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Shoulder Injuries Related to Vaccine Administration (SIRVA), describes those cases of shoulder severe post-inoculation complications, including pain and prolonged disability. Most of the reported cases have been secondary to influenza vaccination. This study retrospectively describes a series of 18 patients following SARS-CoV-2 inoculation and compares the findings with those previously reported for other vaccines.Inclusion criteria was onset of symptoms within 48 h after injection, symptoms duration of at least seven days, and restricted range of motion in absence of symptoms prior to vaccination. Average age was 59.4 years old (38-76), and 72.2% were women.In many cases (58%) the initial diagnosis was not clear, which lead to incorrect treatment. The most common pathological finding was subacromial-subdeltoid bursitis (66.6%). All patients who received depot corticosteroids followed by a gentle rehabilitation program showed strong clinical improvement but did not completely resolve the symptoms at 7.2 months average final follow-up. Surgical intervention was necessary in one of the patients due to the persistence of symptoms despite conservative treatment.Shoulder injury related to vaccine administration is rare, but when present, its torpid evolution makes it difficult to treat. We have found in our case series a similar pattern to that already described for other vaccines. A high index of suspicion helps to pick up the condition promptly and early treatment can bring satisfactory outcome.

Familial history of cancers of the GEA patients carrying BRCA2 germline LOF mutations.

The current forest fire regimes are increasing due to high temperatures, global warming and frequency of wildfires in dry ecosystems like in the Mediterranean Basin. These issues are decreasing ecosystem’s resistance and resilience, worsening desertification, for this reason, it is of great importance to analyze the effects on the soil. However, it is now possible to apply some preventive tools to avoid wildfire effects or reduce their impacts on ecosystems. Fire is used as preventive tool, prescribed burning (PB) change both the fuel loads in forest ecosystems and vegetation strata. However, fire can produce changes in soil characteristics and physico-chemical parameters.The studied PB was carried out in spring 2021 (early burn) in SE Spain. The mainly vegetation is shrub (i.e., Macrochloa tenacissima (L.) Kunth, Cistus Clusii Dunal, Salvia rosmarinus (L.) Schleid) with poor dry soils formed mainly by cambisols. For improve the knowledge at short/medium-term PB effects on soil, this study attempted to analyze the ecological early PB effects on semi-arid land soils by CO2 flow soil respiration (SR) automatic chamber (CFLUX-1 Soil CO2 Flux System), minidisk infiltrometers for soil hydraulic conductivity (SHC) by infiltration rate and Water Drop Penetration Time (WDPT) methodology for measuring soil water repellency (SWR). It also analyzed soil physico-chemical properties. In addition, this study tries to generate a protocol or guide of good practices for PB. There were no significant differences in any studied variables after the 1-year period according to our formulated hypotheses. However, effects were observed on some parameters on the first days after the PB, such as SOM and nutrients.

The main objective of this project is to investigation and develop new tools aimed at adapting Iberian Aleppo pine forests to climate change, as well as their demonstrative application through forest management actions. will focus on the early detection of decay processes and on the improvement of the resilience of this ecosystem by increasing its vigour, its capacity to adapt to climatic aridification and the ability to recover its functions after natural disturbances. The geographical scope of the project will cover the potential area of distribution of the habitat subtype in the Iberian Peninsula, across sub-humid and semi-arid ecological gradient, including the Mediterranean slopes of the Catalan mountains and the Iberian System, the Ebro basin and the pre-Baetic mountain ranges. This will facilitate an integrated implementation of the methodology that involving the main stakeholders that are responsible for the regulation of forest management throughout the area:- To implement silvicultural treatments aimed at improving vitality and reducing the effects of reduced water availability in a scenario of recurrence of droughts and increased evapotranspiration.- To implement adaptive treatments to improve the resilience and adaptive capacity of Aleppo pine post-fire regeneration in a scenario of higher frequency and severe wildfires.After the implementation of ecohydrology and post-fire treatments, a monitoring program will be carried out in the forest stands where the treatments have been executed. We measure physicochemical and biologic parameters of soil and vegetation. Measurements will be realized after the execution and annually to study if the treatments have had the desired effects or not.

Molecular, histological and pathological features of the 57 metastatic gastric cancer patients included in the retrospective analysis

Supplementary Methods

Mutations; Gastric cancers; PARP inhibitors Mutacions; Càncers gàstrics; Inhibidors de PARP Mutaciones; Cánceres gástricos; Inhibidores de PARP Despite negative results of clinical trials conducted on the overall population of patients with gastric cancer, PARP inhibitor (PARPi) therapeutic strategy still might represent a window of opportunity for a subpopulation of patients with gastric cancer. An estimated 7% to 12% of gastric cancers exhibit a mutational signature associated with homologous recombination (HR) failure, suggesting that these patients could potentially benefit from PARPis. To analyze responsiveness of gastric cancer to PARPi, we exploited a gastroesophageal adenocarcinoma (GEA) platform of patient-derived xenografts (PDX) and PDX-derived primary cells and selected 10 PDXs with loss-of-function mutations in HR pathway genes. Cell viability assays and preclinical trials showed that olaparib treatment was effective in PDXs harboring BRCA2 germline mutations and somatic inactivation of the second allele. Olaparib responsive tumors were sensitive to oxaliplatin as well. Evaluation of HR deficiency (HRD) and mutational signatures efficiently stratified responder and nonresponder PDXs. A retrospective analysis on 57 patients with GEA showed that BRCA2 inactivating variants were associated with longer progression-free survival upon platinum-based regimens. Five of 7 patients with BRCA2 germline mutations carried the p.K3326* variant, classified as “benign.” However, familial history of cancer, the absence of RAD51 foci in tumor cells, and a high HRD score suggest a deleterious effect of this mutation in gastric cancer. In conclusion, PARPis could represent an effective therapeutic option for BRCA2-mutated and/or high HRD score patients with GEA, including patients with familial intestinal gastric cancer. This work was funded by the Italian Association for Cancer Research (AIRC), IG 20210 and IG 27531 to S. Giordano; IG 23624 to F. Pietrantonio; IG 21770 to S. Corso. FPRC 5×1000 2015 Min. Salute “Strategy” to SG; Fondazione Piemontese per la Ricerca sul Cancro (FPRC) 5×1000 MS2017 PTCRC-intra 2020 to S. Giordano; Ricerca Locale Dept. Oncology 2021 to S. Corso; Italian Ministry of Health-Ricerca Corrente 2022–23. B. Pellegrino was supported by ESMO with a Clinical Translational Fellowship aid supported by Roche and received research grants from GOIRC. Fondazione CR Firenze to M. Benelli.

Despite negative results of clinical trials conducted on the overall population of patients with gastric cancer, PARP inhibitor (PARPi) therapeutic strategy still might represent a window of opportunity for a subpopulation of patients with gastric cancer. An estimated 7% to 12% of gastric cancers exhibit a mutational signature associated with homologous recombination (HR) failure, suggesting that these patients could potentially benefit from PARPis. To analyze responsiveness of gastric cancer to PARPi, we exploited a gastroesophageal adenocarcinoma (GEA) platform of patient-derived xenografts (PDX) and PDX-derived primary cells and selected 10 PDXs with loss-of-function mutations in HR pathway genes. Cell viability assays and preclinical trials showed that olaparib treatment was effective in PDXs harboring BRCA2 germline mutations and somatic inactivation of the second allele. Olaparib responsive tumors were sensitive to oxaliplatin as well. Evaluation of HR deficiency (HRD) and mutational signatures efficiently stratified responder and nonresponder PDXs. A retrospective analysis on 57 patients with GEA showed that BRCA2 inactivating variants were associated with longer progression-free survival upon platinum-based regimens. Five of 7 patients with BRCA2 germline mutations carried the p.K3326* variant, classified as “benign.” However, familial history of cancer, the absence of RAD51 foci in tumor cells, and a high HRD score suggest a deleterious effect of this mutation in gastric cancer. In conclusion, PARPis could represent an effective therapeutic option for BRCA2-mutated and/or high HRD score patients with GEA, including patients with familial intestinal gastric cancer.Significance:PARP inhibition is a potential strategy for treating patients with gastric cancer with mutated BRCA2 or homologous repair deficiency, including patients with familial intestinal gastric cancer, for whom BRCA2 germline testing should be recommended.

Baseline characteristics of the 349 enrolled patients.

Supplementary Figure 1

ROC curves of Lee MSI signature predicting MSI genetic status in PDXs and TCGA samples cohorts.

Supplementary Table 1

Purpose:Gastric and gastroesophageal adenocarcinomas represent the third leading cause of cancer mortality worldwide. Despite significant therapeutic improvement, the outcome of patients with advanced gastroesophageal adenocarcinoma is poor. Randomized clinical trials failed to show a significant survival benefit in molecularly unselected patients with advanced gastroesophageal adenocarcinoma treated with anti-EGFR agents.Experimental Design:We performed analyses on four cohorts: IRCC (570 patients), Foundation Medicine, Inc. (9,397 patients), COG (214 patients), and the Fondazione IRCCS Istituto Nazionale dei Tumori (206 patients). Preclinical trials were conducted in patient-derived xenografts (PDX).Results:The analysis of different gastroesophageal adenocarcinoma patient cohorts suggests that EGFR amplification drives aggressive behavior and poor prognosis. We also observed that EGFR inhibitors are active in patients with EGFR copy-number gain and that coamplification of other receptor tyrosine kinases or KRAS is associated with worse response. Preclinical trials performed on EGFR-amplified gastroesophageal adenocarcinoma PDX models revealed that the combination of an EGFR mAb and an EGFR tyrosine kinase inhibitor (TKI) was more effective than each monotherapy and resulted in a deeper and durable response. In a highly EGFR-amplified nonresponding PDX, where resistance to EGFR drugs was due to inactivation of the TSC2 tumor suppressor, cotreatment with the mTOR inhibitor everolimus restored sensitivity to EGFR inhibition.Conclusions:This study underscores EGFR as a potential therapeutic target in gastric cancer and identifies the combination of an EGFR TKI and a mAb as an effective therapeutic approach. Finally, it recognizes mTOR pathway activation as a novel mechanism of primary resistance that can be overcome by the combination of EGFR and mTOR inhibitors.See related commentary by Openshaw et al., p. 2964

Supplementary Methods

Gastric cancer is the world's third leading cause of cancer mortality. In spite of significant therapeutic improvements, the clinical outcome for patients with advanced gastric cancer is poor; thus, the identification and validation of novel targets is extremely important from a clinical point of view. We generated a wide, multilevel platform of gastric cancer models, comprising 100 patient-derived xenografts (PDX), primary cell lines, and organoids. Samples were classified according to their histology, microsatellite stability, Epstein–Barr virus status, and molecular profile. This PDX platform is the widest in an academic institution, and it includes all the gastric cancer histologic and molecular types identified by The Cancer Genome Atlas. PDX histopathologic features were consistent with those of patients' primary tumors and were maintained throughout passages in mice. Factors modulating grafting rate were histology, TNM stage, copy number gain of tyrosine kinases/KRAS genes, and microsatellite stability status. PDX and PDX-derived cells/organoids demonstrated potential usefulness to study targeted therapy response. Finally, PDX transcriptomic analysis identified a cancer cell–intrinsic microsatellite instability (MSI) signature, which was efficiently exported to gastric cancer, allowing the identification, among microsatellite stable (MSS) patients, of a subset of MSI-like tumors with common molecular aspects and significant better prognosis. In conclusion, we generated a wide gastric cancer PDX platform, whose exploitation will help identify and validate novel “druggable” targets and optimize therapeutic strategies. Moreover, transcriptomic analysis of gastric cancer PDXs allowed the identification of a cancer cell–intrinsic MSI signature, recognizing a subset of MSS patients with MSI transcriptional traits, endowed with better prognosis.Significance:This study reports a multilevel platform of gastric cancer PDXs and identifies a MSI gastric signature that could contribute to the advancement of precision medicine in gastric cancer.

Resumen La aplicacion de ondas de choque focales y de ondas de presion radial en patologia musculoesqueletica ha tenido un gran desarrollo y difusion en la ultima decada. Si bien la mayoria de las publicaciones han resaltado su seguridad y eficacia, no estan exentas de malos resultados y complicaciones. Esta revision analiza las principales causas de los malos resultados, efectos adversos y complicaciones, haciendo enfasis en su prevencion.

Introduction: To confront the SARS-CoV-2 pandemic, a large share of the population must be immunized. Intramuscular vaccination of the shoulder is the preferred technique as it is easily exposed and guarantees a good immune reaction. Local side effects, such as pain and swelling, are common after deltoid inoculation. They usually resolve within 3 days. Shoulder injury related to vaccine administration (SIRVA) should be considered if the symptoms persist. The aim of this presentation is to describe a typical case of SIRVA after SARS-CoV-2 vaccination and provide information to the general orthopedic surgeon to properly diagnose, report, and treat these cases. Case Report: To confront the SARS-CoV-2 pandemic, a large share of the population must be immunized. Intramuscular vaccination of the shoulder is the preferred technique as it is easily exposed and guarantees a good immune reaction. Local side effects, such as pain and swelling, are common after deltoid inoculation. They usually resolve within 3 days. Shoulder injury related to vaccine administration (SIRVA) should be considered if the symptoms persist. The aim of this presentation is to describe a typical case of SIRVA after SARS-CoV-2 vaccination and provide information to the general orthopedic surgeon to properly diagnose, report, and treat these cases. Conclusion: SIRVA cases may occur and should be suspected in all individuals without a history of shoulder symptoms or dysfunction who experience sudden pain and reduced ROM following deltoid muscle vaccination. Treatment must be initiated early with corticosteroids and rehabilitation. The low probability of this complication does not outweigh the advantages of vaccination.

Focused shock waves have emerged as a highly effective noninvasive therapeutic option for the treatment of calcific tendinitis of the shoulder. There are three types of focused shock wave generators: electrohydraulic, electromagnetic, and piezoelectric. According to our literature search, there are no reports of results with the use of single-crystal piezoelectric generators in calcific tendinitis of the shoulder. In a consecutive retrospective series of 23 patients with Gärtner type I and II calcifications of the rotator cuff, we performed three applications of high-energy piezoelectric focused waves (4,000 pulses per session with a frequency of 6 Hz). At the final follow-up (average of 14 months), 82.6% of the cases showed complete resorption of the calcification in radiographic controls. In 8.7% of the cases, partial disappearance of the calcification was achieved, and in the remaining 8.7% there were no significant changes. Single-crystal piezoelectric generators have a success rate comparable to those already reported with electrohydraulic and electromagnetic devices.

The influence of the past on the present and the need to revise and update it are concerns that transcend the professional field of historians. The Restoration, the Civil War, Franco’s regime, the Transition, etc. The revision of such complex periods always entails the risk of forgetting part of the story. The importance of having mature, plural reflections from different perspectives is a requirement when it comes to understanding what happened in one or more specific periods. Communication and forgotten history: a cross-sectional view from contemporaneity is the title of this book in which we find approaches signed by researchers from different areas and with sensitive differences in their interpretation of the period they are studying. Its chapters unearth that «forgotten» history that acquires a special dimension in the media. Journalism, public opinion, politics, identity, ideology, terms such as these come together in a work that aims to offer a pleasant reading, but in accordance with the criteria of rigor and professionalism that the mission of connecting yesterday with contemporary views implies.

Wildfires have historically been a natural alteration in Mediterranean ecosystems. Despite these ecosystems' high resilience, the expected climate change scenarios may lead into more recurrent and severe wildfires, and erosion and degradation processes can be enhanced.Post-fire restoration measures, seek to minimize wildfire negative impacts on the burned area as well as its ecological rehabilitation. Among these measures, soil stabilization treatments like erosion barriers or mulching are key for erosion and flood control. Nevertheless, its economic viability can be limited, and therefore these treatments must be thoroughly evaluated considering their costs and their efficiency to achieve the objective. Additionally, there is a need to evaluate new techniques, which can be implemented in places where, due to the scarce vegetation, some traditional treatments as log barriers cannot be implemented. This study seeks to evaluate the cost-efficiency of alternative post-fire emergency measures for erosion control in a semi-arid Mediterranean area.The study area is located in the SE of Spain, more specifically in Hellín (Albacete). Wildfire took place on July 27 of 2020, and severely affected 266 ha of Pinus halepensis forest. Soil erosion was measured in 9 different micro-catchments (≈0.5 ha) located in the burned area. Three groups of micro-catchments were created, and a different treatment was randomly applied to each group. The applied treatments were the combination of straw mulch (0.25 kg/m2) with contour-felled logs (ML), and prefabricated biodegradable barriers (350 m/ha), Easy-Barriers ® (EB). The last three micro-catchments were designated as control and no treatment was applied. At the outlet of each micro-catchment, sediment traps were settled to measure sediment yield. Additionally, rainfall intensity and erodibility were measured with pluviometers installed on the field.The outcomes of the experiment, show that only the ML treatment resulted in a significant reduction (Kruskal-Wallis H test) of the eroded sediment for the first 15 months after fire. For the studied period, a total mean eroded sediment of 9.61 and 8.41 ton/ha was measured at the control and the EB traps respectively, while at the ML traps this amount was significantly lower (1.43 ton/ha). The difference between the two applied treatments increased as the rainfall events occurred, due to the breaking of the EB and the transport downstream of the sediment they were retaining. Therefore, the measured sediment yield at the EB traps during the autumn of the second year was higher than in the control ones. According to these results, ML must be considered as an effective treatment to soil stabilization, whereas EB did not perform as expected. That underlines the need to improve the strength and durability of the EB, as their aim is to hold on until the vegetation recovery is sufficient to retain those sediments. As well, the efficiency of the combination of EB with mulch treatments should be studied as the use of EB considerably reduce costs and allows managers not to depend on the availability of material to place contour-felled logs throughout the burned area.

With current global warming, the exacerbation of climate change and the progression of neglect in rural areas, forest fires are increasing in extent and severity. To alleviate these changes in the fire regime and seek the reduction of large severe fires, the use of fire as a preventive management tool is being implemented through the application of prescribed burns in Mediterranean forests, used in forestry actions to reduce the understory and break both vertical and horizontal continuity of fuels. In this study we want to see the efficacy of the treatment by determining the effects of the prescribed burns on the soil, both physical-chemical and biological parameters, as well as on the vegetation, in a semi-arid forest ecosystem. The prescribed burns were performed in the municipality of Ayna, Albacete (SE Spain). To evaluate and monitor the ecological damage to the soil in the short term (1 year), CO2 flow measurement cameras were used to measure soil respiration, mini-disk infiltrometers, with a monthly monitoring period throughout the year. The results do not show significant alterations in all the parameters studied due to these prescribed burns over a long period, stabilizing together with the unburned plots. However, in the short period of time (3 months later), some variables are affected. This study aims to observe, and make known, the effects that these actions have on the soil, being these of great relevance to carry out a design, management, and application of these tools to forest management in the Mediterranean area.

The entry of the 21st century has transformed the world of sport in tune with the socioeconomic dynamics resulting from neoliberalism. This article proposes, on the one hand, a discussion about the validity of sport as a cultural industry in terms of its roots and social impact, as well as its ability to spread values. And, on the other hand, it shows a specific case study, that of City Football Group, the main sports conglomerate worldwide, with eleven clubs on four continents. This conglomerate crosses the borders of football to reach large companies outside the sports sector, including the media.; La entrada del siglo XXI ha transformado el mundo del deporte en sintonía con las dinámicas socioeconómicas productos del neoliberalismo. Este artículo propone, por un lado, una discusión acerca de la validez del deporte como industria cultural en tanto su arraigo e impacto social así como su capacidad para difundir valores. Y, por otro, muestra un estudio de caso concreto, el de City Football Group, el principal conglomerado deportivo a nivel mundial, con once clubes en cuatro continentes. Este conglomerado traspasa las fronteras del fútbol para alcanzar a grandes empresas ajenas al sector del deporte, incluidos los medios de comunicación.

Rehabilitation has a fundamental role in the management of rotator cuff pathology whether the final choice is conservative or surgical treatment. Conservative treatment can give excellent results in cases of rotator cuff tendinopathies without rupture, partial tears less than 50% of the thickness of the tendon, chronic full-thickness tears in elderly patients and irreparable tears. It is an option prior to reconstructive surgery in non-pseudo paralytic cases. When surgery is indicated, adequate postoperative rehabilitation is the best complement to obtain a successful result. No consensus has still been established on the optimal postoperative protocol to follow. No differences were found between delayed, early passive and early active protocols after rotator cuff repair. However, early motion improved the range of motion in the short and mid-term, allowing faster recovery. A 5-phase postoperative rehabilitation protocol is described. Rehabilitation is also an option in specific failed surgical procedures. To choose a therapeutic strategy in these cases, it is reasonable to differentiate between Sugaya type 2 or 3 (tendinopathy of the tendon) and type 4 or 5 (discontinuity/retear). The rehabilitation program should always be tailored to the individual patient.

The soil microbiota is vulnerable to burning; however, it shows some resilience. No indices have yet been developed to assess fire damage related to soil biota. We evaluated the biological soil indices recorded by a Biolog EcoPlate System in a Mediterranean ecosystem. The experiment was carried out in an outdoor forest lysimeter facility (MedForECOtron), where we simulated burns with different burn severities. Burning increased the metabolic diversity of bacteria and most C-substrate utilization groups. Soil organic matter, phosphorus, electric conductivity, and calcium increased with increasing burn severity. Microbial richness and activity, as well as the integrated capacity of soil microbes to use a C source, lowered by burning, but recovered 6 months later. The functional diversity and amount of the C source used by microbes immediately increased after fire, and values remained higher than for unburned soils. We evaluated the changes in the vulnerability and resilience of fire-adapted ecosystems to improve their adaptive forest management. We found that the high burn severity reduced microbial richness, functional diversity, and the C source utilization of soil microbes (marked vulnerability to high temperatures), which recovered in the short term (high resilience). These results help to understand the main mechanisms of the effects of wildfire on semi-arid Mediterranean ecosystems, whose field validation will be helpful for fire prevention planning and restoration of burned areas.

It is not well understood why diabetic individuals are more prone to develop severe COVID-19. To this, we here established a human kidney organoid model promoting early hallmarks of diabetic kidney disease development. Upon SARS-CoV-2 infection, diabetic-like kidney organoids exhibited higher viral loads compared with their control counterparts. Genetic deletion of the angiotensin-converting enzyme 2 (ACE2) in kidney organoids under control or diabetic-like conditions prevented viral detection. Moreover, cells isolated from kidney biopsies from diabetic patients exhibited altered mitochondrial respiration and enhanced glycolysis, resulting in higher SARS-CoV-2 infections compared with non-diabetic cells. Conversely, the exposure of patient cells to dichloroacetate (DCA), an inhibitor of aerobic glycolysis, resulted in reduced SARS-CoV-2 infections. Our results provide insights into the identification of diabetic-induced metabolic programming in the kidney as a critical event increasing SARS-CoV-2 infection susceptibility, opening the door to the identification of new interventions in COVID-19 pathogenesis targeting energy metabolism.

Contour-felled log debris (CFD) and log erosion barriers (LEB) are two restoration practices used worldwide on hillslopes to avoid soil erosion after wildfires. Although significant work has evaluated the effectiveness of these practices on soil loss prevention, their effects on soil properties have been little researched to date. Here, the effects of CFD and LEB treatments on several physico-chemical and biological soil properties were investigated across four post-fire zones in Mediterranean forest (Sierra de Los Donceles, Spain). Results suggest that post-fire management similarly altered the recovery of microbiological soil properties and soil functionality for both CFD and LEB treatments. Post-fire management enhanced soil organic matter (SOM) and basal respiration, while suppressing soil microbial activities. SOM enhancement at our plots may have been associated with suppressed soil microbial decomposition activity due to post-fire increases in electrical conductivity. Plots with post-fire management recovered microbiological soil properties better than unmanaged burn plots, but not to the same level as nearby unburned plots. LEB and CFD may not only be effective in retaining sediments, but also in improving post-fire microbiological soil properties in comparison to unmanaged plots. However, after eight years of post-fire management, soil microbiological soil properties did not completely recover compared to unburnt areas. That is, fire may shift the development trajectory of microbiological soil properties so that they may no longer be able to return to the same unburnt conditions. Post-fire restoration plans should consider the use of LEB and CFD when aiming to aid soil-related ecosystem recovery processes after wildfires.

Purpose The purpose of this study was to establish consensus statements via a modified Delphi process on revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability. Methods A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. Results The primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of reinjury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed up for a minimum of 12 months or until a return to full, premorbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific, patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction. Conclusion Overall, 92% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous consensus on the role of psychological factors in the return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up. Level of Evidence Level V, expert opinion.

Purpose The purpose of this study was to establish consensus statements via a modified Delphi process on the Latarjet procedure, remplissage, and glenoid-bone grafting for anterior shoulder instability. Methods A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. Results The technical approaches identified in the statements on the Latarjet procedure and glenoid bone-graft were that a subscapularis split approach should be utilized, and that it is unclear whether a capsular repair is routinely required. Furthermore, despite similar indications, glenoid bone-grafting may be preferred over the Latarjet in patients with bone-loss greater than can be treated with a coracoid graft, and in cases of surgeon preference, failed prior Latarjet or glenoid bone-grafting procedure, and epilepsy. In contrast, the primary indications for a remplissage procedure was either an off-track or engaging Hill-Sachs lesion without severe glenoid bone loss. Additionally, in contrast to the bone-block procedure, complications following remplissage are rare, and loss of shoulder external rotation can be minimized by performing the tenodesis via the safe-zone and not over medializing the fixation. Conclusion Overall, 89% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the prognostic factors that are important to consider in those undergoing a glenoid bone-grafting procedure including age, activity level, Hill-Sachs Lesion, extent of glenoid bone-loss, hyperlaxity, prior surgeries, and arthritic changes. Furthermore, there was unanimous agreement that it is unclear whether a capsular repair is routinely required with a glenoid bone graft, but it may be beneficial in some cases. There was no unanimous agreement on any aspect related to the Latarjet procedure or Remplissage. Level of Evidence Level V: expert opinion.