So thank you to Dr. Posby and Dr. O'Brien for this tremendous opportunity. I'm excited to be here and to demonstrate why arthroscopic bank card repair is clearly the way in this 17-year-old baseball pitcher. So you've heard the first part of this debate and I would just encourage all of you not to be enamored by Dr. Murthy's smooth words and good looks, and that by the end I think you're all going to be celebrating with me after an unequivocal knockout. These are my- It's always easier to go last. It's always easier to go last. Disclosures, none of which are directly relevant to this talk. So shoulder instability is a problem that we face commonly in our athletes, especially male collision athletes. The incidence range is anywhere from 8 to 25 per 100,000 person years and it's much higher in our athletes. Recurrence rate also is high, upwards of 88% with the majority of redislocations occurring within the first year of dislocation. In terms of shoulder instability in baseball, it's rare compared to other contact sports like football and hockey, but mechanisms like collision and sliding toward base do increase the risk of dislocation in these athletes. There's a lot of evidence in the literature to support huge efficacy of Bankart repair after a first-time dislocation. So here we see only 9.7% risk of recurrent instability in the Bankart repair group compared to those treated conservatively, a very low risk of subsequent stabilization procedure as well, and then certainly return to play is a high priority for us and our patients. 93% of patients undergoing Bankart repair were able to return to play. The main conclusion from this, very important, those that underwent Bankart repair had a seven-fold lower recurrence rate compared to those treated conservatively for a first-time anterior shoulder dislocation and there was a significantly higher rate of return to play. So that tells us for our 17-year-old pitcher here, it is definitely advisable to perform an arthroscopic Bankart repair for him. This was a great paper at JSCS 2019. They looked at pitchers, catchers, and infielders. The range of return to play was anywhere from seven to nine months depending on the position played. Overall return to play rate was about 64% for pitchers, up to 90% for our infielders, and so again return to play after Bankart shows favorable results, but non-throwing shoulder and infield position overall yielded the best results. And then what about overhead versus non-overhead athletes in general? Overhead athletes are more likely to present with subluxation as opposed to frank dislocation in our non-overhead athletes. The number of instability events, however, tends to be similar at the time of presentation and those overhead athletes are more likely to undergo initial operative management. There's no significant difference in the rate of recurrent instability post-op and then rate of return to play does vary depending on the type of sport. So about 80% for our non-overhead athletes, 70% for overhead, and about 64% for our throwers. This also is a very good study by the Moon Shoulder Instability Consortium 2019. 49 athletes, they had 49 athletes, 23 of whom played baseball. All of them underwent arthroscopic Bankart repair. 63% were able to return to play as of two-year follow-up. About 45% returned to their previous level of play and only two patients or 4% underwent revision stabilization. Age, sex, baseline level of competition were not predictive of return to sport and there was no difference in range of motion or WOSI scores. So primary arthroscopic anterior stabilization in these overhead athletes is associated with a low rate of recurrent stabilization surgery and then when looking at overhead athletes, it's certainly returned or short-term follow-up return to play is lower than previously reported for general athletic population. So in summary, shoulder instability is rare in baseball but the mechanisms, collision and sliding into base, do increase the risk of dislocation in these patients and surgery after a first-time dislocation is absolutely indicated. So arthroscopic Bankart repair is clearly the way in this 17-year-old picture. Thank you so much for your attention and the opportunity to be here.

arthroscopic Bankart repair

shoulder instability

baseball pitcher

athletes

stabilization surgery