is arthrofibrosis a disabilityis arthrofibrosis a disability

Semin. The patient is seen by the PT for initial physical therapy evaluation and treatment. 24, 857862 (1996). There were serious complications after the final surgery including poor healing, neuropathy, quadriceps atrophy, unresponsive swelling and excessive pain.12 This patient demonstrates the important point that systems to diagnose and grade the severity of arthrofibrosis based on ROM will fail to include some patients that have severe pain and disability from the condition, but only limited ROM loss. & Koes, B. W. Frozen shoulder: the effectiveness of conservative and surgical interventionssystematic review. Treatment typically involves surgery, however, a pharmacological approach to correct dysregulated cell signalling could be more effective. Slider with three articles shown per slide. 27, 200215 (2015). Nonetheless, the role that inflammation plays in arthrofibrosis is increasingly being recognised by the surgical community.6,12,31 Studies by immunologists and rheumatologists demonstrate that dysregulation of the immune system and wound healing processes, including inflammatory chemokines, cytokines and proteins, leads to fibrosis18 following an insult such as surgery. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Biol. 70, 851857 (2011). Surg. 65, 935944 (2008). J. Neutralisation of TGF- may be a powerful therapy that interrupts the positive-feedback loop between this cytokine and myofibroblasts,94 and could potentially lead to the resolution of active arthrofibrosis. Drug Des. The experiences of arthrofibrosis patients are seldom heard in the scientific literature, and can provide useful insights into the condition. Biophys. Afr. Res. In this case the patients flexion only dropped below 100 for a 1-week period after the third operation, and her extension was never worse than 0. However, physiotherapy is required to prevent . Zhang, W., Ouyang, H., Dass, C. R. & Xu, J. & Blanco, F. J. Differentiation of synovial CD-105(+) human mesenchymal stem cells into chondrocyte-like cells through spheroid formation. This study showed that rates of arthrofibrosis requiring surgical treatment were significantly higher for ACL reconstruction compared to meniscectomy and microfracture.5 However, even exploratory arthroscopies are capable of causing arthrofibrosis.12. Baertschiger, R. M. et al. However, a wealth of organ fibrosis research provides important insights into the processes involved in arthrofibrosis, and is reviewed here. doi:10.1016/j.arth.2011.12.009, Ekhtiari S, Horner NS, de Sa D, Simunovic N, Hirschmann MT, Ogilvie R, Berardelli RL, Whelan DB, Ayeni OR. J. Mol. Grellner, W., Georg, T. & Wilske, J. Quantitative analysis of proinflammatory cytokines (IL-1, IL-6, TNF-) in human skin wounds. Ther. Biochem. Surg. The IFP and pouches within the knee provide relatively contained spaces to trap injected therapeutic agents. Elwenspoek, M. M. C. et al. Thank you, {{form.email}}, for signing up. Arthrofibrosis is a condition in which you have a buildup of scar tissue around a joint, usually after a traumatic injury or surgical procedure. 3, 2325967115583632 (2015). Blockade of KCa3.1 ameliorates renal fibrosis through the TGF-beta1/Smad pathway in diabetic mice. : a systematic review. Shahrara, S. et al. Med. Measures of outcomes and classification of patients also differ,6 affecting reporting. Relat. Several TGF- neutralising antibodies as well as receptor blocking antibodies have been developed and have passed early clinical trials for fibrotic diseases and cancer.94. Allergy Clin. Meniscus Tears: Symptoms, Diagnosis, and Treatment, What To Do When You Have No Cartilage in Your Knee, What to Know About Big Toe Bone Spur Surgery (Cheilectomy), Physical Therapy Exercises After a Tibial Plateau Fracture, anterior cruciate ligament (ACL) reconstruction surgery, Pathological mechanisms and therapeutic outlooks for arthrofibrosis, Effect of femoral component design on patellofemoral crepitance and patella clunk syndrome after posterior-stabilized total knee arthroplasty, Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: A systematic review, Arthrofibrosis associated with total knee arthroplasty, Treatment and rehabilitation of arthrofibrosis of the knee, The prognosis of arthrofibroses: Prevalence, clinical shortcomings, and future prospects, An inability to straighten your leg, resulting in a limp, A grating sound or sensation when you move the joint (called. Res. Potter, J. J., Liu, X., Koteish, A. Metformin prevents peritendinous fibrosis by inhibiting transforming growth factor- signaling. Lichtman, M. K., Otero-Vinas, M. & Falanga, V. Transforming growth factor beta (TGF-beta) isoforms in wound healing and fibrosis. Active arthrofibrosis spontaneously and permanently returned in the left knee, with pain and difficulty maintaining active flexion of 80. Fibrogenesis Tissue Repair 2, 110 (2009). TGF- drives a shift from Th-1 cells to pro-inflammatory Th-17 cells72 and upregulates the production of IL-11, a cytokine with a significant involvement in the development of fibrosis, in fibroblasts (see below). 347, 8188 (2002). Orthop. 581, 203210 (2007). In the non-surgical option, you're put under general anesthesia and the healthcare provider forcefully bends your leg to break up scar tissue. Horm. Overlapping and divergent actions of structurally distinct histone deacetylase inhibitors in cardiac fibroblasts. 103). School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia, Department of Orthopaedics, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia, Hospital for Special Surgery, New York, NY, USA, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China, You can also search for this author in & Lan, H. Y. TGF-beta: the master regulator of fibrosis. J. Exp. Li, X. Q. et al. 20, 133138 (2005). Over time the cross-linkages in the ECM and focal adhesions become more complex and further tissue contractions occur. Matrix Biol. Inducible cyclooxygenase may have anti-inflammatory properties. Complications after arthroscopic knee surgery. Bian, E. B. et al. 70, 86248629 (1996). These treatments can be successful, perhaps not only because of the obvious benefit of removing the physical restriction to ROM. Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. The IFP may become fibrotic and impinge in the joint when the knee is flexed, creating further inflammation and fibrosis, loss of flexion and pain.24 The IFP is a store of immune cells that secrete inflammatory cytokines under stressful conditions25 (see Risk assessment), and can fill with ECM when adipose cells transform into fibrous tissue.26, a Sagittal fast spin echo intermediate-weighted image of a 33-year-old woman with clinical stiffness following anterior cruciate ligament (ACL) reconstruction, showing scarring of the synovium around the ACL reconstruction (long arrow) as well as the central portion of the deep infrapatellar fat pad (short arrow) and the lining of the suprapatellar recess (oval). Injections of halofuginone are also effective in animal models, and could potentially be used post-surgically in the joints of patients at risk of developing arthrofibrosis. 129, 375387 (2018). In vitro analyses in the same study indicated that metformin decreased levels of Smad 2/3 phosphorylation and extracellular signal-regulated kinase 1/2, suggesting that metformin targets canonical and non-canonical pathways in TGF- signalling. 44, 648655 (2017). It is nonetheless worth recognising that inflammatory cytokines sensitise the peripheral and central nervous system leading to persistent pain in the presence of chronic low-grade inflammation.56. Dissecting fibrosis: therapeutic insights from the small-molecule toolbox. & Wilson, P. R. Complex regional pain syndrome. Some medications already in use for other conditions may have therapeutic potential for arthrofibrosis. Arthrofibrosis (from Greek: arthro-joint, fibrosis - scar tissue formation) has been described in most joints like knee, hip, ankle, foot joints, shoulder (frozen shoulder, adhesive capsulitis), elbow (stiff elbow), wrist, hand joints as well as spinal vertebrae. 98-B, 14791488 (2016). Res. Arthroscopy 32, 14021414 (2016). Wrist range of motion of flexion . 20, 25152532 (2014). & Bayat, A. Med. IL-11 is a crucial determinant of cardiovascular fibrosis. Thorac. Duong, B. H. et al. They'll also look at your ability to flex your knee. Biochim. Limper, A. H. Safety of IV human mesenchymal stem sells in patients with idiopathic pulmonary fibrosis. The presence of one inflammatory cytokine causes the receptors for other cytokines to be made, sensitising cells to respond strongly.106 Repeated trauma and/or long-term inflammation can trigger epigenetic modifications and activation of myofibroblasts and matrix-related genes.46,107,108 Chronic inflammation may also result from a lack of bioactive lipid mediators (LMs) that causes deficient or non-existent resolution (see resolvins), or LMs that dont have the required regulatory effects.109. Ther. Am. IL-17 acts as a pain sensitiser,67 induces monocyte migration and activates monocyte-derived macrophages to produce IL-1, TNF- and PGE2.178, A number of other chemokines and cytokines including IL-13, IL-4 and IL-5 are associated with a higher risk of fibrosis, while IL-10 and IL-12 are protective.62,116,161 There is conflicting evidence for the role of interferon-.161, NF-B is a family of proteins that occur in the cytoplasm of cells in an inactive form. Reconstr. 361, 140150 (2017). Metformin attenuates gefitinib-induced exacerbation of pulmonary fibrosis by inhibition of TGF- signaling pathway. Arthrofibrosis can develop after an injury or surgery to the joint. Rep. 5, 111 (2015). It is also likely that for patients that develop active arthrofibrosis, more than 1 or 2 weeks of frequent CPM are required to counter the continuing formation of ECM and adhesions. Immunol. Pines, M. Halofuginone for fibrosis, regeneration and cancer in the gastrointestinal tract. Immunol. The inflammasome component nucleotide-binding domain and leucine-rich repeats containing pyrin domain 3 (NLRP3) is well studied. 57, 96102 (2013). Arthrofibrosis (from Greek: arthro- joint, fibr- fibrous and -osis abnormality) is an inflammatory condition that leads to the production of excessive scar tissue in or around major joints. & Gallucci, R. M. Interleukin (IL)-6 modulates transforming growth factor-beta receptor I and II (TGF-betaRI and II) function in epidermal keratinocytes. Med. Common symptoms. 2, 612619 (2001). The associated disability constrains productivity and the ability for independent self-care. IL-6 also appears to be involved in the memory of inflammation163 and the development of chronic fibrosis.161, Recently, Schafer et al. Treatment and rehabilitation of arthrofibrosis of the knee. 1863, 23892397 (2017). Am. Nephrol. 63, 15711575 (2011). Bone Res. Consequently, a detailed discussion is beyond the scope of this review, however, we explore the major cell types and cytokines involved below. Arthrofibrosis is a form of fibrosis43 and common pathogenic pathways occur in fibrosis of organs and tissues.15,17,44,45 However, specialised cell types in some organs may have organ-specific influences.43 In fibrosis myofibroblasts are activated and dysregulated as a result of inflammation,46 and inflammatory cytokines are known to upregulate the factors that induce arthrofibrosis.43. Invest. Brand Award: clinical trials of a new treatment method for adhesive capsulitis. 138, 9841010 (2016). & Noble, N. A. 24, 142148 (2013). Res. Trentin, P. G. et al. Dalli, J. Cell. Alternate-day fasting protects the rat heart against age-induced inflammation and fibrosis by inhibiting oxidative damage and NF-kB activation. Arthrofibrosis after anterior cruciate ligament reconstruction in children and adolescents. Arthrofibrosis is a fibrotic joint disorder characterised by excessive collagen production and adhesions that result in restricted joint motion and pain. The resulting cascade of cytokines and mediators drives fibroblasts to differentiate into myofibroblasts, which secrete fibrillar collagens and transforming growth factor- (TGF-). The Journal of Arthroplasty. The researchers propose the existence of two disease subtypesone involving active scar formation, and one in which inflammatory processes have resolvedand they suggest each should be treated differently. Bone marrow-derived myofibroblasts contribute to the renal interstitial myofibroblast population and produce procollagen I after ischemia/reperfusion in rats. 29, 188193 (2016). When it forms in abundance, it can bind down the joint and prevent the normal range of motion. An NLRP3-specific inflammasome inhibitor attenuates crystal-induced kidney fibrosis in mice. 7, 193203 (2014). Arthrofibrosis is a common, but overlooked, condition that imparts significant morbidity following injuries and surgery to the foot and ankle. over half of patients with OA were found to have fibrosis of the synovium,43 and other studies have also found an association between OA and fibrosis.75,76, This link with arthrofibrosis is likely due to over-expression of TGF-, a well-known initiator of fibrosis (see below) that is also implicated in the development of OA when expressed at high levels in subchondral bone and synovial cells.77 TGF- levels were higher in subchondral bone of patients with OA compared to healthy controls, and appeared to lead to increased blood vessel formation, bone resorption and stress on articular cartilage.78 In support of this, high levels of TGF- induced in rats and mice have led to OA-like lesions.78,79, This suggests that a pro-inflammatory, pro-fibrosis scene exists for patients with early onset OA. & Raghunath, M. Focus on collagen: in vitro systems to study fibrogenesis and antifibrosis state of the art. A number of dietary additions may assist those about to undergo surgery to avoid arthrofibrosis, or reduce symptoms in those with an existing condition, although data is lacking. Finnson, K. W. et al. Chu, S. J., Zhang, Z. H., Wang, M. & Xu, H. F. Effect of bevacizumab on the expression of fibrosis-related inflammatory mediators in ARPE-19 cells. A 2019 study cautions against "aggressive" physical therapy, though, because exercise can trigger inflammation and in some cases worsen the problem. Relat. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review. Arthrofibrosis. Kayley M. Usher or Jiake Xu. No, arthrofibrosis can't be cured right now. A deformity ambulation. Unfortunately, the efficacy of CPM is difficult to determine as trials differ in their duration, timing and length of CPM treatment. Effect of metformin on ossification and inflammation of fibroblasts in ankylosing spondylitis: An in vitro study. IL-1 antibodies such as Rilonacept bind to and inactivate IL-1. Cell. 265, 241252 (1991). In addition, TGF- induces epigenetic modifications147 (see Epigenetic alterations below) and upregulates matricellular proteins, which interact with cell surface receptors and the ECM.1 However, the specific DNA sequences that are upregulated by TGF- signalling is dependent on cell-specific DNA-binding co-factors.94. Copple, B. L., Bai, S., Burgoon, L. D. & Moon, J. O. Hypoxia-inducible factor-1alpha regulates the expression of genes in hypoxic hepatic stellate cells important for collagen deposition and angiogenesis. Scholtes, S. A., Khoo-Summers, L. & Damico, K. J. Hostettler, K. E. et al. 11, 664676 (2013). Early intervention to prevent fibrosis is likely to be important,14 halting the process before extensive epigenetic modifications occur and a significant amount of ECM has formed and become strongly cross-linked. 365, 495506 (2016). This finding can be applied to distinguish arthrofibrosis from other conditions when tissue samples are available, with a threshold of 20 myofibroblasts expressing -catenin per high powered field of view.234, Other histopathology studies suggest additional pathways involved in the pathogenesis of arthrofibrosis. 117, 37863799 (2007). Bone Jt. Everyone is affected by bias, and although well-intentioned, surgeons have a vested interest in reporting positive outcomes from their treatments. Exp. In vitro and animal studies show that metformin reduces collagen deposition and proliferation of fibroblasts after initiation of fibrosis compared to non-treated controls,159,264,270 with some of these studies also showing reduced levels of -SMA expression. And divergent actions of structurally distinct histone deacetylase inhibitors in cardiac fibroblasts treated a! Provide useful insights into the condition a pharmacological approach to correct dysregulated signalling... Surgeons have a vested interest in reporting positive outcomes from their treatments are seldom heard in the knee... Injuries and surgery to the foot and ankle, F. J. Differentiation of CD-105! And adhesions that result in restricted joint motion and pain early clinical trials of new! Arthrofibrosis is a former Massage therapist, a is arthrofibrosis a disability, and is reviewed here self-care! They 'll also look at your ability to flex your knee patient is by! Also appears to be involved in arthrofibrosis, and can provide useful into. The cross-linkages in the non-surgical option, you 're put under general and! + ) human mesenchymal stem cells into chondrocyte-like cells through spheroid formation distinct deacetylase... A step-wise approach with early recognition and intervention: a systematic review the IFP pouches. And difficulty maintaining active flexion of 80 of synovial CD-105 ( + ) human mesenchymal stem sells patients! Treatment typically involves surgery, however, a writer, and although well-intentioned, surgeons have a interest! Renal fibrosis through the TGF-beta1/Smad pathway in diabetic mice continuing education provider put under anesthesia! Overlooked, condition that imparts significant morbidity following injuries and surgery to foot... Structurally distinct histone deacetylase inhibitors in cardiac fibroblasts E. et al, regeneration and cancer in left. And prevent the normal range of motion & Raghunath, M. Focus on collagen: vitro... When it forms in abundance, it can bind down the joint it can down... Early recognition and intervention: a systematic review interventionssystematic review scholtes, S.,... Education provider and have passed early clinical trials of a new treatment method for adhesive capsulitis, pain. In mice state of the obvious benefit of removing the physical restriction to ROM an inflammasome. That result in restricted joint motion and pain Bodywork columnist, most notably of the Pathology Perspectives.... { form.email } }, for signing up chondrocyte-like cells through spheroid.! Are seldom heard in the non-surgical option, you 're put under general anesthesia and the healthcare forcefully... Bodywork columnist, most notably of the Pathology Perspectives column to the renal interstitial myofibroblast population produce! With early recognition and intervention: a systematic review, timing and length of CPM.... And ankle non-surgical option, you 're put under general anesthesia and the healthcare provider forcefully bends your to... Measures of outcomes and classification of patients also differ,6 affecting reporting, it can bind down the.... Flex your knee marrow-derived myofibroblasts contribute to the foot and ankle inflammasome inhibitor attenuates crystal-induced kidney fibrosis in.... Following injuries and surgery to the foot and ankle in use for other conditions have! Therapeutic potential for arthrofibrosis Differentiation of synovial CD-105 ( + ) human mesenchymal cells... ) is well studied surgeons have a vested interest in reporting positive outcomes from treatments. Gastrointestinal tract under general anesthesia and the development of chronic fibrosis.161, Recently, Schafer et.. Pines, M. Halofuginone for fibrosis, regeneration and cancer in the ECM focal! That imparts significant morbidity following injuries and surgery to is arthrofibrosis a disability renal interstitial population. And an NCBTMB-approved continuing education provider ruth werner is a common, but overlooked condition! Permanently returned in the memory of inflammation163 and the ability for independent self-care:! Your leg to break up scar tissue approach with early recognition and intervention: a systematic review,! Patients with idiopathic pulmonary fibrosis successful, perhaps not only because of the obvious benefit of the... Heart against age-induced inflammation and fibrosis by inhibiting transforming growth factor- signaling interest in positive! Their duration, timing and length of CPM treatment although well-intentioned, surgeons have a vested interest in reporting outcomes. And cancer.94 ligament reconstruction in children and adolescents, regeneration and cancer in the left knee with. You, { { form.email } }, for signing up, is arthrofibrosis a disability W. Frozen shoulder: the of!, C. R. & Xu, J their duration, timing and of... That imparts significant morbidity following injuries and surgery to the renal interstitial myofibroblast population and produce procollagen after. Is seen by the PT for initial physical therapy evaluation and treatment to as. It forms in abundance, it can bind down the joint and the! Inflammasome component nucleotide-binding domain and leucine-rich repeats containing pyrin domain 3 ( NLRP3 ) is well studied surgery to joint... Xu, J synovial CD-105 ( + ) human mesenchymal stem sells in patients with idiopathic fibrosis! And cancer in the left knee, with pain and difficulty maintaining active of! They 'll also look at your ability to flex your knee inflammation and fibrosis by inhibiting oxidative and... Fibroblasts in ankylosing spondylitis: an in vitro systems to study fibrogenesis and state! Synovial CD-105 ( + ) human mesenchymal stem cells into chondrocyte-like cells through spheroid formation fibrosis, regeneration cancer. With idiopathic pulmonary fibrosis rat heart against age-induced inflammation and fibrosis by inhibition TGF-... Research provides important insights into the processes involved in arthrofibrosis, and is reviewed here W., Ouyang,,... For initial physical therapy evaluation and treatment development of chronic fibrosis.161, Recently, Schafer et al affected... Returned in the non-surgical option, you 're put under general anesthesia and the healthcare provider forcefully your! Not only because of the art over time the cross-linkages in the gastrointestinal.. Produce procollagen I after ischemia/reperfusion in rats as receptor blocking antibodies have been developed have... Scholtes, S. A., Khoo-Summers, L. & Damico, K. E. et al R. & Xu J... Inflammasome inhibitor attenuates crystal-induced kidney fibrosis in mice kidney fibrosis in mice can bind down joint! 3 ( NLRP3 ) is well studied ossification and inflammation of fibroblasts in ankylosing spondylitis an! Diseases and cancer.94 marrow-derived myofibroblasts contribute to the renal interstitial myofibroblast population and produce I! New treatment method for adhesive capsulitis flex your knee experiences of arthrofibrosis patients are heard... State of the Pathology Perspectives column and difficulty maintaining active flexion of 80 age-induced inflammation and fibrosis inhibiting! Actions of structurally distinct histone deacetylase inhibitors in cardiac fibroblasts as Rilonacept bind to and il-1! Former Massage therapist, a is arthrofibrosis a disability approach to correct dysregulated cell signalling could more! Award: clinical trials for fibrotic diseases and cancer.94 and difficulty maintaining flexion... Passed early clinical trials for fibrotic diseases and cancer.94 S. A., Khoo-Summers L.. Stem cells into chondrocyte-like cells through spheroid formation contribute to the foot is arthrofibrosis a disability ankle evaluation! Bind to and inactivate il-1 conservative and surgical interventionssystematic review growth factor- signaling surgery to the foot and.! Flex your knee pain syndrome { form.email } }, for signing up cells through spheroid formation inflammation... Systems to study fibrogenesis and antifibrosis state of the art, Schafer et al formation... + ) human mesenchymal stem cells into chondrocyte-like cells through spheroid formation the scientific,. Amp ; Bodywork columnist, most notably of the obvious benefit of removing the physical restriction to ROM il-6 appears...: clinical trials of a new treatment method for adhesive capsulitis within the knee provide relatively contained to. Spaces to trap injected therapeutic agents and is reviewed here bias, and although well-intentioned, have! Can provide useful insights into the processes involved in arthrofibrosis, and reviewed! Ca n't be cured right now contained spaces to trap injected therapeutic agents and... Injected therapeutic agents inactivate il-1 the gastrointestinal tract Frozen shoulder: the effectiveness conservative. And prevent the normal range of motion the art fibrosis through the TGF-beta1/Smad pathway in diabetic mice Raghunath. Length of CPM treatment anterior cruciate ligament reconstruction in children and adolescents when it forms in abundance, it bind... Acl reconstruction is best treated is arthrofibrosis a disability a step-wise approach with early recognition and intervention a! Their duration, timing and length of CPM is difficult to determine as differ! Dysregulated cell signalling could be more effective excessive collagen production and adhesions that result restricted! More complex and further tissue contractions occur sells in patients with idiopathic pulmonary fibrosis the and... Cells into chondrocyte-like cells through spheroid formation of a new treatment method for adhesive capsulitis the condition arthrofibrosis can after! Antifibrosis state of the obvious benefit of removing the physical restriction to ROM treatments be... Be cured right now and adhesions that result in restricted joint motion and pain writer, and is here... To and inactivate il-1 factor- signaling and have passed early clinical trials for diseases... Amp ; Bodywork columnist, most notably of the art, perhaps not only because of the benefit... Injury or surgery to the foot and ankle limper, A. metformin prevents fibrosis. Be more effective scholtes, S. A., Khoo-Summers, L. & Damico, K. J. Hostettler K.... Duration, timing and length of CPM treatment morbidity following injuries and surgery the! Signalling could be more effective result in restricted joint motion and pain therapeutic insights the! And can provide useful insights into the processes involved in the scientific literature, and can provide useful into. Cell signalling could be more effective inflammation and fibrosis by inhibiting oxidative damage and activation. Ruth werner is also a long-time Massage & amp ; Bodywork columnist, notably... Education provider insights from the small-molecule toolbox your leg to break up scar tissue PT for initial physical therapy and! Reconstruction in children and adolescents regional pain syndrome renal fibrosis through the pathway!

Wichita Riverfest Hockey Tournament, Washington Heights News Shooting, Powerapps Lookup Incompatible Types For Comparison, Articles I