Thank you to all the authors for staying right on time. We have five minutes for Q&A. If you do have questions, please submit them through the app. Dr. Lamplot, let's start with you. Can you comment on the activity level of those patients who had the radiographic loss of reduction? Were they overhead athletes? Were you able to quantify, when you said there was no difference, what were they doing pre and what were they doing post? It was a mix. As far as overhead athletes, there were no more than a few in that age group, or in that participation group. It did take us 10 years to enroll all the patients in that study with about eight surgeons, so it was a very heterogeneous group, so I unfortunately can't make many conclusions based on that. And then the other question related to that is, what was their radiographic loss of reduction specifically? So in other words, did they go from type 3s pre-op to type 2s? Is that what we're saying? So we had, it was 25% or more, so it was quite sensitive to loss of reduction. So in every case, it was no more than 50% loss of reduction. So the last question I'll ask you to tease you a little bit is then, what is the indication for surgery for a non-type 5, since you had a third of the patients were about type 3s, if we operated and it failed and they did well, why did we operate? That's a great question. That's why I asked it. If you have an irreducible dislocation, and as I said, most of these were in the chronic setting. They were at seven months on average, so these patients have declared themselves as failing non-operative treatment at seven months. If they have an irreducible AC dislocation and they've undergone a conservative course for at least four to six months, I think it's an appropriate indication for treatment. Great. Thank you. Dr. Anderson, we'll go down the line. Great study. Can you comment on the numbers? I don't know if you were able to do this, but with posterior instability, those patients often have a level of glenoid hypoplasia or dysplasia with a compensatory labral hypertrophy often and are more likely to get posterior labral tears. So they're a little different, right, than our anterior. So can you comment at all with this series? Were you able to identify what the glenoid morphology and or pathology was? Thank you for that question. I don't have that information from our database, but I think that just most of these patients were reviewed by fellowship-trained surgeons within the military healthcare system, but they didn't document that in their review. So we would have to go back and look at those imaging. So we could obtain that, but it would have to be reviewing the data again. All right. Do you have that for the paper, for the final manuscript, will you have the opportunity to look at that, or is that not possible to get because it's just a registry review of the other data, but not the radiographic data? Yes, sir. It would be potential data that we could obtain. Because it's a small enough group, I would suggest if you can, it will dramatically strengthen your paper when you submit it. Thank you. Any other discussion? Dr. Haber, congratulations on presenting the only paper that's already been published. So I guess if we can't criticize it too much since it's already been published. So good job. But my question to you, and obviously we're going to hear from Peter in a minute, but I'm going to ask, you're finished his fellowship or you're there now? Finished the fellowship. I'm 10 months into practice. Oh, congratulations. Thank you. So you're 10 months into practice. Have you performed a CAM procedure independently now that you aren't under the incredible tutelage of Dr. Millett? I have one in all of 10 months of practice. And what I'd like you to share, and this is really important for us because we have the creator of an incredible operation. You've demonstrated phenomenal results, but it hasn't necessarily been reproduced and it's not something that everyone... So as you spent a year now and 10 months, I guess what I'd like you to share is if there are... Do you think there's a key factor of the CAM procedure that is more important than others because there's so many parts of it, some of them more risky for the average shoulder surgeon and some less. So do you think, have you taken away from it? Is there a key factor that you would say these are the two things if you don't necessarily want to see the nerve every time or are all of the parts impossible to separate out? Yeah, that's a great question. And of course I'll defer to Dr. Millett to probably address that further, but my impression is that the humeral osteoplasty I think is a very key important part of this procedure. There's been several papers published on arthroscopic treatment of arthritis in the shoulder. However, I believe that this is one of the only that specifically includes that. And as a result, I think the outcomes are far better than what we've seen with other sets of arthroscopic procedures. I think also when you take down that large osteophyte, it also removes the impingement on the axillary nerve. And then when you further free that up from the soft tissue adhesions there, I believe also that's an essential part that provides the patient pain relief. Thanks very much. Dr. Grogan has the final question. Yes, we have an audience write-in question here. So they're wanting to know what was the actual age distribution in the clavicle study? So a 10-year-old and an 18-year-old are actually quite different. And also, do you have data on early pain and function? Because in this questioner's experience, that's the primary benefit of fixation, which is feeling better sooner. Yeah, thanks for the question. So the age distribution, there's no doubt there's a difference in adolescence as defined by the World Health Organization. This study was really 14 to 18. In our study, the patients were evenly divided and equal in both cohorts. So as far as the age, there was no difference, and it was all 14 to 18. And Dr. Spence, just one final follow-up as we finish up this great session is, were you able to measure the final shortening on the healed non-operative group relative to where they started? And did that play any role in, or is that another question we can ask moving forward? Yeah, no, I think that is another question. In fact, we've got another study looking at that. Starting shortening after remodeling is a surprisingly hard thing to do, as you know. And so really getting adequate number of chest x-ray or comparison films, I think, is necessary. We have a separate cohort that we're looking at that, but that was not part of this study. Round of applause for these four great papers. Thanks so much.

Q&A session

medical topics

activity level

radiographic loss of reduction

glenoid morphology