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Yeah, good evening everyone. I just uh waiting one minute for Mr has to join us. Yeah, I within up is that how they can find it? Uh He uh Mister has is with us or he is uh not joining yet. Unfortunately, he, he, he didn't join yet. Uh Hopefully he will join. Uh I messaged him just waiting to join us. He was just speaking to me on the whatsapp. I think he's ready to join. OK. Waiting for him. Sam is uh with us. Uh uh our uh papers today will be presented by me and uh our colleague, our colleague, Romi. Yeah, nice to meet you, sir. Nice to meet you. Yeah, from Friendly Park or from uh where me, I'm working at a hospital. Yeah. And also we are working toge together in the same trust. Yeah, the most active trust. It's located in the middle of UK or, or more. Yes, Midlands. Yeah, I think mister has joined us and look up and look in. I good. Let's start. Totally, totally fine. It's a great chance for me and a great honor to announce for the I think the fourth uh uh specialty day. Uh doctor. Yes, yes. The uh representing the cooperation between the Egyptian orthopedic ashes and the orthoped and uh II, it's of my fortunate and my uh big, big chance to, to meet uh my dear colleagues and my dear friends from uh UK uh tonight in representing and presenting to, representing the Ortho and presenting to uh uh paper in the upper limb. Uh Professor Hashem. Thank you so much uh Doctor Hashim for uh your great effort in uh preparing such uh uh and uh very, very fruitful and uh very uh eminent scientific uh presentation regarding the specialty days. Thank you so much. Uh Mister Hashem for this Journal club, please, sir. Uh pleasure, Professor Ham. And uh good evening everyone. So welcome to our month City Journal Club uh between um EA and be and today Rami and uh Mo will be taking us through two em and papers in the upper limb. So we'll start firstly with uh by Mo. Yeah. Yeah. Good. OK. So ca can you hear your screen and start at the present, please? Can you see my screen now? Mister? Yes, it's on. Yeah, good evening everyone. Uh My name is Mohamed Specialist doctor at hospital. It's my pleasure today to present um our first paper, upper limb. It's about effectiveness of open versus arthroscopic rotator cuff repair. This randomized controlled trial rotator cuff tears are a very common source of shoulder pain and decreased motion in uni in, in United states, more than 300,000 rotator cuff repairs are performed annually at a cost of about 3 billion, representing 2.24 of O GB consultation mid the year at UK, 28% of population have a full thickness tear at age older than 60 while 65 a patient above 70 have full sickness. There a sixfold increase in arthroscopic repairs compared with 34% increase in open repairs. There is no consensus on the best method of treatment versus operative versus non operative ed. The slides not moving. What? Moving? She had the holy Yeah, you can see my screen now. You can see my screen, Mister Ham. Yeah. Yes. Our, our report today about the effectiveness of open versus arthroscopic rotator cuff repair is Pragmatic Multicenter parallel group comparative randomized controlled trial involved with 19 centers in the UK, between November 2007 and December 2012 published in Zoon and Joint Journal. In 2017, the study involved with 273 patients were randomly allocated to either arthroscopic repair versus open repair surgeon. Had to perform a minimum of five rotator cuff repairs every year to be eligible to take part in the trial. The study started with three limbs, non operative versus open versus arthroscopic repair but changed in 2009 to Tim Tim is only open versus after COVID due to high crossover to operative management. Smaller changes have been made to the protocol over time to reflect the changes in the points of outcome, data collection and recruitment procedures, randomization. The study was triple blinded patient allocation, assessor and analyst. The patient were randomly allocated to the group using computer software. The surgeon allocation didn't clearly state how and when the surgeon would know the plan plan surgery, the assessor independent consultant, radiologist, blind to the