Thank you, Steve. We have a few minutes for Q&A after this session. If you have any questions, you can come to the microphone, or you can submit it. First question here in front. Michael Ruther from Connecticut Orthopedics. Dr. Moore, I'm interested in your gymnastics setting, because I see a fair amount of gymnasts and who have had to do UCL reconstruction. I always agonize in terms of their return to sport, because there's few other athletes that are weight-bearing on their upper extremity. So what was your experience in terms of how you let them get back to participate? There was no change in the general protocol from the baseball players as far as their general return. It was a standard UCL post-op course. At what point in time do you let them actually bear weight, start doing planks, start doing things that are weight-bearing? Because that's not part of the usual baseball protocol. At what time frame? When they were asymptomatic. So at about the same time that they would start their throwing program for a baseball player? I'm not sure about that. Okay. Yeah, so I think that's the big question, because if you start doing back handsprings, which is a lot of where they've gotten injured to start off with, and the question is, you know, when do you let them start to do that? One of the things we've done is let them start doing, like, wall handstands to start strengthening there as well, but it still doesn't duplicate the load of that. So it's still a question, then. Taylor, just to follow up with that, in these athletes, did you see a particular pattern of injury? Were these mostly acute tears, or were these acute on chronic, or did these athletes have chronic ligament pathology? And are the tears more typically proximal, distal avulsions, or mid-substance? They were definitely acute tears. Eight of the nine were during a traumatic event, traumatic gymnastics injury. The spread between proximal and distal was pretty equal, with only one mid-substance. And I think in your series, there was only a couple that were treated with internal brace, so you can't really comment on primary repair versus reconstruction? Correct. John Conley. So, Taylor, your paper's great. I do a lot of gymnastics. We see a lot of both high-grade pronation, valgus, hyperextension injury, and dislocation. Everything from level eight, usually, up to our national team. In fact, I'm operating on one of our national team members when I get back. And we pretty much have 100% get back, and most of them are back complete by seven months. But we have a completely different approach to it than what you've described, and I thought in answer to his question, I'll describe that. Our protocol for return is, we'll let them do planks, push-ups, handstands, press-up to handstands, starting at about eight to ten weeks. And we actually put them on a trampoline, and let them do all sorts of other things. All their non-hand-down skills on the beam, immediately. We have them in the gym doing everything that's a non-hand-down skill, initially. And one of the things that's really important in managing gymnasts is whether or not it's their dominant arm. Is there a right-hand tumbler or a left-hand tumbler? I hear you commenting on that. Are they a right-hand pirouette? Are they right-hand blind change? And what's their vault entry? Does all those things affect the load on that particular elbow that you're trying to do? The other things that matter are whether or not they've been trained to be parallel or T when they tumble, because the more rotated out, the higher their valgus carrying angle. And so we look at all those things when we try to get them. We let them start to tumble in the tumble track if it's their non-dominant arm. Just as soon as they can do it, say it's their right arm, they can do a left-hand round-off to something that's laid out. We don't have a problem, because they're not putting their hand down. They can do that very early. If it's their dominant arm, they have to be able to do planks, push-ups, handstands, press-up handstands with strength and demonstrate that they've got trunk, scapula, shoulder strength enough to manage that before we let them start to tumble. So we have a protocol that we follow for all that. And from the standpoint of bar skills, they can start to hang, do pull-ups, do core work, toe-to-bar, and then start to do tap swings as soon as on a progression, but it usually starts in the 10 to 12-week timeline. We have a really regimented protocol we follow. Most of all of them are doing everything in the gym except for overshoots and vault by five months, and usually by six months they have unrestricted skills. And most of them will say it takes seven to eight months to really feel like they can do all their skills unrestricted. So there's a guideline for you. Thanks, John. In the interest of time, we need to move on. Again, Neil's session's been moved back to the end, so Jeff, you guys don't have to come up yet, because Neil's session's moved back to the end. So we're going to go on with the next three papers, and Luke, my co-moderator, is going to take over.

UCL reconstruction

gymnasts

return to sport protocol

weight-bearing activities

acute tears