Dy","startTime":58.87,"endTime":59.8,"body":"Sanj, welcome back."},{"speaker":"Sanj Kakar","startTime":60.34,"endTime":62.98,"body":"It's good to be here"},{"speaker":"Sanj Kakar","startTime":60.34,"endTime":62.98,"body":"Chuck and Chris and always happy"},{"speaker":"Sanj Kakar","startTime":62.98,"endTime":66.28,"body":"to talk about anything in life,"},{"speaker":"Sanj Kakar","startTime":62.98,"endTime":66.28,"body":"but especially wrist and"},{"speaker":"Sanj Kakar","startTime":66.28,"endTime":68.38,"body":"arthroscopy. Yes,"},{"speaker":"Charles Goldfarb","startTime":68.38,"endTime":70.42,"body":"I think Saj"},{"speaker":"Charles Goldfarb","startTime":68.38,"endTime":70.42,"body":"and I are both in the office."},{"speaker":"Charles Goldfarb","startTime":70.42,"endTime":71.26,"body":"Chris, where are you?"},{"speaker":"Chris Dy","startTime":71.77,"endTime":74.05,"body":"I'm at home."},{"speaker":"Chris Dy","startTime":71.77,"endTime":74.05,"body":"Fortunately, Saturday morning."},{"speaker":"Chris Dy","startTime":74.05,"endTime":77.08,"body":"Can't think of a better way than"},{"speaker":"Chris Dy","startTime":74.05,"endTime":77.08,"body":"to spend it with you guys. I'm"},{"speaker":"Chris Dy","startTime":77.08,"endTime":80.08,"body":"sure you're both doing your"},{"speaker":"Chris Dy","startTime":77.08,"endTime":80.08,"body":"diligence and rounding and"},{"speaker":"Chris Dy","startTime":80.08,"endTime":83.98,"body":"seeing patients and cleaning up"},{"speaker":"Chris Dy","startTime":80.08,"endTime":83.98,"body":"cases from, uh, from your call,"},{"speaker":"Charles Goldfarb","startTime":84.73,"endTime":87.43,"body":"I think. And I"},{"speaker":"Charles Goldfarb","startTime":84.73,"endTime":87.43,"body":"love Sanj's opinion when I"},{"speaker":"Charles Goldfarb","startTime":87.43,"endTime":90.7,"body":"round, which I try to do as"},{"speaker":"Charles Goldfarb","startTime":87.43,"endTime":90.7,"body":"little as possible, but when I"},{"speaker":"Charles Goldfarb","startTime":90.7,"endTime":93.85,"body":"do round, it's always enjoyable."},{"speaker":"Charles Goldfarb","startTime":90.7,"endTime":93.85,"body":"It's just like coming in for a"},{"speaker":"Charles Goldfarb","startTime":93.85,"endTime":96.28,"body":"case in the middle of night."},{"speaker":"Charles Goldfarb","startTime":93.85,"endTime":96.28,"body":"It's never the actual coming in"},{"speaker":"Charles Goldfarb","startTime":96.28,"endTime":99.43,"body":"and doing the case. It's sort of"},{"speaker":"Charles Goldfarb","startTime":96.28,"endTime":99.43,"body":"what happens after. But I got to"},{"speaker":"Charles Goldfarb","startTime":99.43,"endTime":101.98,"body":"hang out with one of our amazing"},{"speaker":"Charles Goldfarb","startTime":99.43,"endTime":101.98,"body":"residents, Jeremy Huckabee,"},{"speaker":"Charles Goldfarb","startTime":101.98,"endTime":105.85,"body":"who's just an amazing guy, and I"},{"speaker":"Charles Goldfarb","startTime":101.98,"endTime":105.85,"body":"learned things about him I"},{"speaker":"Charles Goldfarb","startTime":105.85,"endTime":108.37,"body":"didn't know. And it was, it was"},{"speaker":"Charles Goldfarb","startTime":105.85,"endTime":108.37,"body":"kind of fun,"},{"speaker":"Sanj Kakar","startTime":109.66,"endTime":111.7,"body":"Chuck, I think"},{"speaker":"Sanj Kakar","startTime":109.66,"endTime":111.7,"body":"you're rounding early like me,"},{"speaker":"Sanj Kakar","startTime":111.7,"endTime":114.46,"body":"because you know that the soccer"},{"speaker":"Sanj Kakar","startTime":111.7,"endTime":114.46,"body":"matches are going to kick off."},{"speaker":"Sanj Kakar","startTime":114.88,"endTime":117.88,"body":"You know, we're six hours behind"},{"speaker":"Sanj Kakar","startTime":114.88,"endTime":117.88,"body":"the UK. So that's why you're"},{"speaker":"Sanj Kakar","startTime":117.88,"endTime":120.48,"body":"you're rounding now. Don't let"},{"speaker":"Sanj Kakar","startTime":117.88,"endTime":120.48,"body":"anyone believe anything else"},{"speaker":"Sanj Kakar","startTime":120.96,"endTime":121.56,"body":"this."},{"speaker":"Charles Goldfarb","startTime":121.62,"endTime":124.44,"body":"This is true."},{"speaker":"Charles Goldfarb","startTime":121.62,"endTime":124.44,"body":"And then I also have a business"},{"speaker":"Charles Goldfarb","startTime":124.44,"endTime":126.06,"body":"school final to finish this"},{"speaker":"Charles Goldfarb","startTime":124.44,"endTime":126.06,"body":"morning."},{"speaker":"Chris Dy","startTime":127.8,"endTime":130.26,"body":"You know, you know,"},{"speaker":"Chris Dy","startTime":127.8,"endTime":130.26,"body":"Chuck, the residents are going"},{"speaker":"Chris Dy","startTime":130.44,"endTime":132.48,"body":"to realize, those that are"},{"speaker":"Chris Dy","startTime":130.44,"endTime":132.48,"body":"listening are gonna realize how"},{"speaker":"Chris Dy","startTime":132.48,"endTime":135.24,"body":"out of touch you are. You know,"},{"speaker":"Chris Dy","startTime":132.48,"endTime":135.24,"body":"rounding is just a novel, fun"},{"speaker":"Chris Dy","startTime":135.24,"endTime":138.66,"body":"thing for you, and it's just day"},{"speaker":"Chris Dy","startTime":135.24,"endTime":138.66,"body":"in, day out slog for them for"},{"speaker":"Chris Dy","startTime":138.66,"endTime":142.76,"body":"years. So we're very lucky that"},{"speaker":"Chris Dy","startTime":138.66,"endTime":142.76,"body":"we have residents and fellows"},{"speaker":"Chris Dy","startTime":142.76,"endTime":144.62,"body":"that carry the load for sure,"},{"speaker":"Charles Goldfarb","startTime":145.46,"endTime":148.52,"body":"very, very"},{"speaker":"Charles Goldfarb","startTime":145.46,"endTime":148.52,"body":"true. All right, let's not keep"},{"speaker":"Charles Goldfarb","startTime":148.52,"endTime":153.32,"body":"our listeners waiting too long."},{"speaker":"Charles Goldfarb","startTime":148.52,"endTime":153.32,"body":"We have four or five points we"},{"speaker":"Charles Goldfarb","startTime":153.32,"endTime":157.46,"body":"want to cover with Sanj Over the"},{"speaker":"Charles Goldfarb","startTime":153.32,"endTime":157.46,"body":"next 40 minutes, and we'll start"},{"speaker":"Charles Goldfarb","startTime":157.46,"endTime":160.66,"body":"with something I know he feels"},{"speaker":"Charles Goldfarb","startTime":157.46,"endTime":160.66,"body":"passionately about, which is dry"},{"speaker":"Charles Goldfarb","startTime":160.66,"endTime":165.34,"body":"arthroscopy. So Sanj, give us a"},{"speaker":"Charles Goldfarb","startTime":160.66,"endTime":165.34,"body":"little background on how and why"},{"speaker":"Charles Goldfarb","startTime":165.34,"endTime":168.58,"body":"you started using dry arthrospy."},{"speaker":"Charles Goldfarb","startTime":165.34,"endTime":168.58,"body":"Do you always use dry"},{"speaker":"Charles Goldfarb","startTime":168.58,"endTime":171.34,"body":"arthroscopy and what you think"},{"speaker":"Charles Goldfarb","startTime":168.58,"endTime":171.34,"body":"the benefits are?"},{"speaker":"Sanj Kakar","startTime":172.42,"endTime":174.46,"body":"Yeah, it's a great,"},{"speaker":"Sanj Kakar","startTime":172.42,"endTime":174.46,"body":"great question, Chuck, and I'm"},{"speaker":"Sanj Kakar","startTime":174.46,"endTime":178.0,"body":"asked this a lot. You know, I"},{"speaker":"Sanj Kakar","startTime":174.46,"endTime":178.0,"body":"trained here at Mayo, doing my"},{"speaker":"Sanj Kakar","startTime":178.0,"endTime":182.04,"body":"fellowship with Dick Berger and"},{"speaker":"Sanj Kakar","startTime":178.0,"endTime":182.04,"body":"Alan bishop, and were big wet"},{"speaker":"Sanj Kakar","startTime":182.1,"endTime":185.88,"body":"arthroscopy proponents. So"},{"speaker":"Sanj Kakar","startTime":182.1,"endTime":185.88,"body":"that's what I did in my, I would"},{"speaker":"Sanj Kakar","startTime":185.88,"endTime":189.9,"body":"say, early part of my career,"},{"speaker":"Sanj Kakar","startTime":185.88,"endTime":189.9,"body":"and it wasn't until my Bunnell"},{"speaker":"Sanj Kakar","startTime":189.9,"endTime":193.68,"body":"fellowship where I had the"},{"speaker":"Sanj Kakar","startTime":189.9,"endTime":193.68,"body":"opportunity to sort of go and"},{"speaker":"Sanj Kakar","startTime":193.68,"endTime":196.32,"body":"see some of the luminaries"},{"speaker":"Sanj Kakar","startTime":193.68,"endTime":196.32,"body":"around the world. And I would"},{"speaker":"Sanj Kakar","startTime":196.32,"endTime":199.86,"body":"say, you don't need to have a"},{"speaker":"Sanj Kakar","startTime":196.32,"endTime":199.86,"body":"named traveling fellowship to"},{"speaker":"Sanj Kakar","startTime":199.86,"endTime":202.46,"body":"anybody out there who's"},{"speaker":"Sanj Kakar","startTime":199.86,"endTime":202.46,"body":"interested to learn just, just"},{"speaker":"Sanj Kakar","startTime":202.46,"endTime":205.16,"body":"go and visit people, be that"},{"speaker":"Sanj Kakar","startTime":202.46,"endTime":205.16,"body":"nationally, internationally,"},{"speaker":"Sanj Kakar","startTime":205.16,"endTime":208.94,"body":"just even across your town. It's"},{"speaker":"Sanj Kakar","startTime":205.16,"endTime":208.94,"body":"amazing what you can learn from"},{"speaker":"Sanj Kakar","startTime":208.94,"endTime":212.36,"body":"others. And it struck me that"},{"speaker":"Sanj Kakar","startTime":208.94,"endTime":212.36,"body":"there were so many people doing"},{"speaker":"Sanj Kakar","startTime":212.36,"endTime":216.68,"body":"dry arthroscopy, and this was"},{"speaker":"Sanj Kakar","startTime":212.36,"endTime":216.68,"body":"like a real big sort of light"},{"speaker":"Sanj Kakar","startTime":216.68,"endTime":219.86,"body":"bulb going off. And I remember"},{"speaker":"Sanj Kakar","startTime":216.68,"endTime":219.86,"body":"Paco del Pinal at the hand"},{"speaker":"Sanj Kakar","startTime":219.86,"endTime":223.42,"body":"society once talking about dry"},{"speaker":"Sanj Kakar","startTime":219.86,"endTime":223.42,"body":"arthroscopy with distal radius"},{"speaker":"Sanj Kakar","startTime":223.42,"endTime":227.26,"body":"fractures, and just talking to"},{"speaker":"Sanj Kakar","startTime":223.42,"endTime":227.26,"body":"him about his sort of experience"},{"speaker":"Sanj Kakar","startTime":227.26,"endTime":233.14,"body":"with this. And what have I seen"},{"speaker":"Sanj Kakar","startTime":227.26,"endTime":233.14,"body":"now in my practice? Now 2025,"},{"speaker":"Sanj Kakar","startTime":234.28,"endTime":238.48,"body":"basically, and moving forward,"},{"speaker":"Sanj Kakar","startTime":234.28,"endTime":238.48,"body":"it allows me to do much more"},{"speaker":"Sanj Kakar","startTime":238.48,"endTime":241.2,"body":"than I used to do. I used to"},{"speaker":"Sanj Kakar","startTime":238.48,"endTime":241.2,"body":"always get frustrated with fluid"},{"speaker":"Sanj Kakar","startTime":241.2,"endTime":244.38,"body":"in the joint, you get soft"},{"speaker":"Sanj Kakar","startTime":241.2,"endTime":244.38,"body":"tissue extravasation. And as you"},{"speaker":"Sanj Kakar","startTime":244.38,"endTime":247.14,"body":"know, Chuck and Chris, anytime"},{"speaker":"Sanj Kakar","startTime":244.38,"endTime":247.14,"body":"you're doing arthroscopy is"},{"speaker":"Sanj Kakar","startTime":247.14,"endTime":250.92,"body":"sometimes it's more sort of"},{"speaker":"Sanj Kakar","startTime":247.14,"endTime":250.92,"body":"arthroscopic assisted, so you're"},{"speaker":"Sanj Kakar","startTime":250.92,"endTime":253.62,"body":"making incision, so it's harder"},{"speaker":"Sanj Kakar","startTime":250.92,"endTime":253.62,"body":"to find your soft tissue planes"},{"speaker":"Sanj Kakar","startTime":253.62,"endTime":257.52,"body":"with all the soft tissue fluid."},{"speaker":"Sanj Kakar","startTime":253.62,"endTime":257.52,"body":"And then also, I was worried"},{"speaker":"Sanj Kakar","startTime":257.52,"endTime":260.46,"body":"about disadractures, for"},{"speaker":"Sanj Kakar","startTime":257.52,"endTime":260.46,"body":"example, in compartment"},{"speaker":"Sanj Kakar","startTime":260.46,"endTime":264.08,"body":"syndrome, so I never did one"},{"speaker":"Sanj Kakar","startTime":260.46,"endTime":264.08,"body":"wet, because I was worried about"},{"speaker":"Sanj Kakar","startTime":264.08,"endTime":269.12,"body":"that. And then also, I just"},{"speaker":"Sanj Kakar","startTime":264.08,"endTime":269.12,"body":"found that you can do much more"},{"speaker":"Sanj Kakar","startTime":269.12,"endTime":272.42,"body":"dry than wet. You can make"},{"speaker":"Sanj Kakar","startTime":269.12,"endTime":272.42,"body":"bigger portals so you can make"},{"speaker":"Sanj Kakar","startTime":272.48,"endTime":276.2,"body":"you can put larger Shavers and"},{"speaker":"Sanj Kakar","startTime":272.48,"endTime":276.2,"body":"burst your resection is much"},{"speaker":"Sanj Kakar","startTime":276.2,"endTime":279.38,"body":"more efficient. You ask the"},{"speaker":"Sanj Kakar","startTime":276.2,"endTime":279.38,"body":"question, do I always do dry? I"},{"speaker":"Sanj Kakar","startTime":279.38,"endTime":283.0,"body":"would say 99.9% the two times"},{"speaker":"Sanj Kakar","startTime":279.38,"endTime":283.0,"body":"that I don't is when I'm doing"},{"speaker":"Sanj Kakar","startTime":283.06,"endTime":286.84,"body":"thermal shrinkage. And so you do"},{"speaker":"Sanj Kakar","startTime":283.06,"endTime":286.84,"body":"need fluid in the joints. You"},{"speaker":"Sanj Kakar","startTime":286.84,"endTime":291.22,"body":"don't get chondrolysis, and then"},{"speaker":"Sanj Kakar","startTime":286.84,"endTime":291.22,"body":"also when you're doing washout."},{"speaker":"Sanj Kakar","startTime":291.22,"endTime":294.82,"body":"So those you know, you have,"},{"speaker":"Sanj Kakar","startTime":291.22,"endTime":294.82,"body":"have to obviously flush out the"},{"speaker":"Sanj Kakar","startTime":294.82,"endTime":299.38,"body":"joint, septic joint. And it's,"},{"speaker":"Sanj Kakar","startTime":294.82,"endTime":299.38,"body":"it's ironic with with this flu,"},{"speaker":"Sanj Kakar","startTime":299.38,"endTime":302.28,"body":"IV flu. Crisis. I'm not sure"},{"speaker":"Sanj Kakar","startTime":299.38,"endTime":302.28,"body":"what's going on in your"},{"speaker":"Sanj Kakar","startTime":302.28,"endTime":305.16,"body":"institution, but in our"},{"speaker":"Sanj Kakar","startTime":302.28,"endTime":305.16,"body":"institution, that's been a big"},{"speaker":"Sanj Kakar","startTime":305.16,"endTime":307.86,"body":"hit, especially on our sports"},{"speaker":"Sanj Kakar","startTime":305.16,"endTime":307.86,"body":"medicine colleagues, who do a"},{"speaker":"Sanj Kakar","startTime":307.86,"endTime":312.0,"body":"lot of wet arthroscopy, where"},{"speaker":"Sanj Kakar","startTime":307.86,"endTime":312.0,"body":"we're told to sort of decrease"},{"speaker":"Sanj Kakar","startTime":312.0,"endTime":315.18,"body":"our fluid use. So for me, in"},{"speaker":"Sanj Kakar","startTime":312.0,"endTime":315.18,"body":"that way, it hasn't really been"},{"speaker":"Sanj Kakar","startTime":315.18,"endTime":315.48,"body":"an issue."},{"speaker":"Charles Goldfarb","startTime":316.2,"endTime":319.44,"body":"Yeah, it's an"},{"speaker":"Charles Goldfarb","startTime":316.2,"endTime":319.44,"body":"interesting point. I would say I"},{"speaker":"Charles Goldfarb","startTime":319.44,"endTime":323.78,"body":"would maybe 25% now I'm doing"},{"speaker":"Charles Goldfarb","startTime":319.44,"endTime":323.78,"body":"dry arthroscopy, and it is a I'm"},{"speaker":"Charles Goldfarb","startTime":323.78,"endTime":327.92,"body":"just transitioning slowly, and I"},{"speaker":"Charles Goldfarb","startTime":323.78,"endTime":327.92,"body":"absolutely have started to see"},{"speaker":"Charles Goldfarb","startTime":327.92,"endTime":331.76,"body":"the benefit. I'm not completely"},{"speaker":"Charles Goldfarb","startTime":327.92,"endTime":331.76,"body":"convinced yet, but Chris, I know"},{"speaker":"Charles Goldfarb","startTime":331.76,"endTime":334.82,"body":"you don't do a ton of"},{"speaker":"Charles Goldfarb","startTime":331.76,"endTime":334.82,"body":"arthroscopy, but you definitely"},{"speaker":"Charles Goldfarb","startTime":334.82,"endTime":337.34,"body":"do scope. What are your"},{"speaker":"Charles Goldfarb","startTime":334.82,"endTime":337.34,"body":"thoughts? I"},{"speaker":"Chris Dy","startTime":337.34,"endTime":339.98,"body":"haven't I haven't"},{"speaker":"Chris Dy","startTime":337.34,"endTime":339.98,"body":"tried it yet. And now she was"},{"speaker":"Chris Dy","startTime":339.98,"endTime":343.54,"body":"going to ask you a question is,"},{"speaker":"Chris Dy","startTime":339.98,"endTime":343.54,"body":"why for you Chuck, what are the"},{"speaker":"Chris Dy","startTime":343.54,"endTime":345.7,"body":"cases in which you've started to"},{"speaker":"Chris Dy","startTime":343.54,"endTime":345.7,"body":"do it, and what's your"},{"speaker":"Chris Dy","startTime":345.7,"endTime":349.3,"body":"rationale, so that people who"},{"speaker":"Chris Dy","startTime":345.7,"endTime":349.3,"body":"are like me, kind of a general"},{"speaker":"Chris Dy","startTime":349.3,"endTime":352.48,"body":"hand surgeon in that regard, of"},{"speaker":"Chris Dy","startTime":349.3,"endTime":352.48,"body":"via, you know, doing scopes when"},{"speaker":"Chris Dy","startTime":352.48,"endTime":354.88,"body":"I feel that they're appropriate,"},{"speaker":"Chris Dy","startTime":352.48,"endTime":354.88,"body":"and kind of know, my sweet spot"},{"speaker":"Chris Dy","startTime":354.88,"endTime":358.24,"body":"on what I can do and what I"},{"speaker":"Chris Dy","startTime":354.88,"endTime":358.24,"body":"can't do. What are the reasons"},{"speaker":"Chris Dy","startTime":358.24,"endTime":361.38,"body":"that you decided to take this"},{"speaker":"Chris Dy","startTime":358.24,"endTime":361.38,"body":"jump into doing 25% of your"},{"speaker":"Chris Dy","startTime":361.38,"endTime":362.94,"body":"cases with dry arthroscopy well."},{"speaker":"Charles Goldfarb","startTime":362.94,"endTime":365.52,"body":"One, in all"},{"speaker":"Charles Goldfarb","startTime":362.94,"endTime":365.52,"body":"seriousness, I do respect Sanj,"},{"speaker":"Charles Goldfarb","startTime":365.52,"endTime":369.36,"body":"and when someone like that says"},{"speaker":"Charles Goldfarb","startTime":365.52,"endTime":369.36,"body":"that it works for them, I I want"},{"speaker":"Charles Goldfarb","startTime":369.36,"endTime":373.62,"body":"to try it out. Two, I think the"},{"speaker":"Charles Goldfarb","startTime":369.36,"endTime":373.62,"body":"fluid, the lack of IV fluids,"},{"speaker":"Charles Goldfarb","startTime":374.28,"endTime":377.58,"body":"the crisis, so to speak,"},{"speaker":"Charles Goldfarb","startTime":374.28,"endTime":377.58,"body":"contributed to my interest in"},{"speaker":"Charles Goldfarb","startTime":377.58,"endTime":381.86,"body":"doing more of it. And it's just"},{"speaker":"Charles Goldfarb","startTime":377.58,"endTime":381.86,"body":"for certain risks, especially"},{"speaker":"Charles Goldfarb","startTime":381.86,"endTime":385.4,"body":"those where I know I'm doing an"},{"speaker":"Charles Goldfarb","startTime":381.86,"endTime":385.4,"body":"opening procedure, it just makes"},{"speaker":"Charles Goldfarb","startTime":385.4,"endTime":390.8,"body":"sense. And as long as I can"},{"speaker":"Charles Goldfarb","startTime":385.4,"endTime":390.8,"body":"visualize well, and I generally"},{"speaker":"Charles Goldfarb","startTime":390.8,"endTime":397.52,"body":"can, I like it, there's no doubt"},{"speaker":"Charles Goldfarb","startTime":390.8,"endTime":397.52,"body":"I like it. And so it's just, I"},{"speaker":"Charles Goldfarb","startTime":397.52,"endTime":400.7,"body":"feel like, if you know there are"},{"speaker":"Charles Goldfarb","startTime":397.52,"endTime":400.7,"body":"some risk arthros are very"},{"speaker":"Charles Goldfarb","startTime":400.7,"endTime":404.74,"body":"straightforward, and some for me"},{"speaker":"Charles Goldfarb","startTime":400.7,"endTime":404.74,"body":"remain a struggle, whether the"},{"speaker":"Charles Goldfarb","startTime":404.74,"endTime":408.94,"body":"wrist is tight, whether the"},{"speaker":"Charles Goldfarb","startTime":404.74,"endTime":408.94,"body":"humerus is short, and you just"},{"speaker":"Charles Goldfarb","startTime":408.94,"endTime":412.06,"body":"struggle to get things exactly"},{"speaker":"Charles Goldfarb","startTime":408.94,"endTime":412.06,"body":"like you need to. I tend to"},{"speaker":"Charles Goldfarb","startTime":412.06,"endTime":415.36,"body":"blame fluid or not fluid, so I"},{"speaker":"Charles Goldfarb","startTime":412.06,"endTime":415.36,"body":"don't want to bring the lack of"},{"speaker":"Charles Goldfarb","startTime":415.36,"endTime":417.7,"body":"fluid into it, but I do think"},{"speaker":"Charles Goldfarb","startTime":415.36,"endTime":417.7,"body":"it's going to be a slow"},{"speaker":"Charles Goldfarb","startTime":417.7,"endTime":420.72,"body":"transition towards dry"},{"speaker":"Charles Goldfarb","startTime":417.7,"endTime":420.72,"body":"arthroscopy for me, Sanja. Was"},{"speaker":"Charles Goldfarb","startTime":420.72,"endTime":422.82,"body":"it an evolution for you? Would"},{"speaker":"Charles Goldfarb","startTime":420.72,"endTime":422.82,"body":"you go cold turkey?"},{"speaker":"Sanj Kakar","startTime":423.48,"endTime":426.0,"body":"No, I did go cold"},{"speaker":"Sanj Kakar","startTime":423.48,"endTime":426.0,"body":"turkey, Chuck. And so I would"},{"speaker":"Sanj Kakar","startTime":426.0,"endTime":429.96,"body":"say, I would say to people and"},{"speaker":"Sanj Kakar","startTime":426.0,"endTime":429.96,"body":"and even just watching and"},{"speaker":"Sanj Kakar","startTime":429.96,"endTime":432.96,"body":"training people at courses, what"},{"speaker":"Sanj Kakar","startTime":429.96,"endTime":432.96,"body":"I would say to you is this,"},{"speaker":"Sanj Kakar","startTime":433.2,"endTime":435.66,"body":"we're always taught put the"},{"speaker":"Sanj Kakar","startTime":433.2,"endTime":435.66,"body":"needle in three, four portal and"},{"speaker":"Sanj Kakar","startTime":435.66,"endTime":438.12,"body":"insufflate the joint, right? You"},{"speaker":"Sanj Kakar","startTime":435.66,"endTime":438.12,"body":"don't want to do that. You want"},{"speaker":"Sanj Kakar","startTime":438.12,"endTime":440.96,"body":"to stick the needle in. And the"},{"speaker":"Sanj Kakar","startTime":438.12,"endTime":440.96,"body":"goal is to get the shaver in as"},{"speaker":"Sanj Kakar","startTime":440.96,"endTime":443.6,"body":"quickly as possible, because"},{"speaker":"Sanj Kakar","startTime":440.96,"endTime":443.6,"body":"there's some synovial fluid."},{"speaker":"Sanj Kakar","startTime":443.6,"endTime":446.66,"body":"There's bubbles in the joint."},{"speaker":"Sanj Kakar","startTime":443.6,"endTime":446.66,"body":"You can't see so I remember. So"},{"speaker":"Sanj Kakar","startTime":446.66,"endTime":449.24,"body":"you don't want to start off"},{"speaker":"Sanj Kakar","startTime":446.66,"endTime":449.24,"body":"doing, for example, a fracture"},{"speaker":"Sanj Kakar","startTime":449.24,"endTime":452.3,"body":"case, right? So let's say you're"},{"speaker":"Sanj Kakar","startTime":449.24,"endTime":452.3,"body":"doing a TCC debridement. Start"},{"speaker":"Sanj Kakar","startTime":452.3,"endTime":455.6,"body":"off very simple, or a ganglia or"},{"speaker":"Sanj Kakar","startTime":452.3,"endTime":455.6,"body":"something like that. So what I"},{"speaker":"Sanj Kakar","startTime":455.6,"endTime":457.88,"body":"would say to my scrub tech is,"},{"speaker":"Sanj Kakar","startTime":455.6,"endTime":457.88,"body":"I'm going to ask for fluid"},{"speaker":"Sanj Kakar","startTime":457.88,"endTime":461.02,"body":"within 60 seconds, right? Your"},{"speaker":"Sanj Kakar","startTime":457.88,"endTime":461.02,"body":"but your answer is, No, I'm not"},{"speaker":"Sanj Kakar","startTime":461.02,"endTime":464.14,"body":"going to give it to you. And so"},{"speaker":"Sanj Kakar","startTime":461.02,"endTime":464.14,"body":"I had to struggle a bit, a"},{"speaker":"Sanj Kakar","startTime":464.14,"endTime":467.26,"body":"little. And so the key is, get"},{"speaker":"Sanj Kakar","startTime":464.14,"endTime":467.26,"body":"your needle in, make your three"},{"speaker":"Sanj Kakar","startTime":467.26,"endTime":470.14,"body":"four portal, and get your shaver"},{"speaker":"Sanj Kakar","startTime":467.26,"endTime":470.14,"body":"in in the six hour, or the four,"},{"speaker":"Sanj Kakar","startTime":470.14,"endTime":475.48,"body":"five portal, and then you take a"},{"speaker":"Sanj Kakar","startTime":470.14,"endTime":475.48,"body":"10 cc syringe, not a 20 CC, not"},{"speaker":"Sanj Kakar","startTime":475.48,"endTime":478.66,"body":"a 30 CC, a 10 cc syringe. And"},{"speaker":"Sanj Kakar","startTime":475.48,"endTime":478.66,"body":"usually I use a two millimeter"},{"speaker":"Sanj Kakar","startTime":478.66,"endTime":481.92,"body":"shaver, and that's enough,"},{"speaker":"Sanj Kakar","startTime":478.66,"endTime":481.92,"body":"enough suction power on the"},{"speaker":"Sanj Kakar","startTime":481.92,"endTime":485.76,"body":"syringe to do an automatic"},{"speaker":"Sanj Kakar","startTime":481.92,"endTime":485.76,"body":"washout. And, you know, we put"},{"speaker":"Sanj Kakar","startTime":485.76,"endTime":489.78,"body":"this on videos, on handy, or on"},{"speaker":"Sanj Kakar","startTime":485.76,"endTime":489.78,"body":"Anthology, so people can see how"},{"speaker":"Sanj Kakar","startTime":489.78,"endTime":493.2,"body":"to technically do that. And then"},{"speaker":"Sanj Kakar","startTime":489.78,"endTime":493.2,"body":"once you sort of lavage the"},{"speaker":"Sanj Kakar","startTime":493.2,"endTime":495.48,"body":"joint, you leave the shaver on"},{"speaker":"Sanj Kakar","startTime":493.2,"endTime":495.48,"body":"and you want to get rid of all"},{"speaker":"Sanj Kakar","startTime":495.48,"endTime":500.42,"body":"the fluid. And then you can see,"},{"speaker":"Sanj Kakar","startTime":495.48,"endTime":500.42,"body":"and so, for example, TFCC work,"},{"speaker":"Sanj Kakar","startTime":500.42,"endTime":503.24,"body":"I always used to struggle to"},{"speaker":"Sanj Kakar","startTime":500.42,"endTime":503.24,"body":"scope the D, R, U, J, you'd get"},{"speaker":"Sanj Kakar","startTime":503.24,"endTime":505.82,"body":"underneath there, there'll be"},{"speaker":"Sanj Kakar","startTime":503.24,"endTime":505.82,"body":"crab meat in your face. You"},{"speaker":"Sanj Kakar","startTime":505.82,"endTime":508.76,"body":"can't see anything. Can you just"},{"speaker":"Sanj Kakar","startTime":505.82,"endTime":508.76,"body":"pull the camera out and you just"},{"speaker":"Sanj Kakar","startTime":508.76,"endTime":511.52,"body":"say, I'm not going to do this"},{"speaker":"Sanj Kakar","startTime":508.76,"endTime":511.52,"body":"anymore. But if you do it dry,"},{"speaker":"Sanj Kakar","startTime":511.94,"endTime":514.64,"body":"you can sort of see areas. You"},{"speaker":"Sanj Kakar","startTime":511.94,"endTime":514.64,"body":"can see the phobia. I mean, that"},{"speaker":"Sanj Kakar","startTime":514.64,"endTime":518.3,"body":"was a that was a thing for me in"},{"speaker":"Sanj Kakar","startTime":514.64,"endTime":518.3,"body":"2017 I'd never really seen the"},{"speaker":"Sanj Kakar","startTime":518.3,"endTime":521.74,"body":"phobia before, and I didn't know"},{"speaker":"Sanj Kakar","startTime":518.3,"endTime":521.74,"body":"what that looked like. And, you"},{"speaker":"Sanj Kakar","startTime":521.74,"endTime":524.02,"body":"know, we're all well into"},{"speaker":"Sanj Kakar","startTime":521.74,"endTime":524.02,"body":"practice there. So it's just"},{"speaker":"Sanj Kakar","startTime":524.02,"endTime":527.2,"body":"sort of that evolution. But as"},{"speaker":"Sanj Kakar","startTime":524.02,"endTime":527.2,"body":"you said, Chris, you know, you"},{"speaker":"Sanj Kakar","startTime":527.2,"endTime":531.22,"body":"have to start simple and build"},{"speaker":"Sanj Kakar","startTime":527.2,"endTime":531.22,"body":"up. And you'll you'll see,"},{"speaker":"Sanj Kakar","startTime":531.22,"endTime":534.22,"body":"there's a couple of tricks. So"},{"speaker":"Sanj Kakar","startTime":531.22,"endTime":534.22,"body":"you sometimes you get stuff on"},{"speaker":"Sanj Kakar","startTime":534.22,"endTime":536.32,"body":"the lens of the camera and you"},{"speaker":"Sanj Kakar","startTime":534.22,"endTime":536.32,"body":"can't see. So what are the"},{"speaker":"Sanj Kakar","startTime":536.32,"endTime":540.3,"body":"tricks? So number one, well, the"},{"speaker":"Sanj Kakar","startTime":536.32,"endTime":540.3,"body":"first thing that I do is I wipe"},{"speaker":"Sanj Kakar","startTime":540.3,"endTime":543.36,"body":"the lens in the soft tissue, the"},{"speaker":"Sanj Kakar","startTime":540.3,"endTime":543.36,"body":"bowler capsule, the TFCC,"},{"speaker":"Sanj Kakar","startTime":543.36,"endTime":546.9,"body":"anything soft, not bony, and"},{"speaker":"Sanj Kakar","startTime":543.36,"endTime":546.9,"body":"that usually clears your lens."},{"speaker":"Sanj Kakar","startTime":547.2,"endTime":550.08,"body":"If that doesn't happen, then I"},{"speaker":"Sanj Kakar","startTime":547.2,"endTime":550.08,"body":"do the automatic washout"},{"speaker":"Sanj Kakar","startTime":550.08,"endTime":552.84,"body":"technique. And if that doesn't"},{"speaker":"Sanj Kakar","startTime":550.08,"endTime":552.84,"body":"happen, Chris, I know you're a"},{"speaker":"Sanj Kakar","startTime":552.84,"endTime":555.9,"body":"big micro proponent, and so what"},{"speaker":"Sanj Kakar","startTime":552.84,"endTime":555.9,"body":"we do is we want to be"},{"speaker":"Sanj Kakar","startTime":555.9,"endTime":558.36,"body":"respectful of micro surgery. So"},{"speaker":"Sanj Kakar","startTime":555.9,"endTime":558.36,"body":"we have the micro wipe, you"},{"speaker":"Sanj Kakar","startTime":558.36,"endTime":561.26,"body":"know, that you use to wipe the"},{"speaker":"Sanj Kakar","startTime":558.36,"endTime":561.26,"body":"needle, so we have that wet on"},{"speaker":"Sanj Kakar","startTime":561.26,"endTime":564.44,"body":"the table, and we simply wipe"},{"speaker":"Sanj Kakar","startTime":561.26,"endTime":564.44,"body":"the lens. And those little three"},{"speaker":"Sanj Kakar","startTime":564.44,"endTime":567.98,"body":"tricks are all that you need to"},{"speaker":"Sanj Kakar","startTime":564.44,"endTime":567.98,"body":"ensure that you can see with"},{"speaker":"Sanj Kakar","startTime":567.98,"endTime":568.58,"body":"your camera."},{"speaker":"Charles Goldfarb","startTime":569.12,"endTime":572.54,"body":"So two, two"},{"speaker":"Charles Goldfarb","startTime":569.12,"endTime":572.54,"body":"comments and a question, and"},{"speaker":"Charles Goldfarb","startTime":572.54,"endTime":576.5,"body":"sorry, Chris, I beat you to it."},{"speaker":"Charles Goldfarb","startTime":572.54,"endTime":576.5,"body":"Comment number one is, if"},{"speaker":"Charles Goldfarb","startTime":576.5,"endTime":578.84,"body":"there's a national shortage of"},{"speaker":"Charles Goldfarb","startTime":576.5,"endTime":578.84,"body":"micro wives, we know where"},{"speaker":"Charles Goldfarb","startTime":578.84,"endTime":580.96,"body":"they're going, Chris, they're"},{"speaker":"Charles Goldfarb","startTime":578.84,"endTime":580.96,"body":"all going to Rochester,"},{"speaker":"Charles Goldfarb","startTime":580.96,"endTime":584.26,"body":"Minnesota. But in all"},{"speaker":"Charles Goldfarb","startTime":580.96,"endTime":584.26,"body":"seriousness, comment number one,"},{"speaker":"Charles Goldfarb","startTime":584.32,"endTime":587.62,"body":"even if you don't believe in dry"},{"speaker":"Charles Goldfarb","startTime":584.32,"endTime":587.62,"body":"arthroscopy, stop insufflating"},{"speaker":"Charles Goldfarb","startTime":587.62,"endTime":591.04,"body":"the joint. I stopped that many,"},{"speaker":"Charles Goldfarb","startTime":587.62,"endTime":591.04,"body":"many years ago. It does nothing"},{"speaker":"Charles Goldfarb","startTime":591.04,"endTime":594.58,"body":"for you. It's vital for an elbow"},{"speaker":"Charles Goldfarb","startTime":591.04,"endTime":594.58,"body":"arthroscopy. It's a waste of"},{"speaker":"Charles Goldfarb","startTime":594.58,"endTime":597.82,"body":"time for the wrist. Insufflating"},{"speaker":"Charles Goldfarb","startTime":594.58,"endTime":597.82,"body":"the wrist joint does nothing."},{"speaker":"Charles Goldfarb","startTime":598.3,"endTime":600.84,"body":"That's number one. Number two"},{"speaker":"Charles Goldfarb","startTime":598.3,"endTime":600.84,"body":"is. Essentially use a two"},{"speaker":"Charles Goldfarb","startTime":600.84,"endTime":604.38,"body":"millimeter shaver. I use a three"},{"speaker":"Charles Goldfarb","startTime":600.84,"endTime":604.38,"body":"millimeter shaver in most"},{"speaker":"Charles Goldfarb","startTime":604.38,"endTime":607.26,"body":"situations, just because I'm"},{"speaker":"Charles Goldfarb","startTime":604.38,"endTime":607.26,"body":"impatient. You may be more"},{"speaker":"Charles Goldfarb","startTime":607.26,"endTime":612.06,"body":"patient than I but I like the"},{"speaker":"Charles Goldfarb","startTime":607.26,"endTime":612.06,"body":"you know, size and power, etc."},{"speaker":"Charles Goldfarb","startTime":612.36,"endTime":615.72,"body":"And then my question is, and"},{"speaker":"Charles Goldfarb","startTime":612.36,"endTime":615.72,"body":"we're already on a tangent,"},{"speaker":"Charles Goldfarb","startTime":615.72,"endTime":622.82,"body":"which is totally fine. Explain"},{"speaker":"Charles Goldfarb","startTime":615.72,"endTime":622.82,"body":"how you technically assess the"},{"speaker":"Charles Goldfarb","startTime":622.82,"endTime":627.08,"body":"phobia when you do a d a, quote,"},{"speaker":"Charles Goldfarb","startTime":622.82,"endTime":627.08,"body":"unquote, d r u j, arthroscopy,"},{"speaker":"Charles Goldfarb","startTime":627.2,"endTime":630.02,"body":"because, as I recall, you're not"},{"speaker":"Charles Goldfarb","startTime":627.2,"endTime":630.02,"body":"putting your portals necessarily"},{"speaker":"Charles Goldfarb","startTime":630.02,"endTime":631.82,"body":"in the D R, E, J, but correct me"},{"speaker":"Charles Goldfarb","startTime":630.02,"endTime":631.82,"body":"if I'm wrong,"},{"speaker":"Sanj Kakar","startTime":633.08,"endTime":636.38,"body":"yeah. So, so"},{"speaker":"Sanj Kakar","startTime":633.08,"endTime":636.38,"body":"technically, how to scope the d"},{"speaker":"Sanj Kakar","startTime":636.38,"endTime":641.62,"body":"r u j, so it's a great question,"},{"speaker":"Sanj Kakar","startTime":636.38,"endTime":641.62,"body":"Chuck, because the way I was"},{"speaker":"Sanj Kakar","startTime":641.62,"endTime":644.68,"body":"taught was blind, right? You"},{"speaker":"Sanj Kakar","startTime":641.62,"endTime":644.68,"body":"stick a needle in, and then you"},{"speaker":"Sanj Kakar","startTime":644.68,"endTime":647.44,"body":"spread, and then you worry"},{"speaker":"Sanj Kakar","startTime":644.68,"endTime":647.44,"body":"about, are you gouging the"},{"speaker":"Sanj Kakar","startTime":647.44,"endTime":650.8,"body":"articular cartridge of the I'll"},{"speaker":"Sanj Kakar","startTime":647.44,"endTime":650.8,"body":"be on the head, and you stick it"},{"speaker":"Sanj Kakar","startTime":650.8,"endTime":654.22,"body":"in, you can't see any withdraw."},{"speaker":"Sanj Kakar","startTime":650.8,"endTime":654.22,"body":"So the way that I do this,"},{"speaker":"Sanj Kakar","startTime":654.22,"endTime":657.22,"body":"number one, you need a smaller"},{"speaker":"Sanj Kakar","startTime":654.22,"endTime":657.22,"body":"camera, right? So you use a 1.9"},{"speaker":"Sanj Kakar","startTime":657.64,"endTime":660.42,"body":"millimeter camera, so you have"},{"speaker":"Sanj Kakar","startTime":657.64,"endTime":660.42,"body":"your camera in the three, four"},{"speaker":"Sanj Kakar","startTime":660.42,"endTime":664.2,"body":"portal, and you put your needle"},{"speaker":"Sanj Kakar","startTime":660.42,"endTime":664.2,"body":"underneath the middle of the"},{"speaker":"Sanj Kakar","startTime":664.2,"endTime":668.34,"body":"TFCC, in the middle of the ulna"},{"speaker":"Sanj Kakar","startTime":664.2,"endTime":668.34,"body":"head. What people tend to do is"},{"speaker":"Sanj Kakar","startTime":668.34,"endTime":670.74,"body":"that they go to the words the"},{"speaker":"Sanj Kakar","startTime":668.34,"endTime":670.74,"body":"ulna styloid. They took their"},{"speaker":"Sanj Kakar","startTime":670.74,"endTime":673.98,"body":"two ulna and remember, then"},{"speaker":"Sanj Kakar","startTime":670.74,"endTime":673.98,"body":"you're in the fovea and if"},{"speaker":"Sanj Kakar","startTime":673.98,"endTime":677.22,"body":"there's a foveal injury, you're"},{"speaker":"Sanj Kakar","startTime":673.98,"endTime":677.22,"body":"in scar tissue. So what I do is"},{"speaker":"Sanj Kakar","startTime":677.22,"endTime":680.78,"body":"I slowly pronoun supinate. I"},{"speaker":"Sanj Kakar","startTime":677.22,"endTime":680.78,"body":"feel the D, i, u, j, then I feel"},{"speaker":"Sanj Kakar","startTime":680.78,"endTime":683.3,"body":"the on the styloid, and I put my"},{"speaker":"Sanj Kakar","startTime":680.78,"endTime":683.3,"body":"needle in the middle of the on"},{"speaker":"Sanj Kakar","startTime":683.3,"endTime":685.88,"body":"the head, underneath the TFCC,"},{"speaker":"Sanj Kakar","startTime":683.3,"endTime":685.88,"body":"and I move the needle up and"},{"speaker":"Sanj Kakar","startTime":685.88,"endTime":689.0,"body":"down, so I know 100% I'm in the"},{"speaker":"Sanj Kakar","startTime":685.88,"endTime":689.0,"body":"right spot. Then you make a"},{"speaker":"Sanj Kakar","startTime":689.0,"endTime":691.52,"body":"transverse incision or"},{"speaker":"Sanj Kakar","startTime":689.0,"endTime":691.52,"body":"longitudinal, it doesn't matter,"},{"speaker":"Sanj Kakar","startTime":691.52,"endTime":693.74,"body":"spread, spread, spread. And you"},{"speaker":"Sanj Kakar","startTime":691.52,"endTime":693.74,"body":"pop into your scissors are"},{"speaker":"Sanj Kakar","startTime":693.74,"endTime":697.34,"body":"underneath the TFCC. You move"},{"speaker":"Sanj Kakar","startTime":693.74,"endTime":697.34,"body":"your scissors up and down. You"},{"speaker":"Sanj Kakar","startTime":697.34,"endTime":699.56,"body":"have the camera in the three"},{"speaker":"Sanj Kakar","startTime":697.34,"endTime":699.56,"body":"four portals. You know you're in"},{"speaker":"Sanj Kakar","startTime":699.56,"endTime":702.58,"body":"the right spot. And then the"},{"speaker":"Sanj Kakar","startTime":699.56,"endTime":702.58,"body":"system that I use has two"},{"speaker":"Sanj Kakar","startTime":702.58,"endTime":705.58,"body":"cannulas. And so you simply now"},{"speaker":"Sanj Kakar","startTime":702.58,"endTime":705.58,"body":"bring the second cannula in,"},{"speaker":"Sanj Kakar","startTime":705.82,"endTime":709.72,"body":"you're underneath the TFCC, and"},{"speaker":"Sanj Kakar","startTime":705.82,"endTime":709.72,"body":"then you put the camera in, and"},{"speaker":"Sanj Kakar","startTime":709.72,"endTime":711.7,"body":"the first thing that you're"},{"speaker":"Sanj Kakar","startTime":709.72,"endTime":711.7,"body":"going to see is white because"},{"speaker":"Sanj Kakar","startTime":711.7,"endTime":714.82,"body":"you're adjacent to the bowler"},{"speaker":"Sanj Kakar","startTime":711.7,"endTime":714.82,"body":"capsule. So I bring the camera"},{"speaker":"Sanj Kakar","startTime":714.82,"endTime":717.34,"body":"back, and then I'm slowly"},{"speaker":"Sanj Kakar","startTime":714.82,"endTime":717.34,"body":"pronoun supinating, and I'm"},{"speaker":"Sanj Kakar","startTime":717.34,"endTime":719.8,"body":"looking for the sigmoid notch,"},{"speaker":"Sanj Kakar","startTime":717.34,"endTime":719.8,"body":"because then I know exactly"},{"speaker":"Sanj Kakar","startTime":719.8,"endTime":723.48,"body":"where I'm at. And then I'll move"},{"speaker":"Sanj Kakar","startTime":719.8,"endTime":723.48,"body":"the camera towards the ulna"},{"speaker":"Sanj Kakar","startTime":723.48,"endTime":726.48,"body":"side, and that's where you'll"},{"speaker":"Sanj Kakar","startTime":723.48,"endTime":726.48,"body":"see the phobia. Now, sometimes"},{"speaker":"Sanj Kakar","startTime":726.48,"endTime":729.54,"body":"the scar tissue, though, is you"},{"speaker":"Sanj Kakar","startTime":726.48,"endTime":729.54,"body":"have to bring a shaver in, but I"},{"speaker":"Sanj Kakar","startTime":729.54,"endTime":733.38,"body":"would say seven out of 10 times"},{"speaker":"Sanj Kakar","startTime":729.54,"endTime":733.38,"body":"I'm clinically suspecting a"},{"speaker":"Sanj Kakar","startTime":733.38,"endTime":737.64,"body":"foveal injury, the synovitis in"},{"speaker":"Sanj Kakar","startTime":733.38,"endTime":737.64,"body":"that area. And then you can see"},{"speaker":"Sanj Kakar","startTime":737.64,"endTime":741.62,"body":"the phobia. But to your point,"},{"speaker":"Sanj Kakar","startTime":737.64,"endTime":741.62,"body":"you have to build up, like you"},{"speaker":"Sanj Kakar","startTime":741.62,"endTime":744.98,"body":"showed in that, in this work"},{"speaker":"Sanj Kakar","startTime":741.62,"endTime":744.98,"body":"that that you spearheaded, about"},{"speaker":"Sanj Kakar","startTime":744.98,"endTime":749.0,"body":"the TFCC, right? The trampoline"},{"speaker":"Sanj Kakar","startTime":744.98,"endTime":749.0,"body":"test, the hook test, you have to"},{"speaker":"Sanj Kakar","startTime":749.0,"endTime":753.2,"body":"find out what your normal is for"},{"speaker":"Sanj Kakar","startTime":749.0,"endTime":753.2,"body":"phobial attachments, because"},{"speaker":"Sanj Kakar","startTime":753.44,"endTime":756.68,"body":"it's a gradation of injury,"},{"speaker":"Sanj Kakar","startTime":753.44,"endTime":756.68,"body":"right? It's either torn or it's"},{"speaker":"Sanj Kakar","startTime":756.68,"endTime":759.14,"body":"not torn. I don't think it's as"},{"speaker":"Sanj Kakar","startTime":756.68,"endTime":759.14,"body":"black and white as that. It's"},{"speaker":"Sanj Kakar","startTime":759.14,"endTime":762.22,"body":"gray. So there's partial"},{"speaker":"Sanj Kakar","startTime":759.14,"endTime":762.22,"body":"injuries. There's near complete."},{"speaker":"Sanj Kakar","startTime":762.4,"endTime":765.28,"body":"So you have to scope as many as"},{"speaker":"Sanj Kakar","startTime":762.4,"endTime":765.28,"body":"you can. And trust me, the first"},{"speaker":"Sanj Kakar","startTime":765.28,"endTime":768.4,"body":"one you do, you're going to be"},{"speaker":"Sanj Kakar","startTime":765.28,"endTime":768.4,"body":"frustrated. But again, it's just"},{"speaker":"Sanj Kakar","startTime":768.4,"endTime":771.58,"body":"going through that. And I must"},{"speaker":"Sanj Kakar","startTime":768.4,"endTime":771.58,"body":"stress, you have to, you can't"},{"speaker":"Sanj Kakar","startTime":771.58,"endTime":776.32,"body":"do it with a regular 2.7 camera."},{"speaker":"Sanj Kakar","startTime":771.58,"endTime":776.32,"body":"It's too big. So"},{"speaker":"Chris Dy","startTime":776.32,"endTime":779.2,"body":"the the 1.9 millimeter"},{"speaker":"Chris Dy","startTime":776.32,"endTime":779.2,"body":"camera seems to be pretty"},{"speaker":"Chris Dy","startTime":779.2,"endTime":782.82,"body":"essential for this. But I think"},{"speaker":"Chris Dy","startTime":779.2,"endTime":782.82,"body":"that your your points. I want to"},{"speaker":"Chris Dy","startTime":782.82,"endTime":786.3,"body":"dig in a little bit more about"},{"speaker":"Chris Dy","startTime":782.82,"endTime":786.3,"body":"the experience with arthroscopy"},{"speaker":"Chris Dy","startTime":786.3,"endTime":789.24,"body":"and Chuck. Maybe you could talk"},{"speaker":"Chris Dy","startTime":786.3,"endTime":789.24,"body":"a little bit about two papers"},{"speaker":"Chris Dy","startTime":789.24,"endTime":791.76,"body":"that you worked on, because I"},{"speaker":"Chris Dy","startTime":789.24,"endTime":791.76,"body":"think they're very relevant and"},{"speaker":"Chris Dy","startTime":791.76,"endTime":795.12,"body":"educational. The first being"},{"speaker":"Chris Dy","startTime":791.76,"endTime":795.12,"body":"what Sanja alluded to with the"},{"speaker":"Chris Dy","startTime":795.18,"endTime":799.74,"body":"how you evaluate the TFCC in"},{"speaker":"Chris Dy","startTime":795.18,"endTime":799.74,"body":"terms of trampoline versus hook."},{"speaker":"Chris Dy","startTime":799.74,"endTime":803.84,"body":"So just for the general hand"},{"speaker":"Chris Dy","startTime":799.74,"endTime":803.84,"body":"surgeon or a resident. Talk"},{"speaker":"Chris Dy","startTime":804.08,"endTime":806.72,"body":"about how you do that. And then"},{"speaker":"Chris Dy","startTime":804.08,"endTime":806.72,"body":"the second one is, can you talk"},{"speaker":"Chris Dy","startTime":806.72,"endTime":811.52,"body":"a little bit about the the"},{"speaker":"Chris Dy","startTime":806.72,"endTime":811.52,"body":"variability in in grading of"},{"speaker":"Chris Dy","startTime":811.52,"endTime":813.98,"body":"some of these that's in some of"},{"speaker":"Chris Dy","startTime":811.52,"endTime":813.98,"body":"the more recent work that you,"},{"speaker":"Chris Dy","startTime":813.98,"endTime":814.58,"body":"that you guys have"},{"speaker":"Charles Goldfarb","startTime":814.58,"endTime":816.26,"body":"worked on"},{"speaker":"Charles Goldfarb","startTime":814.58,"endTime":816.26,"body":"together? Yeah, I can super I"},{"speaker":"Charles Goldfarb","startTime":816.26,"endTime":820.16,"body":"can jump in super quick on that."},{"speaker":"Charles Goldfarb","startTime":816.26,"endTime":820.16,"body":"So the first paper we did was a"},{"speaker":"Charles Goldfarb","startTime":820.16,"endTime":824.62,"body":"cadaver study looking at how"},{"speaker":"Charles Goldfarb","startTime":820.16,"endTime":824.62,"body":"does one diagnose a phobial"},{"speaker":"Charles Goldfarb","startTime":824.62,"endTime":827.8,"body":"tear? We certainly didn't come"},{"speaker":"Charles Goldfarb","startTime":824.62,"endTime":827.8,"body":"up with a concept of hook test,"},{"speaker":"Charles Goldfarb","startTime":828.22,"endTime":831.82,"body":"but we took cadavers without"},{"speaker":"Charles Goldfarb","startTime":828.22,"endTime":831.82,"body":"evidence of injury, we used a"},{"speaker":"Charles Goldfarb","startTime":831.82,"endTime":834.88,"body":"beaver blade through a minimally"},{"speaker":"Charles Goldfarb","startTime":831.82,"endTime":834.88,"body":"invasive approach to cut the"},{"speaker":"Charles Goldfarb","startTime":834.88,"endTime":838.24,"body":"foveal insertion, and then we"},{"speaker":"Charles Goldfarb","startTime":834.88,"endTime":838.24,"body":"repeated our arthroscopy. We"},{"speaker":"Charles Goldfarb","startTime":838.24,"endTime":841.08,"body":"started before cutting and then"},{"speaker":"Charles Goldfarb","startTime":838.24,"endTime":841.08,"body":"after cutting, and we"},{"speaker":"Charles Goldfarb","startTime":841.08,"endTime":844.2,"body":"demonstrated that the hook test"},{"speaker":"Charles Goldfarb","startTime":841.08,"endTime":844.2,"body":"was helpful. The hook test is"},{"speaker":"Charles Goldfarb","startTime":844.2,"endTime":848.4,"body":"not a simplistic yes or no test,"},{"speaker":"Charles Goldfarb","startTime":844.2,"endTime":848.4,"body":"either. It's become clear that"},{"speaker":"Charles Goldfarb","startTime":848.4,"endTime":852.54,"body":"people feel there are gradations"},{"speaker":"Charles Goldfarb","startTime":848.4,"endTime":852.54,"body":"to Sandra's point, gradations in"},{"speaker":"Charles Goldfarb","startTime":852.54,"endTime":856.62,"body":"the completeness of a tear, so"},{"speaker":"Charles Goldfarb","startTime":852.54,"endTime":856.62,"body":"to speak. And so the goal is,"},{"speaker":"Charles Goldfarb","startTime":856.62,"endTime":860.9,"body":"you know, the trampoline test is"},{"speaker":"Charles Goldfarb","startTime":856.62,"endTime":860.9,"body":"absolutely non specific, and it"},{"speaker":"Charles Goldfarb","startTime":860.9,"endTime":867.26,"body":"also is very operator dependent"},{"speaker":"Charles Goldfarb","startTime":860.9,"endTime":867.26,"body":"and tactile dependent. But the"},{"speaker":"Charles Goldfarb","startTime":867.26,"endTime":870.86,"body":"hook test, we thought maybe yes"},{"speaker":"Charles Goldfarb","startTime":867.26,"endTime":870.86,"body":"or no, but even that is vague."},{"speaker":"Charles Goldfarb","startTime":870.86,"endTime":874.52,"body":"But the idea is that you go very"},{"speaker":"Charles Goldfarb","startTime":870.86,"endTime":874.52,"body":"olderly, and you take your probe"},{"speaker":"Charles Goldfarb","startTime":874.52,"endTime":878.9,"body":"and put it under the TFCC and"},{"speaker":"Charles Goldfarb","startTime":874.52,"endTime":878.9,"body":"try to lift up towards the"},{"speaker":"Charles Goldfarb","startTime":878.96,"endTime":883.42,"body":"traquitrum. And again, it's a"},{"speaker":"Charles Goldfarb","startTime":878.96,"endTime":883.42,"body":"sense of feel, but that's the"},{"speaker":"Charles Goldfarb","startTime":883.42,"endTime":887.02,"body":"gist behind it. And so what Sanj"},{"speaker":"Charles Goldfarb","startTime":883.42,"endTime":887.02,"body":"and I did, along with others, is"},{"speaker":"Charles Goldfarb","startTime":887.02,"endTime":893.14,"body":"we took 40 videos, and we rated"},{"speaker":"Charles Goldfarb","startTime":887.02,"endTime":893.14,"body":"our ability to assess, basically"},{"speaker":"Charles Goldfarb","startTime":893.14,"endTime":896.98,"body":"our Inter observer liability on"},{"speaker":"Charles Goldfarb","startTime":893.14,"endTime":896.98,"body":"TFCC tears. And suffice to say"},{"speaker":"Charles Goldfarb","startTime":896.98,"endTime":899.5,"body":"is we weren't very good, except"},{"speaker":"Charles Goldfarb","startTime":896.98,"endTime":899.5,"body":"for central tears, where we were"},{"speaker":"Charles Goldfarb","startTime":899.5,"endTime":902.76,"body":"really good. But that should not"},{"speaker":"Charles Goldfarb","startTime":899.5,"endTime":902.76,"body":"be we shouldn't pat ourselves."},{"speaker":"Charles Goldfarb","startTime":902.76,"endTime":907.02,"body":"Look back too much for that, so"},{"speaker":"Charles Goldfarb","startTime":902.76,"endTime":907.02,"body":"that capture it. Sanj, yeah,"},{"speaker":"Sanj Kakar","startTime":907.02,"endTime":909.24,"body":"yeah, absolutely."},{"speaker":"Sanj Kakar","startTime":907.02,"endTime":909.24,"body":"So. So for me, Chris, when I"},{"speaker":"Sanj Kakar","startTime":909.24,"endTime":913.02,"body":"when I'm scoping a risk and I'm"},{"speaker":"Sanj Kakar","startTime":909.24,"endTime":913.02,"body":"worried about the TFCC, I do"},{"speaker":"Sanj Kakar","startTime":913.02,"endTime":917.28,"body":"four tests. I do the trampoline"},{"speaker":"Sanj Kakar","startTime":913.02,"endTime":917.28,"body":"test, I do the the hook test, I"},{"speaker":"Sanj Kakar","startTime":917.28,"endTime":920.18,"body":"do the suction test. We"},{"speaker":"Sanj Kakar","startTime":917.28,"endTime":920.18,"body":"basically have the suction turn."},{"speaker":"Sanj Kakar","startTime":920.18,"endTime":924.14,"body":"You have the suction on shaver"},{"speaker":"Sanj Kakar","startTime":920.18,"endTime":924.14,"body":"in sorry, you lift it off the"},{"speaker":"Sanj Kakar","startTime":924.14,"endTime":926.84,"body":"TFCC, and you turn the suction"},{"speaker":"Sanj Kakar","startTime":924.14,"endTime":926.84,"body":"on and off, and you see if that"},{"speaker":"Sanj Kakar","startTime":926.84,"endTime":929.84,"body":"lifts up or down. And then the"},{"speaker":"Sanj Kakar","startTime":926.84,"endTime":929.84,"body":"third one that I'll do is I'll"},{"speaker":"Sanj Kakar","startTime":929.84,"endTime":934.94,"body":"always scope the diuj. I always"},{"speaker":"Sanj Kakar","startTime":929.84,"endTime":934.94,"body":"tell our residents and fellows,"},{"speaker":"Sanj Kakar","startTime":934.94,"endTime":938.12,"body":"right? You do a radio carpal"},{"speaker":"Sanj Kakar","startTime":934.94,"endTime":938.12,"body":"joint arthroscopy, you look at"},{"speaker":"Sanj Kakar","startTime":938.12,"endTime":941.92,"body":"the TFCC, and you also always go"},{"speaker":"Sanj Kakar","startTime":938.12,"endTime":941.92,"body":"as far on as you can my mentor,"},{"speaker":"Sanj Kakar","startTime":941.92,"endTime":945.7,"body":"Dick Berger, talked about the"},{"speaker":"Sanj Kakar","startTime":941.92,"endTime":945.7,"body":"only tricoectal Split tear. And"},{"speaker":"Sanj Kakar","startTime":945.7,"endTime":948.76,"body":"so there's always synovitis in"},{"speaker":"Sanj Kakar","startTime":945.7,"endTime":948.76,"body":"that area if there's a tear. And"},{"speaker":"Sanj Kakar","startTime":948.76,"endTime":951.46,"body":"so you have to debride that"},{"speaker":"Sanj Kakar","startTime":948.76,"endTime":951.46,"body":"synovitis to see if there truly"},{"speaker":"Sanj Kakar","startTime":951.46,"endTime":954.88,"body":"is a tear or not. And then I'll"},{"speaker":"Sanj Kakar","startTime":951.46,"endTime":954.88,"body":"scope the D, I, E, J, after"},{"speaker":"Sanj Kakar","startTime":954.88,"endTime":960.96,"body":"that. So those sort of four"},{"speaker":"Sanj Kakar","startTime":954.88,"endTime":960.96,"body":"things in my mind are key when"},{"speaker":"Sanj Kakar","startTime":960.96,"endTime":964.56,"body":"you're looking for the TFCC"},{"speaker":"Sanj Kakar","startTime":960.96,"endTime":964.56,"body":"pathology, I want"},{"speaker":"Chris Dy","startTime":964.56,"endTime":966.66,"body":"to ask one more"},{"speaker":"Chris Dy","startTime":964.56,"endTime":966.66,"body":"question before we shift gears"},{"speaker":"Chris Dy","startTime":966.96,"endTime":971.28,"body":"for the drej arthroscopy. How"},{"speaker":"Chris Dy","startTime":966.96,"endTime":971.28,"body":"essential is that? Do you think"},{"speaker":"Chris Dy","startTime":971.28,"endTime":975.66,"body":"to evaluation of TFCC lesions in"},{"speaker":"Chris Dy","startTime":971.28,"endTime":975.66,"body":"general, in particular for fovea"},{"speaker":"Chris Dy","startTime":975.66,"endTime":978.84,"body":"lesions, do you think that you"},{"speaker":"Chris Dy","startTime":975.66,"endTime":978.84,"body":"gain a lot of information from"},{"speaker":"Chris Dy","startTime":978.84,"endTime":983.06,"body":"that fourth test compared to the"},{"speaker":"Chris Dy","startTime":978.84,"endTime":983.06,"body":"three others that you described."},{"speaker":"Sanj Kakar","startTime":983.78,"endTime":986.96,"body":"So I'll give you a"},{"speaker":"Sanj Kakar","startTime":983.78,"endTime":986.96,"body":"study here, right? So you, and"},{"speaker":"Sanj Kakar","startTime":986.96,"endTime":989.84,"body":"that's what I credit you and a"},{"speaker":"Sanj Kakar","startTime":986.96,"endTime":989.84,"body":"lot of our friends in hand"},{"speaker":"Sanj Kakar","startTime":989.84,"endTime":993.5,"body":"surgeries that we study our"},{"speaker":"Sanj Kakar","startTime":989.84,"endTime":993.5,"body":"outcomes and and how our"},{"speaker":"Sanj Kakar","startTime":993.5,"endTime":996.62,"body":"patients are doing. So we"},{"speaker":"Sanj Kakar","startTime":993.5,"endTime":996.62,"body":"published a study, I think it"},{"speaker":"Sanj Kakar","startTime":996.62,"endTime":1003.6,"body":"was on 24 patients, and all of"},{"speaker":"Sanj Kakar","startTime":996.62,"endTime":1003.6,"body":"them had foveal injuries proved"},{"speaker":"Sanj Kakar","startTime":1003.6,"endTime":1008.82,"body":"on arthroscopy and MRI was only"},{"speaker":"Sanj Kakar","startTime":1003.6,"endTime":1008.82,"body":"accurate in 1/3 of those"},{"speaker":"Sanj Kakar","startTime":1008.82,"endTime":1014.52,"body":"patients. And of those patients,"},{"speaker":"Sanj Kakar","startTime":1008.82,"endTime":1014.52,"body":"about 75% had stable diu J's."},{"speaker":"Sanj Kakar","startTime":1015.06,"endTime":1018.72,"body":"So. So this dogma that we were"},{"speaker":"Sanj Kakar","startTime":1015.06,"endTime":1018.72,"body":"taught that if you have a foveal"},{"speaker":"Sanj Kakar","startTime":1018.72,"endTime":1022.88,"body":"injury is diuj, instability is"},{"speaker":"Sanj Kakar","startTime":1018.72,"endTime":1022.88,"body":"simply not true. So when you see"},{"speaker":"Sanj Kakar","startTime":1022.88,"endTime":1025.58,"body":"a patient in clinic and they're"},{"speaker":"Sanj Kakar","startTime":1022.88,"endTime":1025.58,"body":"tender in the phobia, to me,"},{"speaker":"Sanj Kakar","startTime":1025.58,"endTime":1029.3,"body":"it's a TFCC or on triquetral"},{"speaker":"Sanj Kakar","startTime":1025.58,"endTime":1029.3,"body":"Split tear, until proven"},{"speaker":"Sanj Kakar","startTime":1029.3,"endTime":1031.64,"body":"otherwise. So to your point,"},{"speaker":"Sanj Kakar","startTime":1029.3,"endTime":1031.64,"body":"Chris, if I scope the"},{"speaker":"Sanj Kakar","startTime":1031.64,"endTime":1034.88,"body":"radiocarbon joint, I see a big"},{"speaker":"Sanj Kakar","startTime":1031.64,"endTime":1034.88,"body":"ut split tear, or I see a big"},{"speaker":"Sanj Kakar","startTime":1034.88,"endTime":1039.38,"body":"peripheral TFCC tear. Then,"},{"speaker":"Sanj Kakar","startTime":1034.88,"endTime":1039.38,"body":"then, no, I won't scope the dij."},{"speaker":"Sanj Kakar","startTime":1039.98,"endTime":1042.64,"body":"But you know, I remember sitting"},{"speaker":"Sanj Kakar","startTime":1039.98,"endTime":1042.64,"body":"with Chuck. We were at the hand"},{"speaker":"Sanj Kakar","startTime":1042.64,"endTime":1045.1,"body":"society, and I was saying to"},{"speaker":"Sanj Kakar","startTime":1042.64,"endTime":1045.1,"body":"saying, Chuck, are you seeing"},{"speaker":"Sanj Kakar","startTime":1045.1,"endTime":1048.88,"body":"these patients with central"},{"speaker":"Sanj Kakar","startTime":1045.1,"endTime":1048.88,"body":"tears and a foveal tear at the"},{"speaker":"Sanj Kakar","startTime":1048.88,"endTime":1051.34,"body":"same time? Because we were"},{"speaker":"Sanj Kakar","startTime":1048.88,"endTime":1051.34,"body":"taught you have a central 10."},{"speaker":"Sanj Kakar","startTime":1051.34,"endTime":1053.8,"body":"You just debride them. Because,"},{"speaker":"Sanj Kakar","startTime":1051.34,"endTime":1053.8,"body":"yeah, I'm seeing those as well."},{"speaker":"Sanj Kakar","startTime":1054.22,"endTime":1057.28,"body":"And so those patients, you know,"},{"speaker":"Sanj Kakar","startTime":1054.22,"endTime":1057.28,"body":"you can simply lift the TFCC up"},{"speaker":"Sanj Kakar","startTime":1057.28,"endTime":1059.74,"body":"and you can see a foveal injury."},{"speaker":"Sanj Kakar","startTime":1057.28,"endTime":1059.74,"body":"So again, you don't have to"},{"speaker":"Sanj Kakar","startTime":1059.74,"endTime":1063.42,"body":"scope the Diag for that, for"},{"speaker":"Sanj Kakar","startTime":1059.74,"endTime":1063.42,"body":"those cases, but I think as long"},{"speaker":"Sanj Kakar","startTime":1063.42,"endTime":1067.26,"body":"as you have a high index of"},{"speaker":"Sanj Kakar","startTime":1063.42,"endTime":1067.26,"body":"suspicion, that's when I think"},{"speaker":"Sanj Kakar","startTime":1067.26,"endTime":1067.98,"body":"it's indicated."},{"speaker":"Charles Goldfarb","startTime":1069.06,"endTime":1071.1,"body":"I love that,"},{"speaker":"Charles Goldfarb","startTime":1069.06,"endTime":1071.1,"body":"and we're going to thank our"},{"speaker":"Charles Goldfarb","startTime":1071.1,"endTime":1073.86,"body":"sponsors here in a second. But I"},{"speaker":"Charles Goldfarb","startTime":1071.1,"endTime":1073.86,"body":"would say two things to"},{"speaker":"Charles Goldfarb","startTime":1073.86,"endTime":1076.56,"body":"listeners who are like, Oh my"},{"speaker":"Charles Goldfarb","startTime":1073.86,"endTime":1076.56,"body":"God, I don't think I'm ever"},{"speaker":"Charles Goldfarb","startTime":1076.56,"endTime":1079.62,"body":"scoping a wrist again. Number"},{"speaker":"Charles Goldfarb","startTime":1076.56,"endTime":1079.62,"body":"one, Sanja obviously has an"},{"speaker":"Charles Goldfarb","startTime":1079.62,"endTime":1083.0,"body":"immense experience, and I think"},{"speaker":"Charles Goldfarb","startTime":1079.62,"endTime":1083.0,"body":"his take homes are really"},{"speaker":"Charles Goldfarb","startTime":1083.0,"endTime":1088.88,"body":"important. Number two, I don't"},{"speaker":"Charles Goldfarb","startTime":1083.0,"endTime":1088.88,"body":"have quite as much faith in the"},{"speaker":"Charles Goldfarb","startTime":1088.88,"endTime":1092.18,"body":"suction test. I think it's"},{"speaker":"Charles Goldfarb","startTime":1088.88,"endTime":1092.18,"body":"important to do it. And if you"},{"speaker":"Charles Goldfarb","startTime":1092.18,"endTime":1096.14,"body":"have a guess, I would say a"},{"speaker":"Charles Goldfarb","startTime":1092.18,"endTime":1096.14,"body":"complete foveal tear, then you"},{"speaker":"Charles Goldfarb","startTime":1096.14,"endTime":1099.8,"body":"will see that TFCC elevate. It's"},{"speaker":"Charles Goldfarb","startTime":1096.14,"endTime":1099.8,"body":"not always again, as black and"},{"speaker":"Charles Goldfarb","startTime":1099.8,"endTime":1103.12,"body":"white as we would like. And the"},{"speaker":"Charles Goldfarb","startTime":1099.8,"endTime":1103.12,"body":"last thing in Sanj knows, and"},{"speaker":"Charles Goldfarb","startTime":1103.12,"endTime":1105.16,"body":"I've said this before, and"},{"speaker":"Charles Goldfarb","startTime":1103.12,"endTime":1105.16,"body":"others have said this to him,"},{"speaker":"Charles Goldfarb","startTime":1105.16,"endTime":1110.32,"body":"the LT split tear is, I guess, I"},{"speaker":"Charles Goldfarb","startTime":1105.16,"endTime":1110.32,"body":"would say, harder for some of us"},{"speaker":"Charles Goldfarb","startTime":1110.32,"endTime":1114.22,"body":"to appreciate than others,"},{"speaker":"Charles Goldfarb","startTime":1110.32,"endTime":1114.22,"body":"because of Sanj is influence I"},{"speaker":"Charles Goldfarb","startTime":1114.22,"endTime":1117.82,"body":"look forward every time, my"},{"speaker":"Charles Goldfarb","startTime":1114.22,"endTime":1117.82,"body":"guess is he diagnoses it more"},{"speaker":"Charles Goldfarb","startTime":1117.82,"endTime":1118.36,"body":"than I do. You"},{"speaker":"Chris Dy","startTime":1119.26,"endTime":1121.86,"body":"trying to say it's"},{"speaker":"Chris Dy","startTime":1119.26,"endTime":1121.86,"body":"controversial or maybe fake"},{"speaker":"Chris Dy","startTime":1121.86,"endTime":1122.34,"body":"news?"},{"speaker":"Charles Goldfarb","startTime":1123.12,"endTime":1125.82,"body":"No, I would"},{"speaker":"Charles Goldfarb","startTime":1123.12,"endTime":1125.82,"body":"never say alternative facts."},{"speaker":"Sanj Kakar","startTime":1127.02,"endTime":1128.58,"body":"There we go. Chris,"},{"speaker":"Sanj Kakar","startTime":1127.02,"endTime":1128.58,"body":"be careful."},{"speaker":"Chris Dy","startTime":1132.48,"endTime":1136.5,"body":"Talk about talk about"},{"speaker":"Chris Dy","startTime":1132.48,"endTime":1136.5,"body":"alternative facts before we move"},{"speaker":"Chris Dy","startTime":1136.5,"endTime":1139.68,"body":"to our next topic, we should"},{"speaker":"Chris Dy","startTime":1136.5,"endTime":1139.68,"body":"thank our sponsors. The overhand"},{"speaker":"Chris Dy","startTime":1139.68,"endTime":1142.82,"body":"is sponsored by practicelink.com"},{"speaker":"Chris Dy","startTime":1139.68,"endTime":1142.82,"body":"the most widely used position"},{"speaker":"Chris Dy","startTime":1142.82,"endTime":1145.1,"body":"job search and career"},{"speaker":"Chris Dy","startTime":1142.82,"endTime":1145.1,"body":"advancement resource."},{"speaker":"Charles Goldfarb","startTime":1145.16,"endTime":1147.02,"body":"But coming up"},{"speaker":"Charles Goldfarb","startTime":1145.16,"endTime":1147.02,"body":"position is hard. Finding the"},{"speaker":"Charles Goldfarb","startTime":1147.02,"endTime":1149.42,"body":"right job doesn't have to be"},{"speaker":"Charles Goldfarb","startTime":1147.02,"endTime":1149.42,"body":"joined. Practice link, for free"},{"speaker":"Charles Goldfarb","startTime":1149.42,"endTime":1153.56,"body":"today@www.practicelink.com"},{"speaker":"Charles Goldfarb","startTime":1149.42,"endTime":1153.56,"body":"backslash the upper hand."},{"speaker":"Charles Goldfarb","startTime":1153.68,"endTime":1157.88,"body":"Alright, briefly. Sanj, so far,"},{"speaker":"Charles Goldfarb","startTime":1153.68,"endTime":1157.88,"body":"we're not good at being brief."},{"speaker":"Charles Goldfarb","startTime":1158.12,"endTime":1162.1,"body":"Briefly, tell us about the Nano"},{"speaker":"Charles Goldfarb","startTime":1158.12,"endTime":1162.1,"body":"scope. I know, and I think full"},{"speaker":"Charles Goldfarb","startTime":1162.1,"endTime":1163.72,"body":"disclosure, you do 1.9"},{"speaker":"Chris Dy","startTime":1164.14,"endTime":1167.44,"body":"millimeter Well, well,"},{"speaker":"Chris Dy","startTime":1164.14,"endTime":1167.44,"body":"there are non"},{"speaker":"Charles Goldfarb","startTime":1167.44,"endTime":1170.26,"body":"disposable 1.9"},{"speaker":"Charles Goldfarb","startTime":1167.44,"endTime":1170.26,"body":"millimeter scopes, and there are"},{"speaker":"Charles Goldfarb","startTime":1170.26,"endTime":1174.1,"body":"disposable 1.9 millimeter"},{"speaker":"Charles Goldfarb","startTime":1170.26,"endTime":1174.1,"body":"scopes. And Sanjay, I do believe"},{"speaker":"Charles Goldfarb","startTime":1174.1,"endTime":1177.1,"body":"you work with Arthrex and and my"},{"speaker":"Charles Goldfarb","startTime":1174.1,"endTime":1177.1,"body":"understanding is the nanoscope"},{"speaker":"Charles Goldfarb","startTime":1177.1,"endTime":1180.4,"body":"is a zero degree scope, which"},{"speaker":"Charles Goldfarb","startTime":1177.1,"endTime":1180.4,"body":"takes a little getting used to."},{"speaker":"Charles Goldfarb","startTime":1180.4,"endTime":1185.4,"body":"It is disposable, but explain"},{"speaker":"Charles Goldfarb","startTime":1180.4,"endTime":1185.4,"body":"how you use it, what diagnoses"},{"speaker":"Charles Goldfarb","startTime":1185.4,"endTime":1188.88,"body":"you use it for, and why you"},{"speaker":"Charles Goldfarb","startTime":1185.4,"endTime":1188.88,"body":"think it's super helpful. Yeah,"},{"speaker":"Sanj Kakar","startTime":1188.88,"endTime":1190.98,"body":"no. Thanks for that"},{"speaker":"Sanj Kakar","startTime":1188.88,"endTime":1190.98,"body":"question, and I appreciate Yeah,"},{"speaker":"Sanj Kakar","startTime":1190.98,"endTime":1193.92,"body":"just for transparency and"},{"speaker":"Sanj Kakar","startTime":1190.98,"endTime":1193.92,"body":"disclosure. I do have a"},{"speaker":"Sanj Kakar","startTime":1193.92,"endTime":1196.5,"body":"consulting agreement with our"},{"speaker":"Sanj Kakar","startTime":1193.92,"endTime":1196.5,"body":"threats and have worked on on"},{"speaker":"Sanj Kakar","startTime":1196.5,"endTime":1200.18,"body":"this. What I what I would say to"},{"speaker":"Sanj Kakar","startTime":1196.5,"endTime":1200.18,"body":"you with the nanoscope and. And"},{"speaker":"Sanj Kakar","startTime":1200.18,"endTime":1202.34,"body":"Chris is, as you mentioned,"},{"speaker":"Sanj Kakar","startTime":1200.18,"endTime":1202.34,"body":"there are traditional 1.9"},{"speaker":"Sanj Kakar","startTime":1202.76,"endTime":1206.66,"body":"millimeter scopes out there as"},{"speaker":"Sanj Kakar","startTime":1202.76,"endTime":1206.66,"body":"well. So what the big sort of"},{"speaker":"Sanj Kakar","startTime":1206.66,"endTime":1210.5,"body":"aha moment for me with the with"},{"speaker":"Sanj Kakar","startTime":1206.66,"endTime":1210.5,"body":"the nanoscope, was the degree of"},{"speaker":"Sanj Kakar","startTime":1210.5,"endTime":1214.34,"body":"flexibility. The typical 1.9"},{"speaker":"Sanj Kakar","startTime":1210.5,"endTime":1214.34,"body":"millimeter scopes are very short"},{"speaker":"Sanj Kakar","startTime":1214.34,"endTime":1217.64,"body":"and rigid, and they're fragile."},{"speaker":"Sanj Kakar","startTime":1214.34,"endTime":1217.64,"body":"And I remember on the shelf we"},{"speaker":"Sanj Kakar","startTime":1217.64,"endTime":1220.66,"body":"would ask for one, and they"},{"speaker":"Sanj Kakar","startTime":1217.64,"endTime":1220.66,"body":"would always be broken or in the"},{"speaker":"Sanj Kakar","startTime":1220.66,"endTime":1224.98,"body":"repair shop. And so the beauty"},{"speaker":"Sanj Kakar","startTime":1220.66,"endTime":1224.98,"body":"of the 1.9 millimeter nano scope"},{"speaker":"Sanj Kakar","startTime":1224.98,"endTime":1228.94,"body":"is that it's flexible, so it"},{"speaker":"Sanj Kakar","startTime":1224.98,"endTime":1228.94,"body":"allows you to get into spaces"},{"speaker":"Sanj Kakar","startTime":1228.94,"endTime":1231.64,"body":"where we would struggle with it"},{"speaker":"Sanj Kakar","startTime":1228.94,"endTime":1231.64,"body":"first. So for example, the DI"},{"speaker":"Sanj Kakar","startTime":1231.64,"endTime":1235.66,"body":"EJ, we've talked about, the MCP"},{"speaker":"Sanj Kakar","startTime":1231.64,"endTime":1235.66,"body":"joint. I've never scoped the MCP"},{"speaker":"Sanj Kakar","startTime":1235.66,"endTime":1239.44,"body":"joint, the stt, the CMC. It's"},{"speaker":"Sanj Kakar","startTime":1235.66,"endTime":1239.44,"body":"allowed me to get into those"},{"speaker":"Sanj Kakar","startTime":1239.44,"endTime":1243.72,"body":"smaller joints relatively a"},{"speaker":"Sanj Kakar","startTime":1239.44,"endTime":1243.72,"body":"dramatically. You're right. It's"},{"speaker":"Sanj Kakar","startTime":1243.72,"endTime":1247.14,"body":"a zero degree lens. So typically"},{"speaker":"Sanj Kakar","startTime":1243.72,"endTime":1247.14,"body":"we're used to a 30 degree lens,"},{"speaker":"Sanj Kakar","startTime":1247.14,"endTime":1250.62,"body":"so they do make a trocar, which"},{"speaker":"Sanj Kakar","startTime":1247.14,"endTime":1250.62,"body":"has a degree of bend to give you"},{"speaker":"Sanj Kakar","startTime":1250.62,"endTime":1255.54,"body":"that sort of flexibility, if you"},{"speaker":"Sanj Kakar","startTime":1250.62,"endTime":1255.54,"body":"want. But for me, it's not just"},{"speaker":"Sanj Kakar","startTime":1255.54,"endTime":1259.02,"body":"about the nanoscope chuck and"},{"speaker":"Sanj Kakar","startTime":1255.54,"endTime":1259.02,"body":"Chris. It's about what that has"},{"speaker":"Sanj Kakar","startTime":1259.02,"endTime":1262.04,"body":"given me in terms of"},{"speaker":"Sanj Kakar","startTime":1259.02,"endTime":1262.04,"body":"arthroscopy. So my acronym for"},{"speaker":"Sanj Kakar","startTime":1262.04,"endTime":1265.58,"body":"arthroscopy is first. When I"},{"speaker":"Sanj Kakar","startTime":1262.04,"endTime":1265.58,"body":"think of first, I think of those"},{"speaker":"Sanj Kakar","startTime":1265.58,"endTime":1269.84,"body":"indications for arthroscopy,"},{"speaker":"Sanj Kakar","startTime":1265.58,"endTime":1269.84,"body":"fractures. We talked a little"},{"speaker":"Sanj Kakar","startTime":1269.84,"endTime":1272.9,"body":"bit fusions. For example, you"},{"speaker":"Sanj Kakar","startTime":1269.84,"endTime":1272.9,"body":"have a lunate cyst. How do you"},{"speaker":"Sanj Kakar","startTime":1272.9,"endTime":1276.14,"body":"get into that lunate cyst in an"},{"speaker":"Sanj Kakar","startTime":1272.9,"endTime":1276.14,"body":"arthroscopic way? You can do"},{"speaker":"Sanj Kakar","startTime":1276.14,"endTime":1279.02,"body":"that going through the"},{"speaker":"Sanj Kakar","startTime":1276.14,"endTime":1279.02,"body":"membranous portion of the LT or"},{"speaker":"Sanj Kakar","startTime":1279.02,"endTime":1283.9,"body":"the SL and debride that and bone"},{"speaker":"Sanj Kakar","startTime":1279.02,"endTime":1283.9,"body":"graft that. I think of fusions."},{"speaker":"Sanj Kakar","startTime":1284.2,"endTime":1288.4,"body":"I think of instabilities. TFCC,"},{"speaker":"Sanj Kakar","startTime":1284.2,"endTime":1288.4,"body":"we've talked about, I think of R"},{"speaker":"Sanj Kakar","startTime":1288.4,"endTime":1291.4,"body":"being repair or reconstruction"},{"speaker":"Sanj Kakar","startTime":1288.4,"endTime":1291.4,"body":"scaffold, lunate, that has been"},{"speaker":"Sanj Kakar","startTime":1291.64,"endTime":1294.28,"body":"a big game changer for me, and"},{"speaker":"Sanj Kakar","startTime":1291.64,"endTime":1294.28,"body":"we've talked about that"},{"speaker":"Sanj Kakar","startTime":1294.28,"endTime":1298.24,"body":"previously, about scaphalone"},{"speaker":"Sanj Kakar","startTime":1294.28,"endTime":1298.24,"body":"instability and repairs. The"},{"speaker":"Sanj Kakar","startTime":1298.24,"endTime":1300.6,"body":"other s, as I mentioned, is"},{"speaker":"Sanj Kakar","startTime":1298.24,"endTime":1300.6,"body":"small joint arthroscopy"},{"speaker":"Sanj Kakar","startTime":1300.6,"endTime":1303.72,"body":"yesterday we had a Bennett's"},{"speaker":"Sanj Kakar","startTime":1300.6,"endTime":1303.72,"body":"fracture. And you know those"},{"speaker":"Sanj Kakar","startTime":1303.72,"endTime":1306.0,"body":"Bennett fractures, you have"},{"speaker":"Sanj Kakar","startTime":1303.72,"endTime":1306.0,"body":"those small, little fragments,"},{"speaker":"Sanj Kakar","startTime":1306.0,"endTime":1309.12,"body":"and you think you sort of get it"},{"speaker":"Sanj Kakar","startTime":1306.0,"endTime":1309.12,"body":"on K wire, you take in multiple"},{"speaker":"Sanj Kakar","startTime":1309.12,"endTime":1312.18,"body":"fluoroscopic views. And"},{"speaker":"Sanj Kakar","startTime":1309.12,"endTime":1312.18,"body":"yesterday we had one that was"},{"speaker":"Sanj Kakar","startTime":1312.18,"endTime":1315.18,"body":"fragmented, and I just couldn't"},{"speaker":"Sanj Kakar","startTime":1312.18,"endTime":1315.18,"body":"get it in a closed manner. But"},{"speaker":"Sanj Kakar","startTime":1315.18,"endTime":1318.06,"body":"with arthroscopy, it allowed me"},{"speaker":"Sanj Kakar","startTime":1315.18,"endTime":1318.06,"body":"to get in there, to breathe the"},{"speaker":"Sanj Kakar","startTime":1318.06,"endTime":1322.76,"body":"hematoma and get that reduction."},{"speaker":"Sanj Kakar","startTime":1318.06,"endTime":1322.76,"body":"And the T in first is tunnel, so"},{"speaker":"Sanj Kakar","startTime":1322.76,"endTime":1326.42,"body":"carpal tunnel, cubital tunnel,"},{"speaker":"Sanj Kakar","startTime":1322.76,"endTime":1326.42,"body":"exercise induced compartment"},{"speaker":"Sanj Kakar","startTime":1326.42,"endTime":1330.14,"body":"syndrome. These patients are"},{"speaker":"Sanj Kakar","startTime":1326.42,"endTime":1330.14,"body":"usually young, bilateral, and"},{"speaker":"Sanj Kakar","startTime":1330.14,"endTime":1333.62,"body":"traditional big forearm"},{"speaker":"Sanj Kakar","startTime":1330.14,"endTime":1333.62,"body":"fasciotomies are kind of"},{"speaker":"Sanj Kakar","startTime":1333.62,"endTime":1337.1,"body":"unsightly, but with arthroscopy,"},{"speaker":"Sanj Kakar","startTime":1333.62,"endTime":1337.1,"body":"and it doesn't need to just be"},{"speaker":"Sanj Kakar","startTime":1337.1,"endTime":1340.3,"body":"the nanoscope it could be with"},{"speaker":"Sanj Kakar","startTime":1337.1,"endTime":1340.3,"body":"any camera, it allows you to do"},{"speaker":"Sanj Kakar","startTime":1340.3,"endTime":1343.72,"body":"these sort of procedures in a"},{"speaker":"Sanj Kakar","startTime":1340.3,"endTime":1343.72,"body":"more minimally invasive way. And"},{"speaker":"Sanj Kakar","startTime":1343.72,"endTime":1347.26,"body":"so that's sort of been my"},{"speaker":"Sanj Kakar","startTime":1343.72,"endTime":1347.26,"body":"Genesis on using nanoscope"},{"speaker":"Sanj Kakar","startTime":1347.38,"endTime":1350.62,"body":"technology to allow me to"},{"speaker":"Sanj Kakar","startTime":1347.38,"endTime":1350.62,"body":"address more than I could do"},{"speaker":"Sanj Kakar","startTime":1350.62,"endTime":1351.88,"body":"before you"},{"speaker":"Chris Dy","startTime":1351.88,"endTime":1353.98,"body":"really you know the"},{"speaker":"Chris Dy","startTime":1351.88,"endTime":1353.98,"body":"Rochester spelling is different."},{"speaker":"Chris Dy","startTime":1353.98,"endTime":1361.08,"body":"So you spell first F, F, F, F, I"},{"speaker":"Chris Dy","startTime":1353.98,"endTime":1361.08,"body":"R, R, S T, T, T. Is that"},{"speaker":"Chris Dy","startTime":1361.14,"endTime":1362.16,"body":"correct? F,"},{"speaker":"Sanj Kakar","startTime":1362.16,"endTime":1365.16,"body":"i, r, s, t, but"},{"speaker":"Sanj Kakar","startTime":1362.16,"endTime":1365.16,"body":"there's several F,"},{"speaker":"Chris Dy","startTime":1367.26,"endTime":1368.94,"body":"2r and four T's. But"},{"speaker":"Unknown","startTime":1369.06,"endTime":1371.52,"body":"you can see there's so"},{"speaker":"Unknown","startTime":1369.06,"endTime":1371.52,"body":"many. I've got so many ideas on"},{"speaker":"Unknown","startTime":1371.52,"endTime":1373.62,"body":"how the F is. You started"},{"speaker":"Unknown","startTime":1371.52,"endTime":1373.62,"body":"getting"},{"speaker":"Chris Dy","startTime":1373.62,"endTime":1376.14,"body":"me going using the"},{"speaker":"Chris Dy","startTime":1373.62,"endTime":1376.14,"body":"arthroscope as the nanoscope as"},{"speaker":"Chris Dy","startTime":1376.14,"endTime":1380.04,"body":"an endoscope for the carpal"},{"speaker":"Chris Dy","startTime":1376.14,"endTime":1380.04,"body":"tunnel. That's a whole different"},{"speaker":"Chris Dy","startTime":1380.04,"endTime":1381.5,"body":"episode. I love"},{"speaker":"Charles Goldfarb","startTime":1381.5,"endTime":1383.96,"body":"the comment"},{"speaker":"Charles Goldfarb","startTime":1381.5,"endTime":1383.96,"body":"about the fragility of the non"},{"speaker":"Charles Goldfarb","startTime":1383.96,"endTime":1388.94,"body":"disposable 1.9 scope. I I was"},{"speaker":"Charles Goldfarb","startTime":1383.96,"endTime":1388.94,"body":"doing a small joint arthroscopy,"},{"speaker":"Charles Goldfarb","startTime":1389.0,"endTime":1393.08,"body":"and to your point, small joint"},{"speaker":"Charles Goldfarb","startTime":1389.0,"endTime":1393.08,"body":"for me as MCPS typically. And we"},{"speaker":"Charles Goldfarb","startTime":1393.08,"endTime":1396.38,"body":"had a new SCRUB NURSE paired"},{"speaker":"Charles Goldfarb","startTime":1393.08,"endTime":1396.38,"body":"with an older scrub nurse, and I"},{"speaker":"Charles Goldfarb","startTime":1396.38,"endTime":1398.96,"body":"asked for the scope, and she"},{"speaker":"Charles Goldfarb","startTime":1396.38,"endTime":1398.96,"body":"handed me the scope, kind of"},{"speaker":"Charles Goldfarb","startTime":1398.96,"endTime":1402.16,"body":"like this, holding the barrel of"},{"speaker":"Charles Goldfarb","startTime":1398.96,"endTime":1402.16,"body":"the scope. By the time it got to"},{"speaker":"Charles Goldfarb","startTime":1402.16,"endTime":1406.78,"body":"me, it was totally useless. Like"},{"speaker":"Charles Goldfarb","startTime":1402.16,"endTime":1406.78,"body":"those scopes are really fragile,"},{"speaker":"Charles Goldfarb","startTime":1406.78,"endTime":1409.36,"body":"which is, which is, either you"},{"speaker":"Charles Goldfarb","startTime":1406.78,"endTime":1409.36,"body":"have to be really careful or"},{"speaker":"Charles Goldfarb","startTime":1409.36,"endTime":1412.06,"body":"have a good repair contract, or"},{"speaker":"Charles Goldfarb","startTime":1409.36,"endTime":1412.06,"body":"you just switch and use the"},{"speaker":"Charles Goldfarb","startTime":1412.06,"endTime":1418.6,"body":"disposables, which are not that"},{"speaker":"Charles Goldfarb","startTime":1412.06,"endTime":1418.6,"body":"price crazy. Let's briefly touch"},{"speaker":"Charles Goldfarb","startTime":1418.6,"endTime":1424.56,"body":"on TFCC repairs, specifically"},{"speaker":"Charles Goldfarb","startTime":1418.6,"endTime":1424.56,"body":"foveal repairs. And so a lot of"},{"speaker":"Charles Goldfarb","startTime":1424.56,"endTime":1428.22,"body":"us talk about ulnar tunnel, etc."},{"speaker":"Charles Goldfarb","startTime":1424.56,"endTime":1428.22,"body":"You've described, and I'm"},{"speaker":"Charles Goldfarb","startTime":1428.22,"endTime":1433.08,"body":"curious if you still do it over"},{"speaker":"Charles Goldfarb","startTime":1428.22,"endTime":1433.08,"body":"the top technique for foveal"},{"speaker":"Charles Goldfarb","startTime":1433.08,"endTime":1437.7,"body":"repairs, what's your go to today"},{"speaker":"Charles Goldfarb","startTime":1433.08,"endTime":1437.7,"body":"for foveal repairs? Yes,"},{"speaker":"Sanj Kakar","startTime":1437.7,"endTime":1440.66,"body":"it's a great"},{"speaker":"Sanj Kakar","startTime":1437.7,"endTime":1440.66,"body":"question. And we used to do the"},{"speaker":"Sanj Kakar","startTime":1440.66,"endTime":1443.84,"body":"ALMA tunnel technique, which is"},{"speaker":"Sanj Kakar","startTime":1440.66,"endTime":1443.84,"body":"an outside to inside technique."},{"speaker":"Sanj Kakar","startTime":1444.32,"endTime":1447.62,"body":"But to your point, that can be"},{"speaker":"Sanj Kakar","startTime":1444.32,"endTime":1447.62,"body":"technically challenging when"},{"speaker":"Sanj Kakar","startTime":1447.62,"endTime":1451.04,"body":"you're putting that tunnel, it"},{"speaker":"Sanj Kakar","startTime":1447.62,"endTime":1451.04,"body":"has to be in the right spot and"},{"speaker":"Sanj Kakar","startTime":1451.1,"endTime":1455.0,"body":"and I do worry about tunnel"},{"speaker":"Sanj Kakar","startTime":1451.1,"endTime":1455.0,"body":"fracture. You know when, when"},{"speaker":"Sanj Kakar","startTime":1455.0,"endTime":1458.54,"body":"you see your trainees trying to"},{"speaker":"Sanj Kakar","startTime":1455.0,"endTime":1458.54,"body":"make that tunnel multiple passes"},{"speaker":"Sanj Kakar","startTime":1458.54,"endTime":1463.84,"body":"of the KY you do worry about"},{"speaker":"Sanj Kakar","startTime":1458.54,"endTime":1463.84,"body":"that, and also you're limited in"},{"speaker":"Sanj Kakar","startTime":1463.84,"endTime":1467.62,"body":"terms of the aperture of your"},{"speaker":"Sanj Kakar","startTime":1463.84,"endTime":1467.62,"body":"tunnel, in terms of your suture"},{"speaker":"Sanj Kakar","startTime":1467.62,"endTime":1472.3,"body":"passage. So the over the top"},{"speaker":"Sanj Kakar","startTime":1467.62,"endTime":1472.3,"body":"technique is a relatively more"},{"speaker":"Sanj Kakar","startTime":1472.3,"endTime":1474.94,"body":"straightforward technique, where"},{"speaker":"Sanj Kakar","startTime":1472.3,"endTime":1474.94,"body":"you're literally coming from"},{"speaker":"Sanj Kakar","startTime":1474.94,"endTime":1477.64,"body":"over the top and putting your"},{"speaker":"Sanj Kakar","startTime":1474.94,"endTime":1477.64,"body":"suture through. So the"},{"speaker":"Sanj Kakar","startTime":1477.64,"endTime":1480.78,"body":"difference is here is that you"},{"speaker":"Sanj Kakar","startTime":1477.64,"endTime":1480.78,"body":"have your camera in the six hour"},{"speaker":"Sanj Kakar","startTime":1480.78,"endTime":1484.2,"body":"portal, and you bring the needle"},{"speaker":"Sanj Kakar","startTime":1480.78,"endTime":1484.2,"body":"through the three four portal,"},{"speaker":"Sanj Kakar","startTime":1484.44,"endTime":1487.62,"body":"and you direct it through the"},{"speaker":"Sanj Kakar","startTime":1484.44,"endTime":1487.62,"body":"TFCC, so you see exactly where"},{"speaker":"Sanj Kakar","startTime":1487.62,"endTime":1491.04,"body":"you want to go through the TFCC,"},{"speaker":"Sanj Kakar","startTime":1487.62,"endTime":1491.04,"body":"through the fovea and out the"},{"speaker":"Sanj Kakar","startTime":1491.1,"endTime":1493.86,"body":"other side. So instead of being"},{"speaker":"Sanj Kakar","startTime":1491.1,"endTime":1493.86,"body":"outside to inside, it's an"},{"speaker":"Sanj Kakar","startTime":1493.86,"endTime":1496.68,"body":"inside to outside repair where"},{"speaker":"Sanj Kakar","startTime":1493.86,"endTime":1496.68,"body":"you're putting a vertical"},{"speaker":"Sanj Kakar","startTime":1496.68,"endTime":1500.36,"body":"mattress suture. The advantages"},{"speaker":"Sanj Kakar","startTime":1496.68,"endTime":1500.36,"body":"are, it's it's quite. Cut. You"},{"speaker":"Sanj Kakar","startTime":1500.36,"endTime":1503.66,"body":"don't need fluoro for it. You're"},{"speaker":"Sanj Kakar","startTime":1500.36,"endTime":1503.66,"body":"not making big drill holes. So"},{"speaker":"Sanj Kakar","startTime":1503.66,"endTime":1506.9,"body":"there is a degree of sort of"},{"speaker":"Sanj Kakar","startTime":1503.66,"endTime":1506.9,"body":"flexibility when you put your"},{"speaker":"Sanj Kakar","startTime":1506.9,"endTime":1509.42,"body":"repair in, where you if your"},{"speaker":"Sanj Kakar","startTime":1506.9,"endTime":1509.42,"body":"stitch isn't quite perfect, you"},{"speaker":"Sanj Kakar","startTime":1509.42,"endTime":1514.52,"body":"can put one either more bowler"},{"speaker":"Sanj Kakar","startTime":1509.42,"endTime":1514.52,"body":"or more dorsal. And yeah, at"},{"speaker":"Sanj Kakar","startTime":1514.52,"endTime":1517.52,"body":"this stage, we're doing that"},{"speaker":"Sanj Kakar","startTime":1514.52,"endTime":1517.52,"body":"routinely, and I've definitely"},{"speaker":"Sanj Kakar","startTime":1517.52,"endTime":1519.92,"body":"seen it's much quicker and it's"},{"speaker":"Sanj Kakar","startTime":1517.52,"endTime":1519.92,"body":"easier for actually, the"},{"speaker":"Sanj Kakar","startTime":1519.92,"endTime":1521.56,"body":"trainees to learn that"},{"speaker":"Sanj Kakar","startTime":1519.92,"endTime":1521.56,"body":"technique."},{"speaker":"Charles Goldfarb","startTime":1523.24,"endTime":1525.1,"body":"I continue to"},{"speaker":"Charles Goldfarb","startTime":1523.24,"endTime":1525.1,"body":"use the ulnar tunnel, but I"},{"speaker":"Charles Goldfarb","startTime":1525.1,"endTime":1527.5,"body":"think a couple of your points"},{"speaker":"Charles Goldfarb","startTime":1525.1,"endTime":1527.5,"body":"are really important. First of"},{"speaker":"Charles Goldfarb","startTime":1527.5,"endTime":1530.98,"body":"all, thankfully, I've never seen"},{"speaker":"Charles Goldfarb","startTime":1527.5,"endTime":1530.98,"body":"a fracture. Hope I never do, but"},{"speaker":"Charles Goldfarb","startTime":1530.98,"endTime":1534.64,"body":"you're right. The key aspect is"},{"speaker":"Charles Goldfarb","startTime":1530.98,"endTime":1534.64,"body":"you're typically drilling a 3.0"},{"speaker":"Charles Goldfarb","startTime":1535.12,"endTime":1538.84,"body":"millimeter pole. Once you put"},{"speaker":"Charles Goldfarb","startTime":1535.12,"endTime":1538.84,"body":"your K wire, you over drill"},{"speaker":"Charles Goldfarb","startTime":1538.84,"endTime":1542.88,"body":"through the ulna, starting just"},{"speaker":"Charles Goldfarb","startTime":1538.84,"endTime":1542.88,"body":"proximal to the Ole Miss"},{"speaker":"Charles Goldfarb","startTime":1542.88,"endTime":1546.18,"body":"dialyde, aiming for the fovea"},{"speaker":"Charles Goldfarb","startTime":1542.88,"endTime":1546.18,"body":"region. And then the spread of"},{"speaker":"Charles Goldfarb","startTime":1546.18,"endTime":1549.6,"body":"your sutures, because the goal"},{"speaker":"Charles Goldfarb","startTime":1546.18,"endTime":1549.6,"body":"is a horizontal mattress can be"},{"speaker":"Charles Goldfarb","startTime":1549.6,"endTime":1552.06,"body":"limited, and is technique"},{"speaker":"Charles Goldfarb","startTime":1549.6,"endTime":1552.06,"body":"dependent with trainees,"},{"speaker":"Charles Goldfarb","startTime":1552.06,"endTime":1555.96,"body":"absolutely. I you know, there"},{"speaker":"Charles Goldfarb","startTime":1552.06,"endTime":1555.96,"body":"are different ways to cheat with"},{"speaker":"Charles Goldfarb","startTime":1555.96,"endTime":1558.3,"body":"the ulnar tunnel. You know, you"},{"speaker":"Charles Goldfarb","startTime":1555.96,"endTime":1558.3,"body":"can go outside of the tunnel"},{"speaker":"Charles Goldfarb","startTime":1558.3,"endTime":1560.46,"body":"with one of your sutures."},{"speaker":"Charles Goldfarb","startTime":1558.3,"endTime":1560.46,"body":"There's different ways to do it."},{"speaker":"Charles Goldfarb","startTime":1560.46,"endTime":1564.92,"body":"But I think this concept is"},{"speaker":"Charles Goldfarb","startTime":1560.46,"endTime":1564.92,"body":"innovative that you describe and"},{"speaker":"Charles Goldfarb","startTime":1565.7,"endTime":1568.76,"body":"either be patient, you know, you"},{"speaker":"Charles Goldfarb","startTime":1565.7,"endTime":1568.76,"body":"got to learn a technique and be"},{"speaker":"Charles Goldfarb","startTime":1568.76,"endTime":1572.3,"body":"comfortable with it, but I think"},{"speaker":"Charles Goldfarb","startTime":1568.76,"endTime":1572.3,"body":"the goal is a nice spread in"},{"speaker":"Charles Goldfarb","startTime":1572.3,"endTime":1576.62,"body":"your sutures at the right"},{"speaker":"Charles Goldfarb","startTime":1572.3,"endTime":1576.62,"body":"location. So for example, this"},{"speaker":"Charles Goldfarb","startTime":1576.62,"endTime":1582.04,"body":"week, we had a dorsal radio,"},{"speaker":"Charles Goldfarb","startTime":1576.62,"endTime":1582.04,"body":"ulnar lunate tear and the volar"},{"speaker":"Charles Goldfarb","startTime":1582.1,"endTime":1586.18,"body":"aspect seemed to be intact, and"},{"speaker":"Charles Goldfarb","startTime":1582.1,"endTime":1586.18,"body":"so after debridement, we placed"},{"speaker":"Charles Goldfarb","startTime":1586.18,"endTime":1589.12,"body":"our suture dorsally, and we use"},{"speaker":"Charles Goldfarb","startTime":1586.18,"endTime":1589.12,"body":"the ulnar tunnel technique. But"},{"speaker":"Charles Goldfarb","startTime":1589.12,"endTime":1591.82,"body":"in some ways, I felt like we got"},{"speaker":"Charles Goldfarb","startTime":1589.12,"endTime":1591.82,"body":"a little lucky, because it went"},{"speaker":"Charles Goldfarb","startTime":1591.82,"endTime":1594.28,"body":"in the right spot. I think your"},{"speaker":"Charles Goldfarb","startTime":1591.82,"endTime":1594.28,"body":"technique may have provided more"},{"speaker":"Charles Goldfarb","startTime":1594.28,"endTime":1594.94,"body":"control."},{"speaker":"Sanj Kakar","startTime":1596.02,"endTime":1598.96,"body":"It's better to be"},{"speaker":"Sanj Kakar","startTime":1596.02,"endTime":1598.96,"body":"lucky than good Chuck. But as"},{"speaker":"Sanj Kakar","startTime":1598.96,"endTime":1602.94,"body":"you both are lucky, and good"},{"speaker":"Sanj Kakar","startTime":1598.96,"endTime":1602.94,"body":"works well. But the other thing"},{"speaker":"Sanj Kakar","startTime":1602.94,"endTime":1605.28,"body":"that I would also say is"},{"speaker":"Sanj Kakar","startTime":1602.94,"endTime":1605.28,"body":"sometimes, in these chronic"},{"speaker":"Sanj Kakar","startTime":1605.28,"endTime":1609.48,"body":"cases where the tissue quality"},{"speaker":"Sanj Kakar","startTime":1605.28,"endTime":1609.48,"body":"isn't the best, right, I want to"},{"speaker":"Sanj Kakar","startTime":1609.48,"endTime":1612.9,"body":"have a real wide spread of my"},{"speaker":"Sanj Kakar","startTime":1609.48,"endTime":1612.9,"body":"sutures. And so, as you said, if"},{"speaker":"Sanj Kakar","startTime":1612.9,"endTime":1615.6,"body":"you're cheating, I'd rather"},{"speaker":"Sanj Kakar","startTime":1612.9,"endTime":1615.6,"body":"cheat on getting a good bite of"},{"speaker":"Sanj Kakar","startTime":1615.6,"endTime":1619.32,"body":"the tissue, as opposed to being"},{"speaker":"Sanj Kakar","startTime":1615.6,"endTime":1619.32,"body":"right, perfectly anatomic where"},{"speaker":"Sanj Kakar","startTime":1619.32,"endTime":1623.6,"body":"you've got like, a two"},{"speaker":"Sanj Kakar","startTime":1619.32,"endTime":1623.6,"body":"millimeter suture tissue bridge."},{"speaker":"Sanj Kakar","startTime":1623.6,"endTime":1627.26,"body":"And if you pull you can actually"},{"speaker":"Sanj Kakar","startTime":1623.6,"endTime":1627.26,"body":"pull it out. And if that happens"},{"speaker":"Sanj Kakar","startTime":1627.26,"endTime":1630.86,"body":"and that, then that's that's a"},{"speaker":"Sanj Kakar","startTime":1627.26,"endTime":1630.86,"body":"hard one to salvage. What"},{"speaker":"Charles Goldfarb","startTime":1630.86,"endTime":1633.44,"body":"percentage and"},{"speaker":"Charles Goldfarb","startTime":1630.86,"endTime":1633.44,"body":"you and I have talked offline"},{"speaker":"Charles Goldfarb","startTime":1633.44,"endTime":1635.6,"body":"about this, I think it's"},{"speaker":"Charles Goldfarb","startTime":1633.44,"endTime":1635.6,"body":"important for the listeners to"},{"speaker":"Charles Goldfarb","startTime":1635.6,"endTime":1638.36,"body":"understand this, because I think"},{"speaker":"Charles Goldfarb","startTime":1635.6,"endTime":1638.36,"body":"we see eye to eye on this, what"},{"speaker":"Charles Goldfarb","startTime":1638.36,"endTime":1643.42,"body":"percentage of your TFCC repairs"},{"speaker":"Charles Goldfarb","startTime":1638.36,"endTime":1643.42,"body":"are superficial, peripheral"},{"speaker":"Charles Goldfarb","startTime":1643.42,"endTime":1647.44,"body":"tears, rather than involving the"},{"speaker":"Charles Goldfarb","startTime":1643.42,"endTime":1647.44,"body":"phobia. So traditionally, if you"},{"speaker":"Charles Goldfarb","startTime":1647.44,"endTime":1652.36,"body":"read the textbooks, you'll read"},{"speaker":"Charles Goldfarb","startTime":1647.44,"endTime":1652.36,"body":"about either some type of suit,"},{"speaker":"Charles Goldfarb","startTime":1652.66,"endTime":1656.14,"body":"soft tissue, suture, anchor, TFC"},{"speaker":"Charles Goldfarb","startTime":1652.66,"endTime":1656.14,"body":"to capsule, or you'll read about"},{"speaker":"Charles Goldfarb","startTime":1656.14,"endTime":1659.56,"body":"using the ECU sub sheath in an"},{"speaker":"Charles Goldfarb","startTime":1656.14,"endTime":1659.56,"body":"outside in way to repair the 2c"},{"speaker":"Charles Goldfarb","startTime":1660.1,"endTime":1663.84,"body":"what percent of your repairs are"},{"speaker":"Charles Goldfarb","startTime":1660.1,"endTime":1663.84,"body":"those types versus a foveal"},{"speaker":"Charles Goldfarb","startTime":1663.84,"endTime":1664.38,"body":"repair?"},{"speaker":"Sanj Kakar","startTime":1664.98,"endTime":1669.18,"body":"Yeah, I would say"},{"speaker":"Sanj Kakar","startTime":1664.98,"endTime":1669.18,"body":"so, you know, we have great"},{"speaker":"Sanj Kakar","startTime":1669.18,"endTime":1672.06,"body":"classifications in our in our"},{"speaker":"Sanj Kakar","startTime":1669.18,"endTime":1672.06,"body":"literature, and we were taught"},{"speaker":"Sanj Kakar","startTime":1672.06,"endTime":1675.36,"body":"the Palmer classification, but"},{"speaker":"Sanj Kakar","startTime":1672.06,"endTime":1675.36,"body":"there's the at sea Lucchetti"},{"speaker":"Sanj Kakar","startTime":1675.36,"endTime":1679.02,"body":"classification, which has really"},{"speaker":"Sanj Kakar","startTime":1675.36,"endTime":1679.02,"body":"sort of opened my eyes to what"},{"speaker":"Sanj Kakar","startTime":1679.02,"endTime":1681.86,"body":"we call this type three tear,"},{"speaker":"Sanj Kakar","startTime":1679.02,"endTime":1681.86,"body":"which is where you pop the"},{"speaker":"Sanj Kakar","startTime":1681.86,"endTime":1685.04,"body":"camera in, in the radio carpal"},{"speaker":"Sanj Kakar","startTime":1681.86,"endTime":1685.04,"body":"joint. And the TFCC looks"},{"speaker":"Sanj Kakar","startTime":1685.04,"endTime":1688.64,"body":"relatively pristine, but the"},{"speaker":"Sanj Kakar","startTime":1685.04,"endTime":1688.64,"body":"problem is, like the iceberg"},{"speaker":"Sanj Kakar","startTime":1688.64,"endTime":1691.4,"body":"concept, the problem is"},{"speaker":"Sanj Kakar","startTime":1688.64,"endTime":1691.4,"body":"underneath the top, is in the"},{"speaker":"Sanj Kakar","startTime":1691.4,"endTime":1696.08,"body":"fovea and and this is called"},{"speaker":"Sanj Kakar","startTime":1691.4,"endTime":1696.08,"body":"that at sea, Luke type three"},{"speaker":"Sanj Kakar","startTime":1696.08,"endTime":1699.14,"body":"injury, where the injury is in"},{"speaker":"Sanj Kakar","startTime":1696.08,"endTime":1699.14,"body":"the foveal region. Now, as I"},{"speaker":"Sanj Kakar","startTime":1699.14,"endTime":1702.28,"body":"mentioned, it doesn't have to be"},{"speaker":"Sanj Kakar","startTime":1699.14,"endTime":1702.28,"body":"a gross disruption. There's no"},{"speaker":"Sanj Kakar","startTime":1702.28,"endTime":1705.82,"body":"dij instability, but you get in"},{"speaker":"Sanj Kakar","startTime":1702.28,"endTime":1705.82,"body":"there and there's partial"},{"speaker":"Sanj Kakar","startTime":1705.82,"endTime":1708.88,"body":"fraying, there's partial tear,"},{"speaker":"Sanj Kakar","startTime":1705.82,"endTime":1708.88,"body":"there's some synovitis. Now,"},{"speaker":"Sanj Kakar","startTime":1708.88,"endTime":1711.76,"body":"what's normal, what's abnormal,"},{"speaker":"Sanj Kakar","startTime":1708.88,"endTime":1711.76,"body":"as you've shown from your"},{"speaker":"Sanj Kakar","startTime":1711.76,"endTime":1715.72,"body":"studies, Chuck, there's a high"},{"speaker":"Sanj Kakar","startTime":1711.76,"endTime":1715.72,"body":"degree of subjectivity in that"},{"speaker":"Sanj Kakar","startTime":1715.72,"endTime":1720.46,"body":"call, but I would say now I'm"},{"speaker":"Sanj Kakar","startTime":1715.72,"endTime":1720.46,"body":"doing far more foveal repairs"},{"speaker":"Sanj Kakar","startTime":1720.46,"endTime":1723.78,"body":"and typical, traditional"},{"speaker":"Sanj Kakar","startTime":1720.46,"endTime":1723.78,"body":"peripheral tears. And we talked,"},{"speaker":"Sanj Kakar","startTime":1723.78,"endTime":1725.94,"body":"and we talked a lot of our"},{"speaker":"Sanj Kakar","startTime":1723.78,"endTime":1725.94,"body":"colleagues around the country,"},{"speaker":"Sanj Kakar","startTime":1725.94,"endTime":1728.82,"body":"and they're still doing a lot of"},{"speaker":"Sanj Kakar","startTime":1725.94,"endTime":1728.82,"body":"peripheral tears. But for me, I"},{"speaker":"Sanj Kakar","startTime":1728.82,"endTime":1731.64,"body":"would say it's probably, I would"},{"speaker":"Sanj Kakar","startTime":1728.82,"endTime":1731.64,"body":"say, I don't know, 80% phobial."},{"speaker":"Sanj Kakar","startTime":1731.64,"endTime":1735.3,"body":"I would say it's pretty high."},{"speaker":"Sanj Kakar","startTime":1731.64,"endTime":1735.3,"body":"And if I'm doing a peripheral"},{"speaker":"Sanj Kakar","startTime":1735.3,"endTime":1738.54,"body":"it's more the ulnar ut split"},{"speaker":"Sanj Kakar","startTime":1735.3,"endTime":1738.54,"body":"tear that I'm seeing, as opposed"},{"speaker":"Sanj Kakar","startTime":1738.54,"endTime":1741.26,"body":"to the typical peripheral tear"},{"speaker":"Sanj Kakar","startTime":1738.54,"endTime":1741.26,"body":"for"},{"speaker":"Chris Dy","startTime":1741.26,"endTime":1744.92,"body":"a non sub specialist"},{"speaker":"Chris Dy","startTime":1741.26,"endTime":1744.92,"body":"in this area, can you just use a"},{"speaker":"Chris Dy","startTime":1744.92,"endTime":1746.78,"body":"foveal repair technique for"},{"speaker":"Chris Dy","startTime":1744.92,"endTime":1746.78,"body":"everything?"},{"speaker":"Sanj Kakar","startTime":1748.22,"endTime":1751.16,"body":"Well, I Yeah, cast"},{"speaker":"Sanj Kakar","startTime":1748.22,"endTime":1751.16,"body":"aside, of course, no, I think"},{"speaker":"Sanj Kakar","startTime":1751.16,"endTime":1754.34,"body":"you can. But there is also"},{"speaker":"Sanj Kakar","startTime":1751.16,"endTime":1754.34,"body":"morbidity, right? If you're if"},{"speaker":"Sanj Kakar","startTime":1754.34,"endTime":1758.96,"body":"you are drilling holes in bones,"},{"speaker":"Sanj Kakar","startTime":1754.34,"endTime":1758.96,"body":"you know, it just takes one"},{"speaker":"Sanj Kakar","startTime":1760.94,"endTime":1765.94,"body":"mishap, a fracture or something,"},{"speaker":"Sanj Kakar","startTime":1760.94,"endTime":1765.94,"body":"I wouldn't advocate just go"},{"speaker":"Sanj Kakar","startTime":1765.94,"endTime":1768.64,"body":"ahead and do a bone tunnel for"},{"speaker":"Sanj Kakar","startTime":1765.94,"endTime":1768.64,"body":"everything. You know. That's"},{"speaker":"Sanj Kakar","startTime":1768.64,"endTime":1770.98,"body":"like saying doing almost"},{"speaker":"Sanj Kakar","startTime":1768.64,"endTime":1770.98,"body":"shortening osteotomy for every"},{"speaker":"Sanj Kakar","startTime":1770.98,"endTime":1773.62,"body":"cell the animal side of wrist"},{"speaker":"Sanj Kakar","startTime":1770.98,"endTime":1773.62,"body":"pain. So I think you have to"},{"speaker":"Sanj Kakar","startTime":1773.62,"endTime":1778.84,"body":"have a degree of objectivity of"},{"speaker":"Sanj Kakar","startTime":1773.62,"endTime":1778.84,"body":"when you're using that. But it's"},{"speaker":"Sanj Kakar","startTime":1778.84,"endTime":1779.62,"body":"a good question."},{"speaker":"Charles Goldfarb","startTime":1780.16,"endTime":1782.76,"body":"I think this"},{"speaker":"Charles Goldfarb","startTime":1780.16,"endTime":1782.76,"body":"is important, and I think there"},{"speaker":"Charles Goldfarb","startTime":1782.76,"endTime":1785.28,"body":"will be people who disagree with"},{"speaker":"Charles Goldfarb","startTime":1782.76,"endTime":1785.28,"body":"this, but I'm going to say it"},{"speaker":"Charles Goldfarb","startTime":1785.28,"endTime":1787.5,"body":"relatively strongly, because"},{"speaker":"Charles Goldfarb","startTime":1785.28,"endTime":1787.5,"body":"that's how I feel about it."},{"speaker":"Charles Goldfarb","startTime":1787.5,"endTime":1790.92,"body":"Today, it might change. Number"},{"speaker":"Charles Goldfarb","startTime":1787.5,"endTime":1790.92,"body":"one, if you have a split tear,"},{"speaker":"Charles Goldfarb","startTime":1790.92,"endTime":1794.88,"body":"you have to address it. As Sanj"},{"speaker":"Charles Goldfarb","startTime":1790.92,"endTime":1794.88,"body":"has said, the vast majority of"},{"speaker":"Charles Goldfarb","startTime":1794.88,"endTime":1799.44,"body":"what I do include faucial"},{"speaker":"Charles Goldfarb","startTime":1794.88,"endTime":1799.44,"body":"repairs, what I almost never do"},{"speaker":"Charles Goldfarb","startTime":1799.44,"endTime":1803.3,"body":"now. I almost never, and I don't"},{"speaker":"Charles Goldfarb","startTime":1799.44,"endTime":1803.3,"body":"remember the last time I did was"},{"speaker":"Charles Goldfarb","startTime":1803.3,"endTime":1807.44,"body":"the, what I would call the"},{"speaker":"Charles Goldfarb","startTime":1803.3,"endTime":1807.44,"body":"dorsal ulnar peripheral tear,"},{"speaker":"Charles Goldfarb","startTime":1807.44,"endTime":1811.46,"body":"and that is the ECU subsheet"},{"speaker":"Charles Goldfarb","startTime":1807.44,"endTime":1811.46,"body":"tear. 20 years ago, a private"},{"speaker":"Charles Goldfarb","startTime":1811.46,"endTime":1814.1,"body":"practice hand surgeon in St"},{"speaker":"Charles Goldfarb","startTime":1811.46,"endTime":1814.1,"body":"Louis came to the Shriners, and"},{"speaker":"Charles Goldfarb","startTime":1814.28,"endTime":1817.82,"body":"we used to talk, and he, you"},{"speaker":"Charles Goldfarb","startTime":1814.28,"endTime":1817.82,"body":"know, at that point, had a busy"},{"speaker":"Charles Goldfarb","startTime":1817.82,"endTime":1820.6,"body":"arthroscopy survey. He said,"},{"speaker":"Charles Goldfarb","startTime":1817.82,"endTime":1820.6,"body":"Look, I never repaired this. I'm"},{"speaker":"Charles Goldfarb","startTime":1820.6,"endTime":1822.88,"body":"like, What are you talking"},{"speaker":"Charles Goldfarb","startTime":1820.6,"endTime":1822.88,"body":"about? I always repair this. EC,"},{"speaker":"Charles Goldfarb","startTime":1822.88,"endTime":1825.46,"body":"sharp teeth. Technique is"},{"speaker":"Charles Goldfarb","startTime":1822.88,"endTime":1825.46,"body":"fantastic. He's like, What are"},{"speaker":"Charles Goldfarb","startTime":1825.46,"endTime":1828.16,"body":"you really doing? There's no"},{"speaker":"Charles Goldfarb","startTime":1825.46,"endTime":1828.16,"body":"instability. There may be some"},{"speaker":"Charles Goldfarb","startTime":1828.16,"endTime":1832.12,"body":"pain. If you debride that it'll"},{"speaker":"Charles Goldfarb","startTime":1828.16,"endTime":1832.12,"body":"heal. It took me 20 years to"},{"speaker":"Charles Goldfarb","startTime":1832.12,"endTime":1834.88,"body":"figure it out, but I think he's"},{"speaker":"Charles Goldfarb","startTime":1832.12,"endTime":1834.88,"body":"right, and I just don't do that"},{"speaker":"Charles Goldfarb","startTime":1834.88,"endTime":1836.32,"body":"repair almost ever anymore."},{"speaker":"Sanj Kakar","startTime":1837.52,"endTime":1839.62,"body":"Yeah, you know, it's"},{"speaker":"Sanj Kakar","startTime":1837.52,"endTime":1839.62,"body":"funny. You say that about the UT"},{"speaker":"Sanj Kakar","startTime":1839.62,"endTime":1844.02,"body":"split test in my mind, I always"},{"speaker":"Sanj Kakar","startTime":1839.62,"endTime":1844.02,"body":"fix them. That's, you know, as"},{"speaker":"Sanj Kakar","startTime":1844.02,"endTime":1847.62,"body":"my mentor showed me how to do"},{"speaker":"Sanj Kakar","startTime":1844.02,"endTime":1847.62,"body":"it, and I always fix them. But I"},{"speaker":"Sanj Kakar","startTime":1847.62,"endTime":1850.38,"body":"do know, you know, in my mind, I"},{"speaker":"Sanj Kakar","startTime":1847.62,"endTime":1850.38,"body":"do think to myself, well, what"},{"speaker":"Sanj Kakar","startTime":1850.38,"endTime":1853.8,"body":"happens if you simply debride"},{"speaker":"Sanj Kakar","startTime":1850.38,"endTime":1853.8,"body":"them and you immobilize them? Do"},{"speaker":"Sanj Kakar","startTime":1853.8,"endTime":1857.1,"body":"they heal and so that's, uh, you"},{"speaker":"Sanj Kakar","startTime":1853.8,"endTime":1857.1,"body":"know, that's a thought that goes"},{"speaker":"Sanj Kakar","startTime":1857.1,"endTime":1859.92,"body":"through my mind about that. And"},{"speaker":"Sanj Kakar","startTime":1857.1,"endTime":1859.92,"body":"some people, I think, do they"},{"speaker":"Sanj Kakar","startTime":1859.92,"endTime":1861.86,"body":"just debris them and they were"},{"speaker":"Sanj Kakar","startTime":1859.92,"endTime":1861.86,"body":"mobilizing. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1861.86,"endTime":1863.78,"body":"just to be"},{"speaker":"Charles Goldfarb","startTime":1861.86,"endTime":1863.78,"body":"clear, I'm not saying I'm not"},{"speaker":"Charles Goldfarb","startTime":1863.78,"endTime":1866.3,"body":"talking about that tear. I'm"},{"speaker":"Charles Goldfarb","startTime":1863.78,"endTime":1866.3,"body":"talking about, okay, okay. I"},{"speaker":"Charles Goldfarb","startTime":1866.3,"endTime":1868.82,"body":"just want to be clear. I wasn't"},{"speaker":"Charles Goldfarb","startTime":1866.3,"endTime":1868.82,"body":"questioning that, even though I"},{"speaker":"Charles Goldfarb","startTime":1868.82,"endTime":1871.34,"body":"think it's a fair point. But I"},{"speaker":"Charles Goldfarb","startTime":1868.82,"endTime":1871.34,"body":"wasn't questioning that. Yeah,"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1875.72,"body":"so before we shift to"},{"speaker":"Chris Dy","startTime":1872.36,"endTime":1875.72,"body":"our final topic, we did want to"},{"speaker":"Chris Dy","startTime":1876.44,"endTime":1879.62,"body":"acknowledge our sponsors at"},{"speaker":"Chris Dy","startTime":1876.44,"endTime":1879.62,"body":"checkpoint surgical so market"},{"speaker":"Chris Dy","startTime":1879.62,"endTime":1882.82,"body":"calendars for March 7 and eighth"},{"speaker":"Chris Dy","startTime":1879.62,"endTime":1882.82,"body":"for checkpoint, surgicals. Next"},{"speaker":"Chris Dy","startTime":1882.82,"endTime":1886.0,"body":"category course, restoring hand"},{"speaker":"Chris Dy","startTime":1882.82,"endTime":1886.0,"body":"and wrist function, optimizing"},{"speaker":"Chris Dy","startTime":1886.0,"endTime":1889.3,"body":"surgical results and avoiding"},{"speaker":"Chris Dy","startTime":1886.0,"endTime":1889.3,"body":"complications. Join the course"},{"speaker":"Chris Dy","startTime":1889.3,"endTime":1893.44,"body":"faculty, Doctor Kyle chapla, Dr"},{"speaker":"Chris Dy","startTime":1889.3,"endTime":1893.44,"body":"Amber lease and Dr Deanna Mercer"},{"speaker":"Chris Dy","startTime":1893.44,"endTime":1896.44,"body":"in Las Vegas, Nevada, as a"},{"speaker":"Chris Dy","startTime":1893.44,"endTime":1896.44,"body":"review of management strategies"},{"speaker":"Chris Dy","startTime":1896.44,"endTime":1899.26,"body":"to assess, preserve and restore"},{"speaker":"Chris Dy","startTime":1896.44,"endTime":1899.26,"body":"hand and wrist function."},{"speaker":"Charles Goldfarb","startTime":1899.86,"endTime":1901.8,"body":"Chris gets"},{"speaker":"Charles Goldfarb","startTime":1899.86,"endTime":1901.8,"body":"excited when we talk anything"},{"speaker":"Charles Goldfarb","startTime":1901.8,"endTime":1905.34,"body":"nerve so he read like 90% of the"},{"speaker":"Charles Goldfarb","startTime":1901.8,"endTime":1905.34,"body":"copy for that. And so I get to"},{"speaker":"Charles Goldfarb","startTime":1905.34,"endTime":1908.52,"body":"close that with to learn more"},{"speaker":"Charles Goldfarb","startTime":1905.34,"endTime":1908.52,"body":"about this and other educational"},{"speaker":"Charles Goldfarb","startTime":1908.52,"endTime":1911.76,"body":"programs. Please visit nerve"},{"speaker":"Charles Goldfarb","startTime":1908.52,"endTime":1911.76,"body":"master, calm. Check fully"},{"speaker":"Charles Goldfarb","startTime":1911.76,"endTime":1915.12,"body":"surgical, driving innovation in"},{"speaker":"Charles Goldfarb","startTime":1911.76,"endTime":1915.12,"body":"nerve surgery. I'm"},{"speaker":"Chris Dy","startTime":1915.12,"endTime":1917.04,"body":"so happy that you got"},{"speaker":"Chris Dy","startTime":1915.12,"endTime":1917.04,"body":"three. I mean, you probably take"},{"speaker":"Chris Dy","startTime":1917.04,"endTime":1920.42,"body":"those, those ad copy courses,"},{"speaker":"Chris Dy","startTime":1917.04,"endTime":1920.42,"body":"right, those at the podcast"},{"speaker":"Chris Dy","startTime":1920.42,"endTime":1923.18,"body":"studios to really deliver that"},{"speaker":"Chris Dy","startTime":1920.42,"endTime":1923.18,"body":"last"},{"speaker":"Charles Goldfarb","startTime":1923.18,"endTime":1925.1,"body":"line. You"},{"speaker":"Charles Goldfarb","startTime":1923.18,"endTime":1925.1,"body":"know, I'm working on the voice."},{"speaker":"Charles Goldfarb","startTime":1925.1,"endTime":1931.22,"body":"I need to be a little more, more"},{"speaker":"Charles Goldfarb","startTime":1925.1,"endTime":1931.22,"body":"deep, probably to be, all right,"},{"speaker":"Charles Goldfarb","startTime":1931.22,"endTime":1934.1,"body":"Sanj, we have a few minutes"},{"speaker":"Charles Goldfarb","startTime":1931.22,"endTime":1934.1,"body":"left. We are grateful for your"},{"speaker":"Charles Goldfarb","startTime":1934.1,"endTime":1937.28,"body":"time. We don't want to"},{"speaker":"Charles Goldfarb","startTime":1934.1,"endTime":1937.28,"body":"monopolize it. So let's talk."},{"speaker":"Charles Goldfarb","startTime":1937.64,"endTime":1941.44,"body":"SL, tears. I'm going to start"},{"speaker":"Charles Goldfarb","startTime":1937.64,"endTime":1941.44,"body":"with a simple question, not so"},{"speaker":"Charles Goldfarb","startTime":1941.44,"endTime":1945.94,"body":"simple, when do you open to"},{"speaker":"Charles Goldfarb","startTime":1941.44,"endTime":1945.94,"body":"address a scaffolding ligament"},{"speaker":"Charles Goldfarb","startTime":1945.94,"endTime":1948.58,"body":"injury? And when do you, and"},{"speaker":"Charles Goldfarb","startTime":1945.94,"endTime":1948.58,"body":"let's not get into the specifics"},{"speaker":"Charles Goldfarb","startTime":1948.58,"endTime":1951.94,"body":"yet, and when do you think about"},{"speaker":"Charles Goldfarb","startTime":1948.58,"endTime":1951.94,"body":"an arthroscopic approach? Yeah,"},{"speaker":"Sanj Kakar","startTime":1951.94,"endTime":1955.36,"body":"so very, very"},{"speaker":"Sanj Kakar","startTime":1951.94,"endTime":1955.36,"body":"quickly when I see a patient"},{"speaker":"Sanj Kakar","startTime":1955.42,"endTime":1961.14,"body":"who's tender over the SL right,"},{"speaker":"Sanj Kakar","startTime":1955.42,"endTime":1961.14,"body":"and the X rays are equivocal as"},{"speaker":"Sanj Kakar","startTime":1961.14,"endTime":1964.26,"body":"well as the MRI. And just very"},{"speaker":"Sanj Kakar","startTime":1961.14,"endTime":1964.26,"body":"quickly, when you're looking at"},{"speaker":"Sanj Kakar","startTime":1964.26,"endTime":1967.56,"body":"the scans, I always look at the"},{"speaker":"Sanj Kakar","startTime":1964.26,"endTime":1967.56,"body":"alignment of the scaphoid on the"},{"speaker":"Sanj Kakar","startTime":1967.56,"endTime":1970.32,"body":"sagittal view, the lunate"},{"speaker":"Sanj Kakar","startTime":1967.56,"endTime":1970.32,"body":"alignment on the coronal view"},{"speaker":"Sanj Kakar","startTime":1970.32,"endTime":1972.96,"body":"and the axial view. See if it's"},{"speaker":"Sanj Kakar","startTime":1970.32,"endTime":1972.96,"body":"a dorsal level or through and"},{"speaker":"Sanj Kakar","startTime":1972.96,"endTime":1976.74,"body":"through injury. What I'll say to"},{"speaker":"Sanj Kakar","startTime":1972.96,"endTime":1976.74,"body":"them is, I'm going to scope you,"},{"speaker":"Sanj Kakar","startTime":1976.74,"endTime":1979.86,"body":"and we're going to go on the"},{"speaker":"Sanj Kakar","startTime":1976.74,"endTime":1979.86,"body":"pathway of three ways. If it's"},{"speaker":"Sanj Kakar","startTime":1979.86,"endTime":1983.3,"body":"arthritic, then we have to go"},{"speaker":"Sanj Kakar","startTime":1979.86,"endTime":1983.3,"body":"down the arthritis pathway. Now"},{"speaker":"Sanj Kakar","startTime":1983.3,"endTime":1987.14,"body":"that may be injections, that may"},{"speaker":"Sanj Kakar","startTime":1983.3,"endTime":1987.14,"body":"be a partial denovation. What do"},{"speaker":"Sanj Kakar","startTime":1987.14,"endTime":1991.64,"body":"you want to do if you are"},{"speaker":"Sanj Kakar","startTime":1987.14,"endTime":1991.64,"body":"grossly unstable and I cannot"},{"speaker":"Sanj Kakar","startTime":1991.64,"endTime":1994.1,"body":"get you arthroscopically, then"},{"speaker":"Sanj Kakar","startTime":1991.64,"endTime":1994.1,"body":"we're coming back and doing a"},{"speaker":"Sanj Kakar","startTime":1994.1,"endTime":1998.42,"body":"stage reconstruction. And in my"},{"speaker":"Sanj Kakar","startTime":1994.1,"endTime":1998.42,"body":"hands, that's an SL 360 but I"},{"speaker":"Sanj Kakar","startTime":1998.42,"endTime":2003.0,"body":"can honestly say, in the last"},{"speaker":"Sanj Kakar","startTime":1998.42,"endTime":2003.0,"body":"three years, I've been able to"},{"speaker":"Sanj Kakar","startTime":2003.0,"endTime":2007.02,"body":"always get the reduction with"},{"speaker":"Sanj Kakar","startTime":2003.0,"endTime":2007.02,"body":"arthroscopic means and and I"},{"speaker":"Sanj Kakar","startTime":2007.02,"endTime":2009.6,"body":"think there are, there are five"},{"speaker":"Sanj Kakar","startTime":2007.02,"endTime":2009.6,"body":"sort of ligaments that we have"},{"speaker":"Sanj Kakar","startTime":2009.6,"endTime":2013.14,"body":"to think about. We have to think"},{"speaker":"Sanj Kakar","startTime":2009.6,"endTime":2013.14,"body":"about the DCSS, we have to think"},{"speaker":"Sanj Kakar","startTime":2013.14,"endTime":2016.8,"body":"about the dorsal SL, we have to"},{"speaker":"Sanj Kakar","startTime":2013.14,"endTime":2016.8,"body":"think about the vola SL. We have"},{"speaker":"Sanj Kakar","startTime":2016.8,"endTime":2019.56,"body":"to think about the long radio"},{"speaker":"Sanj Kakar","startTime":2016.8,"endTime":2019.56,"body":"lunate ligament. And we have to"},{"speaker":"Sanj Kakar","startTime":2019.56,"endTime":2022.58,"body":"see think about the insertion of"},{"speaker":"Sanj Kakar","startTime":2019.56,"endTime":2022.58,"body":"the DIC ligament on the Luna."},{"speaker":"Sanj Kakar","startTime":2022.7,"endTime":2024.62,"body":"Those are the five ligaments"},{"speaker":"Sanj Kakar","startTime":2022.7,"endTime":2024.62,"body":"that you can address"},{"speaker":"Sanj Kakar","startTime":2024.62,"endTime":2028.58,"body":"arthroscopically. The one that"},{"speaker":"Sanj Kakar","startTime":2024.62,"endTime":2028.58,"body":"you can't is the stt ligament,"},{"speaker":"Sanj Kakar","startTime":2028.64,"endTime":2031.04,"body":"and that a repair has been"},{"speaker":"Sanj Kakar","startTime":2028.64,"endTime":2031.04,"body":"described by Nick Smith in"},{"speaker":"Sanj Kakar","startTime":2031.04,"endTime":2034.16,"body":"Sydney and Australia, where it's"},{"speaker":"Sanj Kakar","startTime":2031.04,"endTime":2034.16,"body":"a small, mini open incision to"},{"speaker":"Sanj Kakar","startTime":2034.16,"endTime":2038.78,"body":"do those now, if I can get the"},{"speaker":"Sanj Kakar","startTime":2034.16,"endTime":2038.78,"body":"reduction with sutures being"},{"speaker":"Sanj Kakar","startTime":2038.78,"endTime":2041.92,"body":"passed through that way, plus or"},{"speaker":"Sanj Kakar","startTime":2038.78,"endTime":2041.92,"body":"minus k wires, and that's what"},{"speaker":"Sanj Kakar","startTime":2041.92,"endTime":2045.88,"body":"we're doing. And I have found"},{"speaker":"Sanj Kakar","startTime":2041.92,"endTime":2045.88,"body":"that to be a very reproducible"},{"speaker":"Sanj Kakar","startTime":2045.88,"endTime":2049.12,"body":"method to do it. The morbidity"},{"speaker":"Sanj Kakar","startTime":2045.88,"endTime":2049.12,"body":"of doing those is relatively"},{"speaker":"Sanj Kakar","startTime":2049.12,"endTime":2052.6,"body":"minimal. You're not making big"},{"speaker":"Sanj Kakar","startTime":2049.12,"endTime":2052.6,"body":"drill holes in the in the carpus"},{"speaker":"Sanj Kakar","startTime":2053.02,"endTime":2056.32,"body":"and and we've all done SL"},{"speaker":"Sanj Kakar","startTime":2053.02,"endTime":2056.32,"body":"reconstructions where you've had"},{"speaker":"Sanj Kakar","startTime":2056.32,"endTime":2059.26,"body":"a great reconstruction, the"},{"speaker":"Sanj Kakar","startTime":2056.32,"endTime":2059.26,"body":"patient's doing well. You come"},{"speaker":"Sanj Kakar","startTime":2059.26,"endTime":2063.24,"body":"back and they have a big X ray"},{"speaker":"Sanj Kakar","startTime":2059.26,"endTime":2063.24,"body":"gap, but I think, but they're"},{"speaker":"Sanj Kakar","startTime":2063.24,"endTime":2065.94,"body":"doing well. And I think with"},{"speaker":"Sanj Kakar","startTime":2063.24,"endTime":2065.94,"body":"arthroscopy, you're stabilizing"},{"speaker":"Sanj Kakar","startTime":2065.94,"endTime":2068.82,"body":"the carpet. You may not get rid"},{"speaker":"Sanj Kakar","startTime":2065.94,"endTime":2068.82,"body":"of the gap completely, but"},{"speaker":"Sanj Kakar","startTime":2068.82,"endTime":2071.1,"body":"they're stable, and they're and"},{"speaker":"Sanj Kakar","startTime":2068.82,"endTime":2071.1,"body":"they're mobile. They're not"},{"speaker":"Sanj Kakar","startTime":2071.1,"endTime":2074.64,"body":"stuck. They're not stuck in"},{"speaker":"Sanj Kakar","startTime":2071.1,"endTime":2074.64,"body":"terms of scar tissue. And so"},{"speaker":"Sanj Kakar","startTime":2074.64,"endTime":2077.28,"body":"that's sort of my algorithm for"},{"speaker":"Sanj Kakar","startTime":2074.64,"endTime":2077.28,"body":"addressing the SL with the"},{"speaker":"Sanj Kakar","startTime":2077.28,"endTime":2077.58,"body":"scope."},{"speaker":"Charles Goldfarb","startTime":2078.6,"endTime":2082.94,"body":"I love that"},{"speaker":"Charles Goldfarb","startTime":2078.6,"endTime":2082.94,"body":"this is a lot, and obviously"},{"speaker":"Charles Goldfarb","startTime":2082.94,"endTime":2086.18,"body":"we're not going to all our"},{"speaker":"Charles Goldfarb","startTime":2082.94,"endTime":2086.18,"body":"listeners, and likely Chris or I"},{"speaker":"Charles Goldfarb","startTime":2086.18,"endTime":2089.3,"body":"are not going to master this in"},{"speaker":"Charles Goldfarb","startTime":2086.18,"endTime":2089.3,"body":"the next few minutes. But what's"},{"speaker":"Charles Goldfarb","startTime":2089.3,"endTime":2094.16,"body":"the most common arthroscopic"},{"speaker":"Charles Goldfarb","startTime":2089.3,"endTime":2094.16,"body":"procedure you do for SL and"},{"speaker":"Charles Goldfarb","startTime":2094.16,"endTime":2098.42,"body":"obviously it has to be"},{"speaker":"Charles Goldfarb","startTime":2094.16,"endTime":2098.42,"body":"customized to the patient and"},{"speaker":"Charles Goldfarb","startTime":2098.42,"endTime":2101.68,"body":"the situation. But what's. The"},{"speaker":"Charles Goldfarb","startTime":2098.42,"endTime":2101.68,"body":"most common procedure you do?"},{"speaker":"Sanj Kakar","startTime":2102.46,"endTime":2105.58,"body":"Yeah, so did one"},{"speaker":"Sanj Kakar","startTime":2102.46,"endTime":2105.58,"body":"just yesterday, patient came in"},{"speaker":"Sanj Kakar","startTime":2105.58,"endTime":2109.24,"body":"and was tender through and"},{"speaker":"Sanj Kakar","startTime":2105.58,"endTime":2109.24,"body":"through. So I scoped them, and"},{"speaker":"Sanj Kakar","startTime":2109.24,"endTime":2112.66,"body":"the vola SL was off as well as"},{"speaker":"Sanj Kakar","startTime":2109.24,"endTime":2112.66,"body":"the dorsal and I put the volares"},{"speaker":"Sanj Kakar","startTime":2112.78,"endTime":2115.9,"body":"capsular, desist suture, pulled"},{"speaker":"Sanj Kakar","startTime":2112.78,"endTime":2115.9,"body":"it down, reduced the vola side"},{"speaker":"Sanj Kakar","startTime":2115.9,"endTime":2118.84,"body":"and the dorsal side became more"},{"speaker":"Sanj Kakar","startTime":2115.9,"endTime":2118.84,"body":"stable, and we were done. So I"},{"speaker":"Sanj Kakar","startTime":2118.84,"endTime":2124.26,"body":"would say the vola side is where"},{"speaker":"Sanj Kakar","startTime":2118.84,"endTime":2124.26,"body":"I'm going first, but I won't"},{"speaker":"Sanj Kakar","startTime":2124.26,"endTime":2126.72,"body":"hesitate to do the others. But"},{"speaker":"Sanj Kakar","startTime":2124.26,"endTime":2126.72,"body":"to your point, that's what I'm"},{"speaker":"Sanj Kakar","startTime":2126.72,"endTime":2127.62,"body":"doing most often."},{"speaker":"Charles Goldfarb","startTime":2129.06,"endTime":2132.06,"body":"That's so"},{"speaker":"Charles Goldfarb","startTime":2129.06,"endTime":2132.06,"body":"interesting. And let's say you"},{"speaker":"Charles Goldfarb","startTime":2132.06,"endTime":2137.58,"body":"have an MRI that's equivocal. Do"},{"speaker":"Charles Goldfarb","startTime":2132.06,"endTime":2137.58,"body":"you have physical exam? Do you"},{"speaker":"Charles Goldfarb","startTime":2137.58,"endTime":2141.02,"body":"have a feeling about physical"},{"speaker":"Charles Goldfarb","startTime":2137.58,"endTime":2141.02,"body":"exam techniques to identify"},{"speaker":"Charles Goldfarb","startTime":2141.08,"endTime":2144.98,"body":"vulner pathology. In other"},{"speaker":"Charles Goldfarb","startTime":2141.08,"endTime":2144.98,"body":"words, is there a point tender"},{"speaker":"Charles Goldfarb","startTime":2144.98,"endTime":2147.44,"body":"area again? Can you talk about"},{"speaker":"Charles Goldfarb","startTime":2144.98,"endTime":2147.44,"body":"that? Yeah,"},{"speaker":"Sanj Kakar","startTime":2147.44,"endTime":2150.2,"body":"so, so what they"},{"speaker":"Sanj Kakar","startTime":2147.44,"endTime":2150.2,"body":"usually what I do is I'll"},{"speaker":"Sanj Kakar","startTime":2150.38,"endTime":2153.08,"body":"palpate first over the fcr to"},{"speaker":"Sanj Kakar","startTime":2150.38,"endTime":2153.08,"body":"make sure it's not fcr"},{"speaker":"Sanj Kakar","startTime":2153.08,"endTime":2156.62,"body":"tendinitis. I'll then put my"},{"speaker":"Sanj Kakar","startTime":2153.08,"endTime":2156.62,"body":"finger on the fcr and pull it"},{"speaker":"Sanj Kakar","startTime":2156.62,"endTime":2159.2,"body":"only and go deep to that. Now,"},{"speaker":"Sanj Kakar","startTime":2156.62,"endTime":2159.2,"body":"essentially, there's three"},{"speaker":"Sanj Kakar","startTime":2159.2,"endTime":2162.16,"body":"issues there. There's either an"},{"speaker":"Sanj Kakar","startTime":2159.2,"endTime":2162.16,"body":"occult volar ganglion, there's"},{"speaker":"Sanj Kakar","startTime":2162.16,"endTime":2165.04,"body":"either an extrinsic injury,"},{"speaker":"Sanj Kakar","startTime":2162.16,"endTime":2165.04,"body":"maybe radio Skipper caps, or"},{"speaker":"Sanj Kakar","startTime":2165.04,"endTime":2167.68,"body":"long radio lunate ligament. Or,"},{"speaker":"Sanj Kakar","startTime":2165.04,"endTime":2167.68,"body":"if you're pushing really deep,"},{"speaker":"Sanj Kakar","startTime":2168.16,"endTime":2172.42,"body":"it's the volar SL, but those but"},{"speaker":"Sanj Kakar","startTime":2168.16,"endTime":2172.42,"body":"the extrinsic ligaments, RSC,"},{"speaker":"Sanj Kakar","startTime":2172.42,"endTime":2175.84,"body":"long radio lunate ligament,"},{"speaker":"Sanj Kakar","startTime":2172.42,"endTime":2175.84,"body":"volar SL, even occult ganglion,"},{"speaker":"Sanj Kakar","startTime":2176.08,"endTime":2178.66,"body":"you're either seeing well,"},{"speaker":"Sanj Kakar","startTime":2176.08,"endTime":2178.66,"body":"occult ganglion you'll see on"},{"speaker":"Sanj Kakar","startTime":2178.66,"endTime":2182.04,"body":"the MRI. The other three you may"},{"speaker":"Sanj Kakar","startTime":2178.66,"endTime":2182.04,"body":"not and so those are the ones"},{"speaker":"Sanj Kakar","startTime":2182.04,"endTime":2184.74,"body":"that you'll pop the camera in."},{"speaker":"Sanj Kakar","startTime":2182.04,"endTime":2184.74,"body":"And as I said yesterday, we"},{"speaker":"Sanj Kakar","startTime":2184.74,"endTime":2187.02,"body":"popped it in, and there was a"},{"speaker":"Sanj Kakar","startTime":2184.74,"endTime":2187.02,"body":"partial avulsion of the long"},{"speaker":"Sanj Kakar","startTime":2187.02,"endTime":2190.08,"body":"radio lunate ligament off the"},{"speaker":"Sanj Kakar","startTime":2187.02,"endTime":2190.08,"body":"distal radius proximately."},{"speaker":"Charles Goldfarb","startTime":2191.1,"endTime":2193.92,"body":"And this is"},{"speaker":"Charles Goldfarb","startTime":2191.1,"endTime":2193.92,"body":"great. And I think to listeners,"},{"speaker":"Charles Goldfarb","startTime":2193.98,"endTime":2196.5,"body":"this is not something you're"},{"speaker":"Charles Goldfarb","startTime":2193.98,"endTime":2196.5,"body":"typically going to learn on your"},{"speaker":"Charles Goldfarb","startTime":2196.56,"endTime":2199.26,"body":"hand rotation unless someone's"},{"speaker":"Charles Goldfarb","startTime":2196.56,"endTime":2199.26,"body":"really focused. I think that"},{"speaker":"Charles Goldfarb","startTime":2199.26,"endTime":2203.6,"body":"point tender area is under"},{"speaker":"Charles Goldfarb","startTime":2199.26,"endTime":2203.6,"body":"appreciated. And I love the how"},{"speaker":"Charles Goldfarb","startTime":2203.6,"endTime":2207.38,"body":"you stated that. So in the case"},{"speaker":"Charles Goldfarb","startTime":2203.6,"endTime":2207.38,"body":"you did yesterday, you did the"},{"speaker":"Charles Goldfarb","startTime":2207.38,"endTime":2210.8,"body":"volar capso Desis. And I don't"},{"speaker":"Charles Goldfarb","startTime":2207.38,"endTime":2210.8,"body":"want to say it's going to come"},{"speaker":"Charles Goldfarb","startTime":2210.8,"endTime":2213.26,"body":"out wrong, but is that all you"},{"speaker":"Charles Goldfarb","startTime":2210.8,"endTime":2213.26,"body":"did, in the sense you did, you"},{"speaker":"Charles Goldfarb","startTime":2213.26,"endTime":2216.74,"body":"try to do anything to have the"},{"speaker":"Charles Goldfarb","startTime":2213.26,"endTime":2216.74,"body":"long radio lunate heal back to"},{"speaker":"Charles Goldfarb","startTime":2216.74,"endTime":2217.28,"body":"bone?"},{"speaker":"Sanj Kakar","startTime":2217.34,"endTime":2219.62,"body":"Yeah. So what? So"},{"speaker":"Sanj Kakar","startTime":2217.34,"endTime":2219.62,"body":"what I did then is, for that"},{"speaker":"Sanj Kakar","startTime":2219.62,"endTime":2222.16,"body":"one, then I took the shaver in"},{"speaker":"Sanj Kakar","startTime":2219.62,"endTime":2222.16,"body":"because it was a partial injury,"},{"speaker":"Sanj Kakar","startTime":2222.16,"endTime":2226.78,"body":"I'd say maybe 20 to 30% partial."},{"speaker":"Sanj Kakar","startTime":2222.16,"endTime":2226.78,"body":"The rest was on intact. I took a"},{"speaker":"Sanj Kakar","startTime":2226.78,"endTime":2231.04,"body":"shaver and debrided the base of"},{"speaker":"Sanj Kakar","startTime":2226.78,"endTime":2231.04,"body":"the radius and also the long"},{"speaker":"Sanj Kakar","startTime":2231.04,"endTime":2233.74,"body":"radio lunate ligament. And then"},{"speaker":"Sanj Kakar","startTime":2231.04,"endTime":2233.74,"body":"we described this, recently"},{"speaker":"Sanj Kakar","startTime":2233.74,"endTime":2236.98,"body":"published in JHS, the Merlin"},{"speaker":"Sanj Kakar","startTime":2233.74,"endTime":2236.98,"body":"technique, where you basically"},{"speaker":"Sanj Kakar","startTime":2236.98,"endTime":2240.66,"body":"do an invocation long radio"},{"speaker":"Sanj Kakar","startTime":2236.98,"endTime":2240.66,"body":"lunate ligament. Now, if there"},{"speaker":"Sanj Kakar","startTime":2240.66,"endTime":2243.48,"body":"was a complete detachment of the"},{"speaker":"Sanj Kakar","startTime":2240.66,"endTime":2243.48,"body":"long radio ligament off the"},{"speaker":"Sanj Kakar","startTime":2243.48,"endTime":2246.3,"body":"radius, you were already bowler,"},{"speaker":"Sanj Kakar","startTime":2243.48,"endTime":2246.3,"body":"because you made a bola radial"},{"speaker":"Sanj Kakar","startTime":2246.3,"endTime":2250.14,"body":"portal, then you would put an"},{"speaker":"Sanj Kakar","startTime":2246.3,"endTime":2250.14,"body":"anchor into the radius and then"},{"speaker":"Sanj Kakar","startTime":2251.22,"endTime":2253.62,"body":"tie that ligament down to the"},{"speaker":"Sanj Kakar","startTime":2251.22,"endTime":2253.62,"body":"radius."},{"speaker":"Charles Goldfarb","startTime":2254.88,"endTime":2257.22,"body":"Let's step"},{"speaker":"Charles Goldfarb","startTime":2254.88,"endTime":2257.22,"body":"back for one second if you have"},{"speaker":"Charles Goldfarb","startTime":2257.22,"endTime":2261.56,"body":"an MRI identified membranous"},{"speaker":"Charles Goldfarb","startTime":2257.22,"endTime":2261.56,"body":"tear. And for those who don't"},{"speaker":"Charles Goldfarb","startTime":2261.56,"endTime":2264.32,"body":"know the terminology,"},{"speaker":"Charles Goldfarb","startTime":2261.56,"endTime":2264.32,"body":"specifically, that's not dorsal,"},{"speaker":"Charles Goldfarb","startTime":2264.32,"endTime":2268.64,"body":"that's not volar. It's sort of"},{"speaker":"Charles Goldfarb","startTime":2264.32,"endTime":2268.64,"body":"the proximal aspect of the C MRI"},{"speaker":"Charles Goldfarb","startTime":2268.64,"endTime":2272.12,"body":"looks like his membranous a do"},{"speaker":"Charles Goldfarb","startTime":2268.64,"endTime":2272.12,"body":"your arthroscopy for a patient"},{"speaker":"Charles Goldfarb","startTime":2272.12,"endTime":2275.78,"body":"with radio sided pain, dorsal"},{"speaker":"Charles Goldfarb","startTime":2272.12,"endTime":2275.78,"body":"and volar seem to be intact, and"},{"speaker":"Charles Goldfarb","startTime":2275.78,"endTime":2278.36,"body":"he had this membranous tear."},{"speaker":"Charles Goldfarb","startTime":2275.78,"endTime":2278.36,"body":"What do you do then? Is it just"},{"speaker":"Charles Goldfarb","startTime":2278.36,"endTime":2279.38,"body":"a simple debridement?"},{"speaker":"Sanj Kakar","startTime":2280.22,"endTime":2284.38,"body":"Yeah, I'm not, I'm"},{"speaker":"Sanj Kakar","startTime":2280.22,"endTime":2284.38,"body":"not fixing that. But truth be"},{"speaker":"Sanj Kakar","startTime":2284.38,"endTime":2287.74,"body":"told, Chuck, if I'm seeing a"},{"speaker":"Sanj Kakar","startTime":2284.38,"endTime":2287.74,"body":"memoryless tear, I mean, I'll"},{"speaker":"Sanj Kakar","startTime":2287.74,"endTime":2290.38,"body":"debride it. But in my, in my"},{"speaker":"Sanj Kakar","startTime":2287.74,"endTime":2290.38,"body":"sort of gut instinct, I'm"},{"speaker":"Sanj Kakar","startTime":2290.38,"endTime":2292.42,"body":"thinking, Am I really addressing"},{"speaker":"Sanj Kakar","startTime":2290.38,"endTime":2292.42,"body":"the problem here?"},{"speaker":"Charles Goldfarb","startTime":2292.96,"endTime":2294.76,"body":"That that's"},{"speaker":"Charles Goldfarb","startTime":2292.96,"endTime":2294.76,"body":"what I was hoping you would say."},{"speaker":"Charles Goldfarb","startTime":2294.82,"endTime":2299.08,"body":"I think that situations really"},{"speaker":"Charles Goldfarb","startTime":2294.82,"endTime":2299.08,"body":"rare where you just have"},{"speaker":"Charles Goldfarb","startTime":2299.08,"endTime":2303.48,"body":"memories, and I see op notes"},{"speaker":"Charles Goldfarb","startTime":2299.08,"endTime":2303.48,"body":"where people have just debrided"},{"speaker":"Charles Goldfarb","startTime":2303.48,"endTime":2306.06,"body":"the membrane is tear. And I'm"},{"speaker":"Charles Goldfarb","startTime":2303.48,"endTime":2306.06,"body":"always a little questioning is,"},{"speaker":"Charles Goldfarb","startTime":2306.06,"endTime":2307.92,"body":"was there really something else"},{"speaker":"Charles Goldfarb","startTime":2306.06,"endTime":2307.92,"body":"going on?"},{"speaker":"Sanj Kakar","startTime":2308.04,"endTime":2310.26,"body":"Yeah, yeah. So"},{"speaker":"Chris Dy","startTime":2310.26,"endTime":2312.36,"body":"he actually brings up"},{"speaker":"Chris Dy","startTime":2310.26,"endTime":2312.36,"body":"a really good point. I wanted to"},{"speaker":"Chris Dy","startTime":2312.36,"endTime":2315.48,"body":"ask both you, given that you are"},{"speaker":"Chris Dy","startTime":2312.36,"endTime":2315.48,"body":"super specialized experts and"},{"speaker":"Chris Dy","startTime":2315.48,"endTime":2319.68,"body":"nationally and internationally"},{"speaker":"Chris Dy","startTime":2315.48,"endTime":2319.68,"body":"recognized for this area, what"},{"speaker":"Chris Dy","startTime":2319.68,"endTime":2323.66,"body":"are the most common things that"},{"speaker":"Chris Dy","startTime":2319.68,"endTime":2323.66,"body":"people don't treat appropriately"},{"speaker":"Chris Dy","startTime":2324.02,"endTime":2329.48,"body":"or miss, or, you know, lead to"},{"speaker":"Chris Dy","startTime":2324.02,"endTime":2329.48,"body":"issues down the line. With"},{"speaker":"Chris Dy","startTime":2329.48,"endTime":2330.44,"body":"regards to SL,"},{"speaker":"Sanj Kakar","startTime":2331.4,"endTime":2334.82,"body":"I think, honestly,"},{"speaker":"Sanj Kakar","startTime":2331.4,"endTime":2334.82,"body":"it's the diagnosis, right? I"},{"speaker":"Sanj Kakar","startTime":2334.82,"endTime":2339.08,"body":"think it's we were, we were"},{"speaker":"Sanj Kakar","startTime":2334.82,"endTime":2339.08,"body":"taught, if the X rays are"},{"speaker":"Sanj Kakar","startTime":2339.08,"endTime":2342.52,"body":"normal, get a stress view, and"},{"speaker":"Sanj Kakar","startTime":2339.08,"endTime":2342.52,"body":"if the stress views are normal,"},{"speaker":"Sanj Kakar","startTime":2342.7,"endTime":2346.0,"body":"there's not an SL problem,"},{"speaker":"Sanj Kakar","startTime":2342.7,"endTime":2346.0,"body":"right? There's a lot of patients"},{"speaker":"Sanj Kakar","startTime":2346.0,"endTime":2351.58,"body":"who have high grade instability."},{"speaker":"Sanj Kakar","startTime":2346.0,"endTime":2351.58,"body":"We publish a series on this, on"},{"speaker":"Sanj Kakar","startTime":2351.58,"endTime":2358.96,"body":"patients with normal X rays,"},{"speaker":"Sanj Kakar","startTime":2351.58,"endTime":2358.96,"body":"both at rest and stress views,"},{"speaker":"Sanj Kakar","startTime":2359.26,"endTime":2363.6,"body":"and 40% had high grade geyser"},{"speaker":"Sanj Kakar","startTime":2359.26,"endTime":2363.6,"body":"three or four instability. So I"},{"speaker":"Sanj Kakar","startTime":2363.6,"endTime":2366.0,"body":"think that's the first one. I"},{"speaker":"Sanj Kakar","startTime":2363.6,"endTime":2366.0,"body":"think getting the diagnosis"},{"speaker":"Sanj Kakar","startTime":2366.0,"endTime":2369.12,"body":"correct. I think the second"},{"speaker":"Sanj Kakar","startTime":2366.0,"endTime":2369.12,"body":"thing is coming in with a hammer"},{"speaker":"Sanj Kakar","startTime":2369.18,"endTime":2373.8,"body":"as one treatment suits all and"},{"speaker":"Sanj Kakar","startTime":2369.18,"endTime":2373.8,"body":"so, you know, when, when, when"},{"speaker":"Sanj Kakar","startTime":2373.8,"endTime":2376.44,"body":"we were residents and fellows."},{"speaker":"Sanj Kakar","startTime":2373.8,"endTime":2376.44,"body":"It was a three ligament Tina"},{"speaker":"Sanj Kakar","startTime":2376.44,"endTime":2379.02,"body":"thesis, right? And that was the"},{"speaker":"Sanj Kakar","startTime":2376.44,"endTime":2379.02,"body":"one that was being done"},{"speaker":"Sanj Kakar","startTime":2379.26,"endTime":2382.4,"body":"essentially, for most SLS, and"},{"speaker":"Sanj Kakar","startTime":2379.26,"endTime":2382.4,"body":"I'm not knocking that operation,"},{"speaker":"Sanj Kakar","startTime":2382.4,"endTime":2386.06,"body":"but my point is that it may be a"},{"speaker":"Sanj Kakar","startTime":2382.4,"endTime":2386.06,"body":"border injury, maybe a dorsal"},{"speaker":"Sanj Kakar","startTime":2386.06,"endTime":2388.28,"body":"injury, maybe through and"},{"speaker":"Sanj Kakar","startTime":2386.06,"endTime":2388.28,"body":"through, there may be extrinsic"},{"speaker":"Sanj Kakar","startTime":2388.28,"endTime":2391.34,"body":"ligament injuries as well. So"},{"speaker":"Sanj Kakar","startTime":2388.28,"endTime":2391.34,"body":"you can't just have one approach"},{"speaker":"Sanj Kakar","startTime":2391.58,"endTime":2395.12,"body":"to addressing the SL so I would"},{"speaker":"Sanj Kakar","startTime":2391.58,"endTime":2395.12,"body":"say those are the two biggest"},{"speaker":"Sanj Kakar","startTime":2396.2,"endTime":2399.14,"body":"sort of areas that I think,"},{"speaker":"Sanj Kakar","startTime":2396.2,"endTime":2399.14,"body":"hopefully, that we can address"},{"speaker":"Sanj Kakar","startTime":2399.14,"endTime":2403.36,"body":"for. For people that you can't"},{"speaker":"Sanj Kakar","startTime":2399.14,"endTime":2403.36,"body":"think of it as a like an action"},{"speaker":"Sanj Kakar","startTime":2403.36,"endTime":2405.52,"body":"potential. It's not all or"},{"speaker":"Sanj Kakar","startTime":2403.36,"endTime":2405.52,"body":"nothing. Chris, so there you"},{"speaker":"Sanj Kakar","startTime":2405.52,"endTime":2409.36,"body":"are. We got nerve in there for"},{"speaker":"Sanj Kakar","startTime":2405.52,"endTime":2409.36,"body":"you, right? It has to be more of"},{"speaker":"Sanj Kakar","startTime":2409.36,"endTime":2412.48,"body":"a rainbow approach. And how to"},{"speaker":"Sanj Kakar","startTime":2409.36,"endTime":2412.48,"body":"address this,"},{"speaker":"Charles Goldfarb","startTime":2413.44,"endTime":2417.1,"body":"I would close"},{"speaker":"Charles Goldfarb","startTime":2413.44,"endTime":2417.1,"body":"by offering this. When I was a"},{"speaker":"Charles Goldfarb","startTime":2417.1,"endTime":2422.04,"body":"resident, we were and Chris, you"},{"speaker":"Charles Goldfarb","startTime":2417.1,"endTime":2422.04,"body":"were in grade school. We were"},{"speaker":"Charles Goldfarb","startTime":2422.52,"endTime":2428.88,"body":"essentially witnessing a"},{"speaker":"Charles Goldfarb","startTime":2422.52,"endTime":2428.88,"body":"transformation from open rotator"},{"speaker":"Charles Goldfarb","startTime":2428.88,"endTime":2432.36,"body":"cuff repairs to many open"},{"speaker":"Charles Goldfarb","startTime":2428.88,"endTime":2432.36,"body":"rotator cuff repairs to all"},{"speaker":"Charles Goldfarb","startTime":2432.36,"endTime":2436.02,"body":"arthroscopic repairs. And that"},{"speaker":"Charles Goldfarb","startTime":2432.36,"endTime":2436.02,"body":"happened over a period of, I"},{"speaker":"Charles Goldfarb","startTime":2436.02,"endTime":2439.62,"body":"don't know how many years, six,"},{"speaker":"Charles Goldfarb","startTime":2436.02,"endTime":2439.62,"body":"810, years, and I would say"},{"speaker":"Charles Goldfarb","startTime":2439.62,"endTime":2444.8,"body":"we're in the midst of that for"},{"speaker":"Charles Goldfarb","startTime":2439.62,"endTime":2444.8,"body":"SL and Sandra is leading the"},{"speaker":"Charles Goldfarb","startTime":2444.8,"endTime":2448.16,"body":"way, certainly amongst"},{"speaker":"Charles Goldfarb","startTime":2444.8,"endTime":2448.16,"body":"Americans. I think we may be"},{"speaker":"Charles Goldfarb","startTime":2448.16,"endTime":2452.72,"body":"behind some of our international"},{"speaker":"Charles Goldfarb","startTime":2448.16,"endTime":2452.72,"body":"colleagues, but I think in 10"},{"speaker":"Charles Goldfarb","startTime":2452.72,"endTime":2457.52,"body":"years from now, the landscape is"},{"speaker":"Charles Goldfarb","startTime":2452.72,"endTime":2457.52,"body":"a look very different on how we"},{"speaker":"Charles Goldfarb","startTime":2457.52,"endTime":2461.08,"body":"approach these and you know, we"},{"speaker":"Charles Goldfarb","startTime":2457.52,"endTime":2461.08,"body":"have to do a lot of things. We"},{"speaker":"Charles Goldfarb","startTime":2461.08,"endTime":2463.96,"body":"have to communicate better on"},{"speaker":"Charles Goldfarb","startTime":2461.08,"endTime":2463.96,"body":"what we're doing to treat these"},{"speaker":"Charles Goldfarb","startTime":2463.96,"endTime":2468.04,"body":"arthroscopically. We have to"},{"speaker":"Charles Goldfarb","startTime":2463.96,"endTime":2468.04,"body":"really simplify techniques, and"},{"speaker":"Charles Goldfarb","startTime":2468.04,"endTime":2472.24,"body":"industry needs to partner with"},{"speaker":"Charles Goldfarb","startTime":2468.04,"endTime":2472.24,"body":"us to assist in that. And then"},{"speaker":"Charles Goldfarb","startTime":2472.24,"endTime":2475.18,"body":"we need to popularize these"},{"speaker":"Charles Goldfarb","startTime":2472.24,"endTime":2475.18,"body":"techniques. Because I do agree,"},{"speaker":"Charles Goldfarb","startTime":2475.36,"endTime":2478.48,"body":"there has been one big hammer,"},{"speaker":"Charles Goldfarb","startTime":2475.36,"endTime":2478.48,"body":"and I have been guilty, one big"},{"speaker":"Charles Goldfarb","startTime":2478.48,"endTime":2481.92,"body":"hammer to treat these injuries,"},{"speaker":"Charles Goldfarb","startTime":2478.48,"endTime":2481.92,"body":"and it needs to be much more"},{"speaker":"Charles Goldfarb","startTime":2481.92,"endTime":2482.88,"body":"refined than that."},{"speaker":"Chris Dy","startTime":2485.34,"endTime":2487.56,"body":"Thank you, both of"},{"speaker":"Chris Dy","startTime":2485.34,"endTime":2487.56,"body":"you. That was That was"},{"speaker":"Chris Dy","startTime":2487.56,"endTime":2491.22,"body":"fantastic. We I've learned a lot"},{"speaker":"Chris Dy","startTime":2487.56,"endTime":2491.22,"body":"on this episode, and I think"},{"speaker":"Chris Dy","startTime":2491.22,"endTime":2494.1,"body":"it's a really nice way to set"},{"speaker":"Chris Dy","startTime":2491.22,"endTime":2494.1,"body":"the stage for the young folks"},{"speaker":"Chris Dy","startTime":2494.1,"endTime":2498.48,"body":"who want to take this take this"},{"speaker":"Chris Dy","startTime":2494.1,"endTime":2498.48,"body":"charge and lead us forward. So"},{"speaker":"Chris Dy","startTime":2498.54,"endTime":2501.86,"body":"Sarge, always super fun to have"},{"speaker":"Chris Dy","startTime":2498.54,"endTime":2501.86,"body":"you on. I'm sure we'll get"},{"speaker":"Chris Dy","startTime":2501.86,"endTime":2504.92,"body":"listener feedback that we want"},{"speaker":"Chris Dy","startTime":2501.86,"endTime":2504.92,"body":"to have you on again. So thank"},{"speaker":"Chris Dy","startTime":2504.92,"endTime":2508.82,"body":"you for becoming our recurring"},{"speaker":"Chris Dy","startTime":2504.92,"endTime":2508.82,"body":"guest for arthroscopy and wrist"},{"speaker":"Chris Dy","startTime":2508.82,"endTime":2509.0,"body":"pain."},{"speaker":"Sanj Kakar","startTime":2510.38,"endTime":2512.36,"body":"Always a pleasure."},{"speaker":"Sanj Kakar","startTime":2510.38,"endTime":2512.36,"body":"Chuck and Chris, it's good to"},{"speaker":"Sanj Kakar","startTime":2512.36,"endTime":2516.26,"body":"see you, and I love spending"},{"speaker":"Sanj Kakar","startTime":2512.36,"endTime":2516.26,"body":"this time with you, and happy to"},{"speaker":"Sanj Kakar","startTime":2516.26,"endTime":2519.62,"body":"come back and talk more about"},{"speaker":"Sanj Kakar","startTime":2516.26,"endTime":2519.62,"body":"wrist and arthroscopy."},{"speaker":"Charles Goldfarb","startTime":2520.22,"endTime":2523.24,"body":"Awesome. Thank"},{"speaker":"Charles Goldfarb","startTime":2520.22,"endTime":2523.24,"body":"you so much. Hey, Chris, that"},{"speaker":"Charles Goldfarb","startTime":2523.24,"endTime":2525.16,"body":"was fun. Let's do it again real"},{"speaker":"Charles Goldfarb","startTime":2523.24,"endTime":2525.16,"body":"soon."},{"speaker":"Chris Dy","startTime":2525.7,"endTime":2527.86,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2525.7,"endTime":2527.86,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2527.86,"endTime":2530.26,"body":"suggestions and feedback. You"},{"speaker":"Chris Dy","startTime":2527.86,"endTime":2530.26,"body":"can reach us at hand"},{"speaker":"Chris Dy","startTime":2530.26,"endTime":2530.86,"body":"podcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2532.54,"endTime":2534.76,"body":"and remember"},{"speaker":"Charles Goldfarb","startTime":2532.54,"endTime":2534.76,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2534.76,"endTime":2536.38,"body":"get your podcast, and"},{"speaker":"Chris Dy","startTime":2536.38,"endTime":2538.96,"body":"be sure to leave a"},{"speaker":"Chris Dy","startTime":2536.38,"endTime":2538.96,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2538.96,"endTime":2539.38,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2540.1,"endTime":2542.1,"body":"Special,"},{"speaker":"Charles Goldfarb","startTime":2540.1,"endTime":2542.1,"body":"thanks to Peter Martin for the"},{"speaker":"Charles Goldfarb","startTime":2542.1,"endTime":2543.9,"body":"amazing music, and"},{"speaker":"Chris Dy","startTime":2543.9,"endTime":2546.06,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2543.9,"endTime":2546.06,"body":"upper hand. Come back next time"},{"speaker":"Chris Dy","startTime":2546.06,"endTime":2546.18,"body":"you"},{"speaker":"Charles Goldfarb","startTime":2564.14,"endTime":2566.12,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2564.14,"endTime":2566.12,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2566.12,"endTime":2566.78,"body":"real soon."},{"speaker":"Chris Dy","startTime":2567.26,"endTime":2569.42,"body":"Sounds good? Well, be"},{"speaker":"Chris Dy","startTime":2567.26,"endTime":2569.42,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2569.42,"endTime":2571.52,"body":"suggestions and feedback. You"},{"speaker":"Chris Dy","startTime":2569.42,"endTime":2571.52,"body":"can reach us. You."}]}