So, it looks like we have about five minutes for questions, so feel free if anybody has a question. There are a couple of questions from the audience in the polling here, and I'll start off with those. First, to Dr. Meyers, this was a question I had and kind of came out of the audience as well. In your cohort, which is a very compelling study, I congratulate you on that large cohort, do you have an idea of what the breakdown is in kind of the general denominator of whether the players were generally using deadness-fitted or self-fitting? It seemed like in the injured series it was a split between the two, but in the general group of players, number one, and then secondly, were you able to get a sense of how this is reported? Were the players being honest? Was this the athletic trainers reporting, or could the players just switch out and be using their own mouthpiece, and how did you account for that? I think it should be on. It should be on. No? Want to jump up to the podium? Let me try the podium. Typically with this group, this has been an ongoing database since 2006, and so our trainers, some of our trainers have been involved with this extensively for 14, 15, 16 years, so we really have had fantastic compliance. As you well know, any athlete is going to sit there and try to, in order to keep their spot, they're going to try to avoid anybody on the sidelines when they get their bell rung, but typically we've had good response, and we again constantly double-check and follow through as far as we can before the athletic trainer says, I can't go any further, now it's up to the hospital. I think what we found as far as wear and tear when we asked, it's about a 60-40 self-fitted to dental-fitted profile, which is actually extremely good compared to the high school and youth level, obviously, and part of it is due to the cost. Yeah. That's great. Thank you. Thank you. G, do you have another question for? I have a question for Dr. Gardner. I saw that you started your collection period for your obstetrics and gynecology injuries about 90 days after. Most players are coming back to concussion maybe one week, two weeks, three weeks. Why wait so long? Can you talk to us about why you chose that 90-day delay, and actually, did you look at the injuries in that 90-day period to see if they were significantly higher? Yeah, no, that's a really important question for our study. The reason that I chose to push out the collection period was a lot of the research on this topic shows that this may be a very long-lasting or possibly permanent change in an athlete's risk for injury, and I wanted to exclude athletes who may be at higher risk in a more acute period right after the concussion, really look at, do they have a long-lasting change? I would have loved to have looked at, you know, in collegiate athletes, there's a pretty short period that we can study the athletes, but, you know, if you looked two, three years out from their concussion, is there still a change in the injury risk? So that's why I chose that, the delay. Why 90 days? To be honest, it was somewhat arbitrary. When we looked at our data, I wanted to include as many athletes as possible, and that was pretty inclusive of athletes varying on their return to play, but, yeah, it was really to look at if this phenomenon is a chronic thing that is going to be seen for a long period after the concussion as opposed to something that happens right after they return to play. They've been, you know, out of play for two or three weeks. They recently had a concussion. That may, in itself, you know, the period right after concussion from rehabilitating impact their injury risk. So that was the explanation there. And just a follow-up question on that is the control group was the individual athlete the year before. Did you look at kind of the overall incidence of upper extremity injuries in the non-concussed athletes so you could compare them? So unfortunately, it was challenging with our data set. We had data from athletes that either had concussion or neck injury or upper extremity injury. So if they were in our data set and they didn't have a concussion, i.e., the control group, then 100% of them had an upper extremity injury. And so we weren't able to really look at a good control group, which is certainly a limitation of our study. Gee, I'm going to put Ryan on the spot here. You're new to this field, but anything from your data that compels you, it seemed like a chronic versus an acute management of these injuries, type 3, type 5, they all kind of do the same. Is there any reason to be managing these injuries acutely from your data? Or it seemed like your description of these type 3s that were managed acutely were these type 3s where there was horizontal instability, which can oftentimes be difficult to assess. Did you or your co-authors take any take-home points there that there's any group that we should be managing acutely, or are these all okay managing chronically? So based on our findings, you saw a lot of demographic differences. So that made making drawn conclusions kind of difficult. But the multivariate regression showed that timing itself might not be the problem. But as for a group where acute may be more recommended, the tables where we compared group 3 only, group 5 only, even though we didn't control for confounders, those are the current indications that were used from 2010 to 2019. And even though AC joint surgeries, many techniques are evolving, based on that decade, it does seem like doing acute for grade 3 injuries would be pretty helpful, because I think SANE scores differed by about 20 points, which is pretty drastic. Yeah. Pretty controversial topic, so nice job exploring it. Yeah, I think we'll move on to the next session here, which is thank you guys for your papers and presenting here.

Q&A session

self-fitted mouthpieces

obstetrics and gynecology injuries

acute management

grade 3 injuries