Thank you. I'd like to thank Dr. Kelly and the program committee and our chairs for allowing us to share the information about return to play in arthroscopic bank cards. What do we know? We know that we claim that contact and collision athletes have a four to five times higher recurrence rate. They're listed all over the board, whether it's arthroscopic repair from 7.5 to 50%, or even open repair that's less, but still pretty disappointing. Non-contact athletes, we see, have lower rates. Can we ever approach it? And we fight about it on the stage. The arthroscopic advantage for most of us, we understand, whether it's better cosmesis, better range of motion, better forward elevation, lower mean VAS scores, no subscapularis complications, and mostly a higher percentage, hopefully, to return to sport. By some, you can see the problem with arthroscopic that we need to figure this out. Our hypothesis was that we wanted to compare functional outcomes between contact and collision athletes and non-contact athletes, and that were fixed arthroscopically. Was there a difference in our null hypothesis between groups to have a low recurrence rate, excellent functional outcomes, return to preoperative sports, and no loss of external rotation? Our inclusion criteria over 18 years, we looked specifically for people with defects in the anterior inferior labrum from 12 o'clock to 6 o'clock. They had to have a very, very large lesion. Sports participation had to classify by the American College of Sports Medicine for collision or contact athletes. We excluded any multi-directional instability, any prior shoulder surgery, any engaging Hill-Sax lesion, and a glenoid lesion, we went up as high as less than 30%. Seventy athletes were found in this cohort of 32 contact athletes and 38 non-contact athletes, where clearly the contact and the collision athletes were specifically younger at a very specific age. Everything was done in the lateral decubitus position, and we changed from a classic arthroscopic Bankart to a procedure more similar, it's described by Navalong, is really an inferior capsular shift, with the same posterior portal of a primary viewing portal, anterior superior to see it, and anterior inferior always making a portal below the subscapularis to access the glenoid. After confirmation, no different than any of us in the audience, after confirmation of the glenoid bone loss, and it should say less than 30%, we placed a minimum of anchors of three, usually four, if not five, below the three o'clock or nine o'clock position, right greater than three millimeters inside the edge of the glenoid, and always to do this with an inferior capsular Navalong type of closure. If someone claimed that they dislocated in their sleep, and there was a recurrence, they had a rotator interval closure as well. They were placed in an abduction sling, immobilized for three and a half weeks, no ER was allowed greater than 10 degrees for four weeks, and then we moved them along with non-contact athletes at three months, contact four to five, overhead athletes at nine months. We evaluated them with WOSI, MISS, ROSE, CONSTANT, and ASES, so we could see exactly their scores. We saw in the physical exam range of motion, stability testing, x-rays, we got MRIs, and we had CT scans to follow up. We looked at continuous variables in our statistics with a statistician for the contact and non-contact athletes with the significance of P is less than .006, corrections for the multiple comparisons. We found, you can see here, the difference in contact and collision athletes, and non-contact with football and hockey and basketball mostly, while we had weightlifters or tennis in the non-contact group, or even baseball. We saw no significant difference in functional scores, and all athletes returned to pre-injury sports. We saw no significant difference in range of motion, no loss of external rotation, no difference in the number of suture anchors as we looked, contact and non-contact and collision. The question is recurrence of instability, obviously, 6% close, 5.7%, contact and collision athletes at 6.3%, non-contact athletes at 5.3%. Four of those patients then went back and underwent, again, an arthroscopic revision bank card, not a Latergé, with plication sutures with excellent outcomes of greater than five years now with no recurrence and even apprehension. Our conclusion is that perhaps inferior capsular shift modified with more suture anchors placed can give a yield for contact and collision athletes when there is a bone presence that's absent. The recurrence rate was 6.3%, but we need to investigate now, which we didn't, does anyone have apprehension in that cohort, to be very fair. Thank you very much.

return to play

arthroscopic Bankart repairs

recurrence rate

contact athletes

non-contact athletes