We appreciate the interest of Carifi and associates in our recent article. They have raised some excellent points regarding the limitations of our study, some of which we acknowledged in the article. Since our study was retrospective and included patient data from as far back as 15 years ago, some of the tools and instruments used in the study have subsequently been replaced in practice with more robust and accurate techniques. We have performed additional analysis of our data in hopes of addressing some of these concerns.

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