You know I've thought endlessly about this and in fact spoke closely with the author who reported the 41% because I was expecting him to say did you give it up and he said are you crazy some of my best results are ACL repairs and I have to agree that there are some unbelievable home runs that you take the morbidity of the procedure out the window and we all know how hard it is to get these adolescents and teenagers through these reconstructive procedures so I can't say to you that I've given it up but I have tightened my indications understand that the 37% is part of the first 113 which was the first 113 I did so I do believe there's some learning curve in there and so I've tightened the indications a lot and I do believe deep down that there isn't there is some portion of this that could include an ALL or a lateral sided procedure I'm not sure the answer I will keep reporting back to you what I find and I do think that you know chefs that don't come up with the recipe the great recipe by opening the book and reading it and making that you know all of us are kind of learning as we go with our each individual practices and I believe there's a lot that we can all learn and share to make it all better and hopefully ACL will find the niche and the right technique for ACL repair that it'll play Ted I appreciate you guys sharing the rock data and congratulations on all the good work you're doing my question had to do really with selection criteria for surgery in these stable OCD and if you could kind of just address what that is and what why there was not a non-operative group because you talked a little bit about that early on but so we're still gathering data on non-operative treatment which includes unloader bracing in that group so that the criteria for this was stable intact OCD lesions strictly on the lateral aspect of the medial femoral condyle that had failed non-operative measures so we're looking at the non-operative treatment of those separately so this was the gold for this was just strictly compare the surgical techniques I had a question for dr. free hill have not seen this protocol used elsewhere in high school college professional or Japan do you foresee that this technique could be used in other areas it sounds like this is a trial and do you have a goal to validate that on the flexor pronator mass as well thanks for your question you know that's obviously a limitation is it hasn't been validated yet it's been validated in the lower extremity so yes the plan is to do that and then as far as again it's it's this is just to try to really get down to better science and take it all the way to the baby steps there's no there's no scientific validity for those pitch counts and we don't even know if it's pitch count or throw count or intensity of throws is a kid that's really musculoskeletally mature and twice as much in weight as another kid is his pet should his throw counter pitch count be the same so it's really just trying to get very granular and starting with baby steps and then build from there and I will ask one question through the app it's for dr. Westerman do you think cam morphology is an overgrowth issue or possibly a feisal rest issue resulting in deformation with continued growth based on a sequential MRI video that was shown I I think it's the feises under stress just like with the Osgood Schlatter's I think a feises under stress can continue to grow and I think it's like an Osgood Schlatter's of the anterolateral femoral head neck junction where the feises is stressed it stays open it grows down the femoral neck and it creates a bump of bone I actually thought about trying to get a student to look at a registry to see if there's any correlation with Osgood Schlatter's and and having a hip scope but I don't know the probably a pretty messy not really publishable study but I think it's a similar phenomenon and where the growth plate is stressed it stays open and it grows down the neck and then it grows grows the extra bone this question is for dr. Tannehill sorry dr. Freo the question is how were you able to look at the glycogen in the flexor pronator mass without getting a biopsy or and also second question is do you think the flexor pronator mass fatigues first and UCL tears or is it the other way around or the UCL tears first and then the flexor pronator mass fatigues yes so good questions again that you know taking that muscle sound technology we're taking a little liberty the studies with the rectus and the vastus lateralis have been done and they've been done with biopsies it would have been hard to get that through an IRB with the kids I think at this point so their studies have correlated what's you know what's the ecogenicity what's water what's edema and how that relates to glycogen stores so we're taking some liberties there based on what's in the literature the second question is a great one too I do think that grips of balls and the older people or older athletes different grips take on different amounts of fatigue at the pronator right at the mass at the wad and the question is do you get to a point where the fatigue is enough that it's not protecting the UCL and is that attenuate with time does it accumulate over a season can it accumulate over one game maybe I don't know I doubt it I think it's an accumulation thing so I just think that it sees more and more micro damage and at some point the threshold is reached all right I think in the interest of time and not running behind I'm gonna finish our Q&A thank you to all of our speakers

ACL repairs

success rates

adolescents

cam morphology

UCL tears