job. We have some time for questions. We do have some audience questions. As a reminder, feel free to text any questions that you might have. We'll start off with Dr. Freshman. With your Moon Instability cohort, really impressive work and another good great contribution to the literature and our understanding of shoulder instability. Dr. Preventer's experience with Hagle lesions demonstrated a difference in presentation between Hagle patients and non-Hagle patients, and he published those results back in 2017. Was there anything from this cohort that we can glean and sort of tease out from our history? Any differences between the Hagle versus non-Hagle patients in terms of mechanism of injury or history? Yeah, that's a good question. That is a good question. We did look a little bit at that. There was some data on sports played, sport at time of dislocation. We saw that if you did have a Hagle lesion that you were more likely, I think, to play tennis and lacrosse, but that didn't translate down to actually dislocating during playing those sports. And then another thing that's often talked about in the literature too is the, as we commonly say, you know, that arm is hyper abducted and externally rotated. So we tried to see if there was any data in chart review of some of these Hagle patients to look at if there was a difference in range of or shoulder position at the time of dislocation, but we didn't actually, weren't able to reach any conclusions from that because there was not enough information within the patient charts to actually figure out where, how they had positioned their arm when they when they came out. So unfortunately not a lot of differences there that we saw. Thank you. Next we have an audience question for Dr. Barrow. Based on your findings, is there a threshold distance to dislocation where you would add a REM plissage in your practice? Can you repeat that one more time? Based on your findings, is there a threshold distance to dislocation that you would add a REM plissage in your practice? I can't say that there's a threshold, but we've since gone back and look at the effect of REM plissage in on-track shoulders and there's definitely a protective nature to adding REM plissage, especially in contact athletes. So that's something that we need to work together to tease out, but yeah there is definitely a role for REM plissage in on-track shoulders. Dr. McRae, was there, we had an audience, a couple of audience questions related to this. Was there any difference in range of motion for the REM plissage patients in your cohort? We didn't actually track that at the medium-term follow-up. It was simply a phone call update. For the original study, I'd have to check, but I believe there was, I believe there was a difference in external range of motion in abduction, but that can be confirmed on our original paper, which was a 2021 publication. Okay, thank you. Okay, for Dr. Taylor, why not just aim for a hundred and ten percent glenoid width reconstruction? Well, I think that certainly from the biomechanical data that we showed that the hundred and one hundred and ten percent glenoid restoration improved the translation. However, you're certainly loading the graft less at a hundred and ten percent and so, you know, it kind of comes into play and is an unloaded graft potentially more susceptible to graft lysis and so, I think from a biomechanical standpoint, a hundred, hundred and ten percent is very reasonable. The ultimate effect on graft healing and potential lysis, we don't know. Okay, and lastly for Dr. Dunn, how would you implement this score into your practice? Well, I like the way that a mentor of mine, Jed Kuhn, thinks about this and he likes to describe it as demonstrable instability, meaning the patient can show it to you and volitional, meaning they want to show it to you and perhaps that's what Roe was getting at with that other group of their secondary gain or there's some behavioral characteristic associated with that that would portend a poor outcome. So, I think the way that this instrument could be used is if you have a patient with demonstrable instability and if it's not obvious to you just by your interview and your time with them, if you wanted to more classify them as that more classic volitional group that you think they'd be at risk and failing if you did surgery on them, I would administer the pass in that group of patients that can demonstrate it, hoping that it might help me identify that subgroup of people that are definitely at higher risk of failure. I think in the interest of time, we'll move on to the next portion of this session. Thanks to all the authors and presenters.

shoulder instability

Hagle lesions

REM plissage

glenoid width reconstruction

score implementation