scholarly journals Understanding Anterior Shoulder Instability Through Machine Learning: New Models That Predict Recurrence, Progression to Surgery, and Development of Arthritis

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110533
Author(s):  
Yining Lu ◽  
Ayoosh Pareek ◽  
Ryan R. Wilbur ◽  
Devin P. Leland ◽  
Aaron J. Krych ◽  
...  
Keyword(s):  
Machine Learning ◽  
Open Access ◽  
Shoulder Instability ◽  
Curve Analysis ◽  
Brier Score ◽  
Anterior Shoulder Instability ◽  
Recurrent Instability ◽  
Radiographic Findings ◽  
Decision Curve Analysis

Background: Management of anterior shoulder instability (ASI) aims to reduce risk of future recurrence and prevent complications via nonoperative and surgical management. Machine learning may be able to reliably provide predictions to improve decision making for this condition. Purpose: To develop and internally validate a machine-learning model to predict the following outcomes after ASI: (1) recurrent instability, (2) progression to surgery, and (3) the development of symptomatic osteoarthritis (OA) over long-term follow-up. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: An established geographic database of >500,000 patients was used to identify 654 patients aged <40 years with an initial diagnosis of ASI between 1994 and 2016; the mean follow-up was 11.1 years. Medical records were reviewed to obtain patient information, and models were generated to predict the outcomes of interest. Five candidate algorithms were trained in the development of each of the models, as well as an additional ensemble of the algorithms. Performance of the algorithms was assessed using discrimination, calibration, and decision curve analysis. Results: Of the 654 included patients, 443 (67.7%) experienced multiple instability events, 228 (34.9%) underwent surgery, and 39 (5.9%) developed symptomatic OA. The ensemble gradient-boosted machines achieved the best performances based on discrimination (via area under the receiver operating characteristic curve [AUC]: AUCrecurrence = 0.86), AUCsurgery = 0.76, AUCOA = 0.78), calibration, decision curve analysis, and Brier score (Brierrecurrence = 0.138, Briersurgery = 0.185, BrierOA = 0.05). For demonstration purposes, models were integrated into a single web-based open-access application able to provide predictions and explanations for practitioners and researchers. Conclusion: After identification of key features, including time from initial instability, age at initial instability, sports involvement, and radiographic findings, machine-learning models were developed that effectively and reliably predicted recurrent instability, progression to surgery, and the development of OA in patients with ASI. After careful external validation, these models can be incorporated into open-access digital applications to inform patients, clinicians, and researchers regarding quantifiable risks of relevant outcomes in the clinic.

scholarly journals Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

2020 ◽  
Vol 23 (2) ◽  
pp. 62-70 ◽  
Author(s):  
Sae Hoon Kim ◽  
Whanik Jung ◽  
Sung-Min Rhee ◽  
Ji Un Kim ◽  
Joo Han Oh
Keyword(s):  
Bone Defect ◽  
Shoulder Instability ◽  
Bone Defects ◽  
Defect Size ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Anterior Instability ◽  
Recurrent Instability ◽  
Capsulolabral Reconstruction

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

scholarly journals A Multicenter Retrospective Study With a Minimum 5-Year Follow-up Comparing Arthroscopic Bankart Repair and the Latarjet Procedure

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094136
Author(s):  
Eran Maman ◽  
Oleg Dolkart ◽  
Rafael Krespi ◽  
Assaf Kadar ◽  
Gabriel Mozes ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Published Data ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores

Background: Arthroscopic Bankart repair (ABR) and the Latarjet procedure are surgical techniques commonly used to treat anterior shoulder instability. There is no consensus among shoulder surgeons regarding the indications for choosing one over the other. Purpose: To compare the results of the Latarjet procedure with those of ABR for the treatment of anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Data on all patients who were treated surgically for recurrent anterior shoulder instability between 2006 and 2011 were retrospectively collected at 4 medical centers. The minimum follow-up was 5 years. Data were retrieved from medical charts, and patients were interviewed to assess their level of satisfaction (range, 0-100), functional outcomes (using the American Shoulder and Elbow Surgeons shoulder score; the Subjective Shoulder Value; and the Disabilities of the Arm, Shoulder and Hand score), and quality of life (using the 12-Item Short Form Health Survey [SF-12]). Information on return to sports activities and postoperative level of activity compared with that of the preinjury state, complications, reoperations, and recurrent instability were recorded and evaluated. Results: A total of 242 patients were included. The Latarjet procedure was performed in 27 shoulders, and ABR was performed in 215 shoulders. Patients in the ABR group had significantly higher rates of redislocation (18.5%; P = .05) and subluxation (21.4%; P = .43) but a lower rate of self-reported apprehension (43.0%; P = .05) compared with patients in the Latarjet group (3.7%, 14.8%, and 63.0%, respectively). There were 5 patients in the ABR group who underwent reoperation with the Latarjet procedure because of recurrent instability. The functional scores in the Latarjet group were better than those in the ABR group. The SF-12 physical score was significantly better in the Latarjet group than in the ABR group (98.1 vs 93.9, respectively; P = .01). Patient satisfaction and subjective scores were similar in both groups. Conclusion: These results support recently published data on the Latarjet procedure that showed its superiority over ABR in midterm stability (dislocations or subluxations). The contribution of self-reported apprehension to the broad definition of stability is not clear, and apprehension rates were not correlated with satisfaction scores or the recurrence of dislocation or subluxation.

scholarly journals Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review

2021 ◽  
pp. 155633162110306
Author(s):  
Ajaykumar Shanmugaraj ◽  
Seaher Sakha ◽  
Tushar Tejpal ◽  
Timothy Leroux ◽  
Jacob M Kirsch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Quality Data ◽  
Anterior Shoulder Instability ◽  
Failure Rates ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair

Background: The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. Purpose: We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. Methods: We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. Results: Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). Conclusion: With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.

scholarly journals Risk Factors for Recurrence of Shoulder Instability after Bankart Lesion Arthroscopic Treatment

2015 ◽  
Vol 22 (3) ◽  
pp. 20-25
Author(s):  
E. A Belyak ◽  
A. A Kubashev ◽  
F. L Lazko ◽  
M. A Abdulkhabirov ◽  
K. A Ptitsyn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Suture Anchors ◽  
Treatment Results ◽  
Recurrent Instability ◽  
Sports Activity ◽  
Risk Factors For Recurrence ◽  
High Level

Analysis of treatment results for 408 patients (17-48 years old) with posttraumatic anterior shoulder instability was performed. In all cases arthroscopic Bankart repair with the use of suture anchors was performed from 1997 to 2013. Follow up period made up 5.7±1.2 years. Recurrent instability was observed in 45 (11%) patients. Comparison of patients with and without recurrent shoulder instability enabled to identify the following risk factors: high-level of sports activity (78.0% vs 27,8%, p

scholarly journals Clinical Outcomes of Primary versus Revision Surgery using Arthroscopic Anatomic Glenoid Reconstruction for Anterior Shoulder Instability. (244)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0035
Author(s):  
Ivan Wong ◽  
Ryland Murphy ◽  
Sara Sparavalo ◽  
Jie Ma
Keyword(s):  
Bone Loss ◽  
Clinical Outcomes ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Primary Group ◽  
Recurrent Instability ◽  
Exclusion Criteria ◽  
Glenoid Reconstruction

Objectives: Revision surgeries after prior shoulder stabilization are known to have worse outcomes as compared to their primary counterparts. To date, no studies have looked at the utility of arthroscopic anatomic glenoid reconstruction (AAGR) as a revision surgery. The purpose of this study was to assess the clinical outcomes of primary versus revision AAGR for anterior shoulder instability with bone loss. Methods: We performed a retrospective review on consecutive patients with prospectively collected data who underwent AAGR from 2012 to 2018. Patients who received AAGR for anterior shoulder instability with bone loss and had a minimum follow-up of two years were included. Exclusion criteria included patients with rotator cuff pathology, multidirectional instability and glenoid fractures. There were 68 patients (48 primary and 20 revision) who met inclusion/exclusion criteria. Our primary outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) and Disabilities of Arm, Shoulder, Hand (DASH) scores. Secondary outcomes included post-operative complications and post-operative recurrent instability. Results: The primary group showed a significant improvement in most-recent post-operative WOSI from 62.7 to 20.7 (P<0.001, α=0.05) and in DASH from 26.89 to 6.7 (p<0.001, α=0.05). The revision group also showed a significant improvement in WOSI from 71.5 to 34.6 (p<0.001, α=0.05) and in DASH from 39.5 to 17.0 (p<0.05, α=0.05). When comparing between groups, the revision group had worse WOSI scores (34.6) at most recent follow-up compared to the primary group (20.7); p<0.05. The most-recent DASH scores also showed the revision group (17.0) having worse outcomes than the primary group (6.7); p<0.05. Important to note that the minimal clinically important difference (MCID) was met for WOSI (MCID=10.4) but not DASH (MCID=10.83). There were no post-operative reports of instability in either group. For complications, one hardware failure (suture anchor) was seen in the primary group, and two hardware removals were seen in the revision group. Conclusions: While patient reported scores indicated worse outcomes in the revision group, the significant clinical improvement in DASH and WOSI, along with the lack of recurrent instability provides evidence that AAGR is a suitable option for revision patients.

scholarly journals Clinical Outcomes of the Traditional Latarjet Versus the Congruent Arc Modification for the Treatment of Recurrent Anterior Shoulder Instability: A Meta-analysis

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110302
Author(s):  
Sunita R.P. Mengers ◽  
Derrick M. Knapik ◽  
Matthew W. Kaufman ◽  
Gary Edwards ◽  
James E. Voos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Meta Analysis ◽  
Return To Sport ◽  
Late Complications ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Instability

Background: Few studies have compared clinical outcomes between the traditional Latarjet procedure for anterior shoulder instability and the congruent arc modification to the Latarjet procedure. Purpose: To systematically evaluate the literature for the incidence of recurrent instability, clinical outcomes, radiographic findings, and complications for the traditional Latarjet procedure and the congruent arc modification and to compare results of each search. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies published between January 1990 and October 2020 that described clinical outcomes of the traditional Latarjet and the congruent arc modification with a follow-up range of 2 to 10 years. The difference in surgical technique was analyzed using a chi-square test for categorical variables, while continuous variables were evaluated using a Student t test. Results: In total, 26 studies met the inclusion criteria: 20 studies describing the traditional Latarjet procedure in 1412 shoulders, and 6 studies describing the congruent arc modification in 289 shoulders. No difference between procedures was found regarding patient age at surgery, follow-up time, Rowe or postoperative visual analog scores, early or late complications, return-to-sport timing, or incidence of improper graft placement or graft fracture. A significantly greater proportion of male patients underwent glenoid augmentation using the congruent arc modification versus traditional Latarjet ( P < .001). When comparing outcomes, the traditional Latarjet procedure demonstrated a lower incidence of fibrous union or nonunion ( P = .047) and broken, loose, or improperly placed screws ( P < .001), and the congruent arc modification demonstrated improved outcomes with regard to overall return to sport ( P < .001), return to sport at the same level ( P < .001), incidence of subluxation ( P = .003) or positive apprehension ( P = .002), and revision surgery for recurrent instability ( P = .027). Conclusion: Outcomes after the congruent arc modification proved at least equivalent to the traditional Latarjet procedure in terms of recurrent instability and return to sport, although early and late complications were equivalent. The congruent arc procedure may be an acceptable alternative to traditional Latarjet for the treatment of anterior shoulder instability with glenoid bone loss; however, long-term outcomes of this procedure are needed.

Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

2020 ◽  
pp. 036354652092583
Author(s):  
Ron Gilat ◽  
Eric D. Haunschild ◽  
Ophelie Z. Lavoie-Gagne ◽  
Tracy M. Tauro ◽  
Derrick M. Knapik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Meta Analysis ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability

Background: Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. Purpose: To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. Results: A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. Conclusion: Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.

scholarly journals Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability: Patients With Prior Arthroscopic Bankart Repair Versus Primary Cases

2019 ◽  
Vol 48 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Jean-David Werthel ◽  
Vincent Sabatier ◽  
Bradley Schoch ◽  
Lior Amsallem ◽  
Geoffroy Nourissat ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Simple Shoulder Test ◽  
Arthroscopic Bankart Repair ◽  
Group 2 ◽  
Group 1

Background: It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation. Purpose: To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test. Results: A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures. Conclusion: Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.

Arthroscopic Stabilization in Patients with an Inverted Pear Glenoid

2007 ◽  
Vol 35 (8) ◽  
pp. 1276-1283 ◽  
Author(s):  
Timothy S. Mologne ◽  
Matthew T. Provencher ◽  
Kyle A. Menzel ◽  
Tyler A. Vachon ◽  
Christopher B. Dewing
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Bony Defect ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Bone Deficiency ◽  
Bony Fragment ◽  
The Mean

Background Recent literature has demonstrated that the success rates of arthroscopic stabilization of glenohumeral instability deteriorate in patients with an anteroinferior glenoid bone deficiency, also known as the “inverted pear” glenoid. Purpose This study was conducted to assess the outcomes of arthroscopic stabilization for recurrent anterior shoulder instability in patients with a mean anteroinferior glenoid bone deficiency of 25% (range, 20%-30%). Study Design Cohort study; Level of evidence, 3. Methods Twenty-one of 23 patients (91% follow-up) undergoing arthroscopic stabilization surgery and noted to have a bony deficiency of the anteroinferior glenoid of 20% to 30% were reviewed at a mean follow-up of 34 months (range, 26-47). The mean age was 25 years (range, 20-34); 2 patients were female and 19 were male. All patients were treated with a primary anterior arthroscopic stabilization using a mean of 3.2 suture anchors (range, 3-4). Eleven patients had a bony Bankart that was incorporated into the repair; 10 had no bone fragment and were considered attritional bone loss. Outcomes were assessed using the Rowe score, the American Shoulder and Elbow Surgeons (ASES) Score, the Single Assessment Numeric Evaluation (SANE), and the Western Ontario Shoulder Instability (WOSI) Index. Findings of recurrent instability and dislocation events were documented. Results Two patients (9.5%) experienced symptoms of recurrent subluxation, and 1 (4.8%) sustained a recurrent dislocation that required revision open surgery. The mean postoperative outcomes scores were as follows SANE = 88.1 (range, 65-100; standard deviation [SD] 9.0); Rowe = 85.2 (range, 55-100; SD 14.1); ASES Score = 93.1 (range, 78-100; SD 5.3); and WOSI Index = 398 (82% of normal; range, 30-1175; SD 264). No patient with a bony fragment experienced a recurrent subluxation or dislocation, and mean outcomes scores for patients with a bony fragment were better than those with no bony fragment (P = .08). No patient required medical discharge from the military for his or her shoulder condition. Conclusions Arthroscopic stabilization for recurrent instability, even in the presence of a significant bony defect of the glenoid, can yield a stable shoulder; however, outcomes are not as predictable especially in attritional bone loss cases. Longer-term follow-up is needed to see if these results hold up over time.

Sign in / Sign up

Export Citation Format

Share Document