Well, thanks so much for having me and thanks Julie. I'd like to acknowledge our co-authors as well. So disclosure not relevant to this study. So we all know that recurrent instability following arthroscopic vanguard remains a problem. I think we're all well aware of the risk factors associated with this. And our European colleagues have long told us that we should be doing latter days on these good long-term follow-up, low occurrence for primary instability, critical, subcritical glenoid bone loss scenarios. But I also think we also know the limitations of Latter-day which is higher, you know, known high rates of complications, large variations in coracoid sides which may be unpredictable to be able to restore glenoid. And then Emilio Calvo has also demonstrated to us that 12% of these following Latter-day can have persistent off-track lesions and this could be associated with increased risk of failure. We've been expanding the glenoid track concept to include more of a continuous concept and we described something called distance to dislocation as a measure of how far an on-track lesion is from being off-track. We know how to make a glenoid track equation scenario where you take the Hill-Sacks interval and subtract it from a glenoid tract. So by definition a DTD less than zero is off-track, an on-track lesion is DTD greater than zero and a high-risk lesion is a DTD between zero to 10 milliliter called near-track and this is a strong predictor for failure following the arthroscopic bank card alone. And so the study objective, our aim is to determine if DTD is a predictor of recurrent dislocation and return to support after open Latter-day and we hypothesize that a lower DTD value or a more off-track lesion will correlate with higher failure rates and lower rates of return to support following an open Latter-day reconstruction. As a retrospect analysis, all consecutive patients over an eight-year period, two fellowship trained surgeons as a young cohort, underwent primary Latter-day with an organized athletics with a minimum of two-year follow-up and we excluded patients with connective tissue disorder and seizure disorder. Our primary outcome was post-operative failure which we defined as recurrent instability, either recurrent dislocation or subjective instability and the secondary outcome is return to support within one year after the index operation. We had 75 patients meeting the inclusion criteria of which 23 are excluded due to seizure disorder or insufficient follow-up. That less of 52 patients, primarily male, average age of 23 years old and average follow-up was almost five years. So we look at recurrent instability, 7% sustained recurrent dislocation, about 9.6% recurrent subjective instability and our Kaplan-Meier survival plot demonstrate about 80 to 90% survival at five years. Univariate predictors of recurrent dislocation including Hill-Sachs interval size, percent glenoid bone loss and DTD. Now if you look at the graph, there's a heat map looking at both DTD and glenoid bone loss. As the glenoid bone loss increase, that increases your risk of recurrent instability but this is compounded by the fact if you have more off-track lesions, this will increase your risk of recurrence. Multivariate analysis essentially demonstrates an entire cohort and if you look at subset analysis of off-track patients and critical bone loss patients which is defined as greater than 15%, that DTD is actually a stronger predictor of recurrent instability than the percentage bone loss. And if you adjust for the percentage glenoid bone loss, which with each one membrane increase in distance to dislocation, which is to say more on-track, this correspond to roughly a 30% reduction in the rate of recurrent instability. Secondary surgery, about five patients underwent subsequent re-operation. In our cohort, 60% of our patients returned to sport. We were unable to find a predictive return to clearance based on this study. So distance to dislocation or DTD is a strong prognostic predictor of recurrent instability following a primary open lattice. Lower DTD values or more off-track lesions predicted higher failure rates even after adjusting for the percent glenoid bone loss and DTD was not predictive of return to sport. So future studies investigating other contributors to that may be necessary in a larger sample size. So in conclusion, DTD may be a more effective prognostic indicator for recurrent instability following a lattice than percent of glenoid bone loss. And this suggests that the amount of glenoid tract correction with the lattice may influence the outcomes. So persistent off-track or near-track lesions may require a different approach. And we believe the findings of the study may influence your decision-making and the patient selection criteria for lattice. Thank you very much.

recurrent instability

Latarjet procedure

distance to dislocation

return to sport

off-track lesions