All right, we have time for a few questions, if anyone wants to come up to the microphone. I'll ask a question to Dr. Rao while we're waiting. You said that you had returned a play system or a particular criteria that you guys followed. Can you expand on that a little bit? You're referring to how we determined what they returned to play? Yeah, the custom return to play questionnaire. Oh, that was just a set of questions that we asked them for the questionnaire. It was nothing specific necessarily. The way we defined return to play was the first game in which they returned to the competitive regular season. Yeah. All right, we'll go to the microphone first. Sam, it's working? Oh, there it goes. In your players, Dr. Andrews talked about Morgan with the GERD, I'm a big GERD endorser and sometimes that is a major problem in a lot of these throwers. Do you know what the percentage of athletes in your study had the GERD pre-op and post-op? No. Unfortunately, we don't. We probably could look it up, but I don't have- Yeah. I mean, that might be good to see what ... Again, why are they getting the slap lesion in this? The young ... The weed pulling technique, maybe it's not the cause of it. Maybe it's someone else. Okay? Sure. Sure, sure. Dr. Andrews, thanks for a great talk and it's always interesting to hear the history and circle back on how we got to where we are now. Can you comment on your current thoughts about anterior plication and where it stands or is there a role in slap surgery for retentioning the anterior capsule? Is that something you still ever do? We were first introduced to what we call micro-instability in throwers in external rotation by Dr. Jobe and we still think about that and it actually plays a big role. You have to have some micro-instability to be able to reach back there and throw, though. In those cases where we see what we call micro-instability, whether it's labral pathology, partial detachment of the middle human ligament, we will do a plication or repair of that particular part of the front of the shoulder. We don't like to do much to the front of the shoulder, though, because if you make them too tight, they're not going to play. So you err on the loose side in a baseball thrower. But the role, the actual role of micro-instability is still very difficult to figure out. They don't tell you that the shoulder comes out of place. They don't complain of instability. They complain of pain on the back side of their shoulder when they try to reach back and throw hard during the early phases of acceleration. So to determine instability in a baseball thrower, it's somewhat difficult. Dr. McDonald? That was a wonderful lecture by Dr. Andrews. Just a question on age. Do you treat the 30-year-old baseball player the same or the thrower the same as a 20-year-old? Like a lot of surgeons will use age as a criteria on what to do if you have to operate. What do you say? Well the biggest problem I have is that high school group. Number one, you don't know whether they're going to be baseball players or not. And if you look at his results, they only went a couple more years and were out of baseball, period. Which is maybe not unusual for that group without an injury. So I'm real slow at operating on the young high school kids. Believe me, the problem I see is that you've got a kid 14 years old that's being abused in youth baseball, he has first-time shoulder pain, the parents are all up in air about it, they take him to a doctor, they do an MRI and they say he's got a slap tear and he wants to operate on him right away with no conservative treatment or whether it's the real problem or not. But you need to stay away from young kids with surgery. I can tell you we did a study at Andrews Sports Medicine in Birmingham where we looked at kids that had slap repairs when they were in the ninth and tenth grade versus the eleventh and twelfth grade. And what we showed was that the kids that were operated on young in the ninth and tenth grade had a five times less chance of playing baseball in college compared to those ones that we operated on in the eleventh and twelfth grade. So don't look for great results, and I think your study showed that. It was perfect. Thanks. Dr. Mirabella. Hi. I was just wondering, if you have somebody with, they lack internal rotation and you can't get it and they have a slap tear, and you fix the slap tear, do you do a release of the posterior inferior capsule? About maybe five to ten percent of the time. Particularly if they've got a throrax exostosis, I'll take all that down. And that's another debate, too. If on exam they're still at neutral, you just, especially if they're still at neutral when you examine them under anesthesia, you just don't worry about it. Because I'm always worried, then they're going to do the same thing and it's going to start all over if they can't get the rotation. You've got to make me take it down. I just don't know. I worry about that, though. Can't come back from it. You know, we go more on overall total arc loss than we do what loss you have with internal rotation. And we follow the advice of Kevin Wilt with that. But it's very seldom do we actually release that posterior inferior capsule. I've done it. And as a matter of fact, I can't remember right now in the last six months whether I've even done one like that. Most of the time you can get that resolved in your conservative treatment protocol. And you don't, when you get to surgery, it should have already been treated and perhaps a kid doesn't need surgery. Thanks. Before we have anybody stir up more questions for Dr. Andrews, I'm going to ask Dr. Barrett a question. Were there any concerns of fracture? And what were the size of the holes that you drilled in the proximal hole? So were there any concerns? What was the size of the hole? And did you offset the two holes to help prevent fracture? Right. Yes, sir. The majority of our holes are about 5 to 5.5 millimeters. Sometimes bigger guys can be about 6 millimeters. But typically it's 5 to 5.5, some of them even 4.5. Our smaller hole is 2.4. So it typically doesn't get into that range, which has been shown to be concurrent with fractures like that 8 millimeter plus. All right. We'll move on. Dr. Peter McDonald.

sports-related injuries

baseball players

criteria for players to return to play

prevalence of GERD in athletes

micro-instability in shoulder injuries