Our next paper, Return to Play Following a Latter-day Procedure in Young Contact Athletes by Dr. Shurharan. Hi, good morning everyone. I'm Mawthangi. I'm a PGY-1 at UCLA and this is research that was done when I was a medical student at Ohio State. We examined return to play following Latter-day Procedure in Contact Athletes. We have nothing to disclose. Some background here. As most everyone here is very familiar, anterior glenohumeral instability is pretty common in contact athletes, especially common in younger contact athletes. It's of high concern because there are high rates of recurrence with non-operative management, high rates of recurrence in some series after an arthroscopic bank art repair as well. So definitely an area to look into in how we can stop the progression and recurrence of instability. Some risk factors for recurrence include glenoid bone loss greater than 14%, duration of instability greater than three months, heel sacks volume greater than 1.3 centimeters, contact sports and again age under 20. And I think this in some kind of defined the population that we wanted to look at in this study which was young athletes that played a particular contact sport. The procedure we looked at, the Latter-day Procedure, it has higher rates of stability than an arthroscopic bank art repair. It involves taking part of the coracoid process and transferring it to the glenoid to provide some more stability to the shoulder. This is an area of innovation and specifically kind of looking at when it's indicated. The bone loss threshold specifically used to be around 25%, but that's decreased in recent years. So the purpose of this study was to evaluate outcomes and return to play in contact athletes that underwent open Latter-day for anterior shoulder instability. The inclusion criteria, the overall cohort was Latter-day Procedures performed between 2018-2022 at one institution, patients with age less than 35 and playing a contact sport at the time of injury. We excluded those with history of seizure or use of allograft during this procedure and this was a retrospective study. We also attempted to contact everyone that was included in this study to form a smaller cohort of patients that were interviewed by phone for a longer follow-up. So overall we had 67 patients and 72 shoulders that was included in the study period. And of those patients, we were able to contact and talk to 46 patients, which was 51 shoulders, about 70% of the cohort, and we caught them on average two years after surgery. The mean age of the cohort was relatively young, around 19 years. And for three-fourths of the cohort, Latter-day was the primary stabilization procedure. These could indicate multiple contact sports that they played at the time of surgery, but the most common were, unsurprisingly, football, followed by basketball and wrestling. And then I went ahead a little bit, but most of the cohort were collegiate or high school athletes and we did not have any professional athletes, though some patients returned to play and then ended up going into the professional level. When we looked at the six-month chart review of the entire cohort, we had a very low complication rate, one hardware failure, one hematoma, and one recurrent instability after a traumatic fall of those to return to the OR for another procedure. In the 46 patients that were reached by phone, recurrent instability was also relatively low. Four patients had subjective instability and one patient had frank instability. None of those four patients returned to play. We had a very high return to play rate. About 75% of the cohort that was interviewed did return to play. Of those, a majority returned to playing the same sport that they were playing at the time of injury at the same level. Of those that did not return to play, the reasons were multifactorial. Most commonly a lot of them aged out by the time that they were recovered from the surgery. Another common reason was fear of further injury as well. It only had one recurrent instability and that was discussed earlier that did return to the OR for his further stabilization procedure. I think this was a very important data point for me seeing that nearly 93% of patients that underwent Ladder J reported a strong improvement in their quality of life. In sum total, we had a high return to play rate following open Ladder J study and a multifactorial reasons for why these young contact athletes wouldn't return to play after the surgery. The quality of life improvement was significant and high throughout the cohort and many returned to playing at the same level. There was also a relatively low re-operation and complication rate. We did have several limitations. This was a retrospective study with short follow-up and the Ladder Js, it's growing in utilization but we did end up having a relatively low sample size of about 46 patients that were interviewed for two-year follow-up. Because of this, we were underpowered at this time to determine factors associated with return to play. We did not evaluate preoperative bone loss and didn't look at long-term x-ray follow-up but hopefully we'll be able to address these in the future. Thank you.

Return to Play

Latter-day Procedure

Young Contact Athletes

Anterior Glenohumeral Instability

Shoulder Stability