Brian Christopher Werner

Background: Increased utilization of the transfer portal in collegiate football has introduced new challenges for orthopaedic sports medicine providers, particularly with respect to postoperative follow-up and continuity of care. Purpose: To evaluate the frequency and timing of transfer following orthopaedic surgery in collegiate football players who entered the transfer portal and subsequently transferred. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review of Division I football players from 2 Football Bowl Subdivision football programs treated at a single institution during the 2020-2025 seasons was performed. Publicly available roster and transfer portal data were analyzed in conjunction with surgical history obtained from the electronic medical record. Primary outcomes of interest included rates of surgical intervention, transfer following surgery, and time from surgery to transfer. Results: A total of 671 players were included, of whom 235 (35.0%) underwent at least 1 orthopaedic procedure (397 total surgeries). Among athletes requiring surgery, 63 (26.8%) subsequently transferred. The mean time from the most recent surgery to the time of transfer portal entry was 356.5 days. Of those who transferred postoperatively, 12.7% did so within 30 days, 15.9% within 90 days, 25.4% within 180 days, and 55.6% within 1 year. Additionally, 31 players (13.2%) underwent subsequent procedures on the same joint, and 20 (8.5%) required revision surgery prior to transfer. Conclusion: More than one-fourth of Division I football athletes undergoing orthopaedic surgery at a single institution subsequently transferred, with most doing so within 1 year of surgery. Increased athlete mobility may disrupt postoperative follow-up and continuity of care, highlighting the need for improved interinstitutional communication and care coordination.

Objectives: Failure of a corticosteroid injection and therapy to provide relief for shoulder adhesive capsulitis results in increasing healthcare costs and patient morbidity from repeat injections and possible surgical intervention. The purpose of this study was to examine the effects of an extended-release corticosteroid injection in shoulder adhesive capsulitis. Methods: This was a phase 2, prospective, non-blinded single-arm study of patients with idiopathic adhesive capsulitis of the shoulder who received a single, image-guided extended-release corticosteroid injection. The visual analog pain scale (VAS) was measured up to 12 months after injection. Secondary endpoints included American Shoulder and Elbow (ASES) score, range of motion (ROM), and need for re-injection. Results: Thirty-nine patients with a mean age of 55 ± 9 years were included; 32 (82%) experienced adequate symptom resolution after a single injection. Mean VAS improved from 5 to 1.4 ( p < 0.01), and mean ASES score improved from 43 to 80 ( p < 0.01) by 6-week post-injection, with sustained improvement through 1-year follow-up. Patients demonstrated improvements in mean passive forward elevation (117–173°; p < 0.01), abduction (98– 162°; p < 0.01), and external rotation with the arm adducted (32–59°; p < 0.01). Conclusion: A single intra-articular injection of extended-release corticosteroid was associated with sustained improvements in pain relief, patient-reported outcomes, and ROM in patients with idiopathic shoulder adhesive capsulitis.

Background: Reverse Hill-Sachs lesions (RHSLs) are compression fractures of the anteromedial humeral head that occur with posterior shoulder dislocations, often contributing to recurrent instability and failure of isolated posterior labral repair. Surgical intervention is indicated for large, engaging lesions to restore bone density and prevent recurrent dislocation. Indications: Lemon wedge humeral head allograft reconstruction is a novel technique used for instances of recurrent posterior shoulder instability resulting in a large RHSL. Technique Description: Arthroscopic evaluation is used to verify a detached posterior labrum and a large RHSL of the anteromedial humeral head. Posterior labral repair is performed with mobilization, debridement, and fixation using 3 knotless suture anchors, restoring the capsulolabral complex to achieve stable reattachment. Next, attention is turned to the RHSL. Through a deltopectoral approach, the subscapularis tendon is tenotomized for exposure, and the lesion is excised in a wedge fashion. A fresh humeral head allograft, precisely shaped using a wax mold, is press-fit into the defect and stabilized with headless compression screws buried beneath the articular surface. Finally, the subscapularis is repaired to cover the reconstruction and restore anterior stability, completing the combined arthroscopic labral repair and open humeral head allograft transplantation. Results: Postoperative imaging confirmed congruent reduction and stable allograft fixation. Rehabilitation was staged with progressive motion, strengthening, and functional recovery, with return to activity anticipated after 6 months. Discussion/Conclusion: RHSLs associated with recurrent posterior instability require careful surgical management. The lemon-wedge humeral head allograft technique provides anatomic reconstruction of the humeral head and restores posterior stability, offering a joint-preserving alternative to arthroplasty in active patients. While technically demanding and biologically limited by graft availability, this approach represents a viable option for managing large RHSLs. The literature suggests that osteochondral allograft transplantation provides favorable outcomes in terms of stability and function. However, long-term complications such as graft resorption, arthritis, and conversion to arthroplasty remain possible. Further studies with long-term follow-up are needed to refine patient selection and optimize surgical outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.