Innovative Clinical Care, Basic Science and Outcomes Research for Shoulder Injuries and Reconstruction Techniques at UPMC

Shoulder injuries, encompassing a spectrum from acute dislocations to chronic degenerative diseases, present unique challenges in orthopaedic surgery. The complexity of shoulder anatomy combined with the joint's high demand for mobility and strength makes the treatment and research of shoulder conditions and complex injuries particularly challenging for surgeons.

UPMC and the University of Pittsburgh Department of Orthopaedic Surgery are working to address the underlying clinical challenges of studying and repairing the shoulder joint to improve long-term patient outcomes, quality, and value of surgical care. By integrating advanced clinical care techniques, pioneering basic science research, and through rigorous patient outcomes research, UPMC is shaping the future of shoulder injury management and reconstruction techniques.

Leading shoulder clinical care and research efforts at UPMC and the University of Pittsburgh is Albert Lin, MD, FAAOS.

As the Vice Chair of Education, Program Director of the Orthopaedic Surgery Residency Program, Chief of Shoulder Service, and Co-Director of the Pittsburgh Shoulder Institute, Dr. Lin's contributions span clinical practice, educational leadership, and innovative research. Dr. Lin's clinical training was conducted primarily at Harvard Medical School and Massachusetts General Hospital, where he completed his medical school, residency, and shoulder fellowship training. Dr. Lin also completed a sports medicine fellowship at the University of Pittsburgh. He joined UPMC and the University of Pittsburgh in 2012.

Dr. Lin’s clinical work is deeply intertwined with his research priorities, which focus on improving surgical techniques and patient outcomes for complex shoulder pathologies and injuries.

His collaborative projects with department colleagues Richard Debski, PhD, from the University of Pittsburgh Orthopaedic Robotics Laboratory (ORL), and William Anderst, PhD, director of the Biodynamics Laboratory (BDL) have led to significant advancements in understanding shoulder instability and developing novel surgical interventions.

In this interview, Dr. Lin discusses the shoulder research and clinical care programs at UPMC, what led him to practice in the region, and his work helping to educate and train up-and-coming orthopaedic surgeons with the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine.

Q: What attracted you to join UPMC and the University of Pittsburgh Department of Orthopaedic Surgery?

A: My decision to join UPMC and Pitt was significantly influenced by the work and legacy of our former chair, the late Freddie Fu, who was a mentor and a visionary leader in orthopaedic surgery – not just in Pittsburgh but across the entire world. His enthusiasm and dedication to the field were truly inspiring. Additionally, being from Pittsburgh, I have always felt a deep connection to the city. Pittsburgh has a unique, resilient character. This aligns with my values and the rigorous demands of orthopaedic surgery. The opportunity to work in such an environment where there is a tangible commitment to excellence and innovation made UPMC the perfect fit for me to call home.

Q: How has working in Pittsburgh as an orthopaedic surgeon and researcher influenced your career path?

A: Working in Pittsburgh, especially at an institution like UPMC, has provided unparalleled opportunities to develop as a clinician, educator, and researcher. The city's rich medical community and UPMC's resources have allowed me to engage in cutting-edge research and complex clinical cases. It’s rewarding to contribute to the city that shaped me, ensuring that our community receives the best possible orthopaedic care while pushing forward global advancements in the field.

Q: Can you describe the scope of your clinical work at UPMC?

A: My clinical work primarily revolves around the comprehensive care of shoulder injuries – for people of all ages and conditions, from acute instabilities to complex reconstructions. This is consistent with the broad mission of our department to provide expert care for all orthopaedic conditions. I manage a wide range of conditions, including sports-related injuries and degenerative pathologies that require surgical intervention. My approach combines the latest surgical techniques with a personalized treatment plan tailored to each patient's needs and activity level. This promotes optimal recovery and return to function, which is particularly important for athletes and individuals with active lifestyles.

Q: What are some common procedures you perform, and how can they influence patient outcomes?

A: One of the common procedures I perform is the arthroscopic repair of torn soft tissues in the shoulder, including ligaments and tendons, such as labral or rotator cuff repairs. I also frequently perform shoulder replacements, including traditional shoulder replacements as well as reverse total shoulder replacements, which are particularly beneficial for patients with arthritis related to long-standing severe rotator cuff disease. These procedures have a profound impact on reducing pain and restoring function, allowing patients to return to their daily activities with improved quality of life. Our goal is not just to correct the anatomical issues but to enhance the overall biomechanical function of the shoulder, which is critical for long-term patient satisfaction and function.

Q: Can you describe your current focus in shoulder instability research?

A: A significant area of my current research interests revolves around shoulder instability, especially anterior shoulder dislocations and the associated bone loss that can occur from these injuries. We're exploring several aspects of this problem, from patient outcomes after different surgical interventions to basic biomechanical studies to modifiable factors in the episode of care, including postoperative rehabilitation and objective criteria for determining readiness to return to sports.

One of the key areas we're investigating involves understanding what we term 'critical bone loss' and how it impacts the choice of surgical procedures for glenoid repairs. Our goal is to refine surgical techniques, determine which treatments are optimal for each specific condition, improve outcomes, and reduce dislocation recurrence rates.

Q: Can you explain some of the current research projects you and your collaborators are working on?

A: We are leading multiple studies, including a large multicenter trial called OASIS that is funded by the U.S. Department of Defense. This is a combined civilian and military study, with Pitt and the Walter Reade National Military Medical Center leading the charge as the primary investigative sites. The OASIS project is focused on addressing subcritical glenoid bone loss associated with shoulder instability. The subject of glenoid bone loss, or bone loss from the socket due to an unstable shoulder, remains a source of significant controversy and debate. This condition poses a considerable challenge in orthopaedic surgery due to its complexity and the variations in how it affects patients. We are trying to determine the most effective surgical treatments for managing this type of bone loss. We are particularly interested in understanding the threshold at which bone loss becomes "critical" and thus dictates a specific surgical approach.

Another exciting area of our research employs advanced imaging technologies to study in vivo shoulder kinematics after surgical treatments. One of our studies is on the reverse total shoulder replacement. Our imaging approach helps us understand how different implants and surgical techniques affect patient mobility and comfort in performing real-world activities in real time. Dr. Anderst's Biodynamics Laboratory and its amazing bi-plane radiography system, one of only a handful in the country, can capture live motion in actual people and create powerful 3D models with submillimeter accuracy for studying all sorts of kinematic questions. Cadaveric studies can only simulate motions that we believe would occur. In vivo capabilities allow us to see inside a joint and watch how the joint actually moves in a live patient. This technology is truly remarkable. The technology and skills in the BDL are a huge part of the shoulder research we are working on.

In fact, Dr. Anderst, in collaboration with our shoulder team, also has a very interesting NIH-funded R01 study linked with our DoD grant that focuses on the biomechanics of shoulder instability, mainly how the humerus and the glenoid interact in the contact of bone loss both on the humerus and the glenoid. This research analyzes the movement of the shoulder to evaluate the glenoid track, which is the area the humerus moves on the glenoid in positions worrisome for instability. Up until now, measurements of this track have been made on 2-dimensional static imaging. With the capabilities in Dr. Anderst's lab, we are able to dynamically assess this track in 3-dimensions. This study will significantly improve our understanding of the mechanical behavior of the shoulder joint in the context of instability. It complements our broader research initiatives on uncovering the best way to repair or replace the shoulder when necessary.

Then, there is our recent work with Dr. Debski and the ORL on a collaborative NIH-funded R21 grant that supports a unique robotic study using cadaveric tissues focused on recurrent shoulder dislocations and their impact on the capsular tissues. Through our collaboration, we have been able to reproducibly simulate and observe real-life injury patterns to the soft tissues following shoulder dislocations. This study is important because it allows us to replicate and observe the patterns of injury and tissue response in a controlled environment using the lab's robotic platform. By understanding how the capsule behaves after multiple dislocations, we can develop more effective surgical techniques aimed at preventing recurrence and improving stability in patients with chronic instability issues.

Those are just a couple of recent examples of our much more broad and innovative shoulder research work.

Q: Can you give examples of advancements or significant findings you and your research colleagues have contributed to the field of shoulder replacement?

A: In the realm of shoulder replacements, particularly the reverse total shoulder replacement, our work has significantly advanced understanding of how different implant combinations and parameters can influence range of motion, kinematics, and outcomes. Our studies explore the biomechanics of how these replacements perform under actual physiological conditions, which is crucial for designing implants that offer better outcomes and compatibility with patients' anatomy. As another tangible example, our research in shoulder instability has advanced our understanding of what constitutes worrisome patterns of bone loss following dislocations and who may benefit from adjunctive procedures to decrease recurrent dislocations in high-risk patients. We continue to move the needle and it is exciting to see the impact our research can have in the field.

Q: How does your role in education within the Department of Orthopaedic Surgery influence your clinical and research work?

A: As Vice Chair for Education, I oversee our residency program and ensure that our educational strategies are not only contemporary but also comprehensive for the next generation of surgeons. For example, we are planning to incorporate technologies like virtual reality to simulate surgical procedures. This will enhance the learning experience for our residents. This integration of technology in education is parallel to its integration in clinical practice, where it helps us perform better diagnostics and more precise surgeries. The possibilities are endless – currently, we already use 3D preoperative planning platforms to simulate surgery, place our implants virtually, and use patient-specific guides and instrumentation. In the near future, this will be combined with augmented reality, artificial intelligence, and navigation. The intersection of education, clinical practice, and research is truly exciting for our future leaders.

Q: Can you explain a little more about integrating modern technologies into the orthopaedic surgery residency program at UPMC?

A: As part of our commitment to providing cutting-edge education to our residents, we are actively integrating modern technologies into the curriculum. The next decade will be an exciting era for technology and education – I believe there will be an unprecedented growth in technologic platforms. This includes the use of virtual reality (VR) simulations, which allow residents to practice complex surgical procedures in a risk-free environment. VR offers an immersive experience than can enhance their understanding of spatial relationships and surgical anatomy, which are critical in orthopaedic surgery. We believe that incorporating such technologies not only speeds up the learning curve but also prepares our residents for the technological advancements they will mostly likely encounter in future as their surgical careers progress.

Q: Can you discuss the Department’s approach to fostering a balanced and supportive training environment for the orthopaedic surgery residents?

A: I think we collectively place a strong emphasis on fostering a training environment that supports both the professional and personal growth of our residents. We understand the intense demands placed on our residents and strive to promote a culture that values work-life balance. This includes addressing aspects such as mental health and resilience, which are crucial for preventing burnout. We have mentorship programs that pair residents with experienced surgeons and researchers, creating a supportive network that aids in their development as confident, competent, and compassionate orthopaedic surgeons.

Q: Can you reflect on what drives your research and clinical practices?

A: My primary motivation is to merge clinical practice with scientific inquiry to push the boundaries of what we can achieve in orthopaedic surgery. By continuously innovating and applying new knowledge, we aim to improve patient care directly. I think this philosophy is just an ingrained part of the way we view and practice orthopaedic surgery at UPMC and the University of Pittsburgh.

More Information

For patient referrals or consultations or to contact Dr. Lin to discuss his shoulder research and ongoing projects in the Department, please call 412-432-3651. For additional information, visit UPMC Orthopaedic Care.

Learn more about the Department of Orthopaedic Surgery at the University of Pittsburgh.